Candid Conversations with Dr. Kelsey

[#11] Why PEACE & LOVE is Replacing RICE for Sprains and Strains

• Dr. Kelsey Changsing, PT, DPT • Episode 11

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The traditional advice to treat sprains and strains with RICE (Rest, Ice, Compression, and Elevation) has been around for decades, but research has continued to evolve. In this episode, I explain why many healthcare professionals now recommend PEACE and LOVE as a more complete approach to managing soft tissue injuries.

We'll discuss why acute inflammation isn't the enemy, how your body's natural healing process works after an injury, and why reducing pain isn't always the same thing as promoting healing. I also break down what each letter of the PEACE and LOVE acronym means, when ice can still be appropriate for pain relief, and why gradually returning to movement is an important part of recovery. Whether you've recently injured yourself or simply want to understand the science behind modern injury management, this episode will help you make more informed decisions about your recovery.

Main topics covered:

  • Why PEACE and LOVE is replacing RICE for treating sprains and strains
  • Why acute inflammation is important and how it helps your body heal soft tissue injuries
  • When ice and anti-inflammatory medications can help—and when they may interfere with recovery
  • A step-by-step explanation of the PEACE and LOVE acronym
  • Practical tips for recovering from sprains and strains while supporting the healing process

References:

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SPEAKER_00

If you've always been told to rest and ice a sprained ankle, you might be surprised to learn that the recommendations have changed. In this episode, I'm breaking down why many healthcare professionals are moving away from RICE and toward the acronym Peace and Love, what the science says about inflammation and healing, and how to manage a sprain or strain without slowing your recovery. Hello and welcome to Candid Conversations with Dr. Kelsey. I'm your host, Dr. Kelsey, and this is the space where I share my honest thoughts, real experiences, and the no BS conversations I wish more people were having about movement, training, injury recovery, and life as an active human. The goal of this podcast is to help you better understand your body, think more critically about rehab and fitness, and feel more confident making decisions so you can stay active long term. Before we start, a quick reminder. I am a physical therapist, but I am not your physical therapist. Nothing here is medical advice. So if you're dealing with something specific, please reach out to your PT or schedule a session to work with me. Alright, now let's get into today's conversation. So a few days ago, the Washington Post Instagram page posted a carousel on a new way to treat sprains and strains and talked about the Peace and Love acronym, which is meant to replace RICE, which you probably know stands for rest, ice, compression, and elevation. Especially if you've ever sprained an ankle, you've probably been told to do rice and you know have done that. But while the Peace and Love acronym isn't necessarily new since this came out in 2019, a lot of people clearly still don't know about it, since the majority of the comments on that post were basically people calling the acronym made up or a scam. And now I don't want to talk about like what went wrong with that post for people to react that way, but I do want to go over what the acronym Peace and Love stands for and a little bit about why we're moving away from ICE and absolute rest when it comes to treating injuries. And so yeah, peace and love is a real acronym, and it is what up-to-date healthcare providers are using in order to treat acute injuries. So things like you know ankle sprains or like knee sprains or what have you. And so let's back up a little bit and talk more about rice. So the the rest, uh, ice compression elevation. So this was coined in 1978. Um, well, I guess it had been in use for a little bit before that, but then in 1978 is when um a doctor Gabe Merkin um coined the acronym, or I guess made it more popular when he wrote about it in his book about treating um soft tissue injuries or something. Um when I was doing research on this, making sure I had uh the evidence correct, um, I came across a story for the reason behind like medical professionals' obsession with ice on like I guess in the 70s, maybe it was the 60s, I don't know. Um, apparently there had been um like rice was or not rice, ice was seen as revolutionary because um there had been a very first of its kind like salvage surgery where a little boy had gotten his arm ripped off and um they were able to salvage it by keeping the arm on ice and then like they were able to reattach the arm basically, and then so they're like, Oh, ice, like uh for the first time, and like he was able to like, yeah, they were able to save his arm. Um, like you know, they didn't have to amputate it later or anything, and so it was like seen as this revolutionary thing, and they're like, Ice was the best thing ever. Um, I don't know where I read that though. I don't I should have noted where I got that story, so I'm just saying like that's probably one of the reasons why ice was seen as like revolutionary or whatever, or using ice for injuries. Um I just don't have the um I don't have the reference