What to do immediately after a soft tissue injury

Soft tissue injuries such as sprains, strains, bruising, and muscle tears are among the most common injuries across all age groups. Whether you rolled your ankle playing badminton, pulled a hamstring at the gym, or bruised your knee in a fall on wet bathroom tiles, the first 48 to 72 hours are important. The guidance on how to manage this period has changed significantly in recent years, and many people are still following advice that has been updated.

Why RICE is no longer the recommendation

For decades, the advice was RICE: Rest, Ice, Compression, Elevation. Recent research has shifted this thinking in important ways. Complete rest delays healing by reducing blood flow to the injured tissue. Ice reduces pain, which is useful, but may also reduce the inflammatory response that triggers healing. Inflammation, used appropriately, is part of the repair process, not just a symptom to suppress. The new framework, developed by sports medicine researchers, is called PEACE and LOVE. It reflects a more nuanced understanding of what helps tissue recover.

The PEACE phase (days 1 to 3)

• P: Protect: Avoid activities that increase pain for the first 1 to 3 days. This does not mean complete immobilisation. Partial weight-bearing with crutches if needed is usually fine for ankle and knee injuries.
• E: Elevate: Keep the injured limb above heart level where possible. This reduces swelling. If you have an ankle injury, lying with your foot on two pillows is enough.
• A: Avoid anti-inflammatories: There is growing evidence that NSAIDs like ibuprofen and diclofenac in the first 48 to 72 hours may reduce the inflammatory response needed for tissue repair. If pain is very severe, paracetamol is a safer first choice.
• C: Compress: A compression bandage reduces swelling and provides some support. Wrap firmly but not so tightly that you restrict circulation. The skin beyond the bandage should still have normal colour and feeling.
• E: Educate: Understand that some pain and swelling is a normal and expected part of healing. Catastrophising about the injury increases pain sensitivity and slows return to activity.

The LOVE phase (day 4 onwards)

• L: Load: Early, gentle loading of the injured tissue promotes better healing than continued rest. For a sprained ankle, this means beginning simple calf raises and balance exercises as soon as you can do them without significant pain.
• O: Optimism: Evidence consistently shows that people with a positive expectation of recovery recover faster. This is not wishful thinking. It reflects the real effect of mindset on pain processing.
• V: Vascularisation: Aerobic activity that does not load the injured area, such as swimming, cycling, or upper body work, keeps blood flowing and maintains fitness during recovery.
• E: Exercise: Targeted rehabilitation exercises for the injured tissue begin in this phase. A physiotherapist can guide you on which exercises are appropriate and at what intensity.

When to see a physiotherapist

Some injuries look like simple sprains but are more significant. See a physiotherapist or doctor if the pain is severe from the start and does not settle with basic management, if you heard or felt a pop at the time of injury, if you cannot put any weight through the limb at all after 24 hours, if there is significant swelling around a joint rather than just soft tissue bruising, or if the affected area feels unstable when you move it. These signs suggest the injury may involve a ligament tear, fracture, or other structural damage that needs specific treatment.