for you because I don't know where I read it or which paper I read it in. But anyway, um with that in mind, so Dr. Merkin wrote about using uh yeah, wrote about using the principle uh or the acronym RICE, so rest, ice, uh, compression, and elevation in the treatment of soft tissue injuries. However, there was uh no actual scientific evidence on the effectiveness of ice in general before it became a guideline. It's just I think it was one of those things where it was just kind of like, okay, this makes sense, um like on a theoretical level, um using and using your you know clinical expertise, and so let we're gonna continue using it. And and that's the way a lot of things are until we um do more research on it and then um update our knowledge around that thing, and then we realize oh, our you know, actually we were probably wrong. So let's, you know, now that we have more information, let's change the way that we're doing things. Um but yeah, so this was in 1978, and then over time this acronym has kind of evolved as scientific knowledge has improved, and so um uh eventually uh price became a thing. So they added a P for protection. So then price is protection rice, uh oh my gosh, protection, rest, ice, compression, and elevation. Um, and then eventually it became police in 2011. So the rest component was like seen as the problematic thing or too much rest, and I'll touch on that um later in a little bit. But so police the so price became police, which stands for protection, um, optimized load, ice compression, and elevation. And then now uh in 2019 is when this changed completely into peace and love. Um, and there is a difference between all of these previous acronyms, so RICE price and police, and the current one of Peace and Love. So this current acronym is meant to encompass both the acute and subacute phases, so like immediately after like spraining your ankle, for example, as well as the few days and weeks after, once the ankle starts feeling better and is like less swollen, versus the other ones like rice, price, and police, maybe mostly rice and price, and then police maybe like kind of straddles the two, but they are mainly addressing the acute phases, so like immediately like the few days after you roll your ankle. Um, so that's one thing that's changed. And um, peace and love also adds a lot more nuance. Um I I mean I this is just my opinion, but I feel like nowadays, um, maybe it's because there's such an abundance of information, but or maybe this is just my own bias because I'm a very nuanced person. But I feel like nowadays people want a little maybe not. I was gonna say people want a little bit more nuance, but actually maybe not. Uh never mind. Um, but anyway, so yeah, that's why like peace and love is a little bit different because it does um kind of encompass that like the later stages like towards rehab and not just like the beginning stages. Um so that's one of the um differences of it. And to talk a little bit more about why ice itself um is seen as more problematic, we have to remember, or um not remember, if this is your first time um knowing about it, then historically removing pain has been associated with healing, but we now know that pain doesn't odd having pain doesn't automatically mean that there is damage, and vice versa, because sometimes sometimes people have like damage, but they don't have the pain. Um so an example of like having pain doesn't mean you have damage is like you know, paper. If you've ever had a paper cut, they are extremely, you know that they're extremely painful, but obviously a paper cut is not a serious injury. Um and as an aside, the reason why they're so painful is because the nerves in your fingers are located near the surface level of your skin versus like the ones on like your back, for example. Um but yeah, so pain and damage have been like linked together for so long, and that was originally why like it was thought that ice healed injuries, but really it was just numbing the injury and providing pain relief when but actually um it was actually slow, it actually slows the healing process, and there are there is evidence of this. Um the degree to which it slows the process is sort of up for debate, or I think people like kind of talk about it, but um about like whether it makes a difference, but it makes enough of a difference for people to now like kind of move away from using ice so heavily, or at least like I said, the more um up-to-date people who are more up to date with the evidence. So why how does ice you know slow down healing? So ICE, like I mentioned, ice and anti-inflammatory medications can help with pain, but if you look at the injury on the cellular level, so if you're actually like looking at the mechanisms of healing and stuff, um people have seen, so this is where they get the evidence, is that like using ice in anti-inflammatory medications like ibuprofen or acetaminophen, like they don't actually help with the healing process and sometimes even hinder the healing process. And so this is because we have to understand what the healing process itself is. So um if you roll your ankle, or even like cut yourself, but we're we're just gonna go on like the ankle sprain analogy, because that's like the I think that's I would say that's probably the number one thing that people use rice for, or now peace and love. Um so if you roll your ankle, sprain your ankle, your body is going to go through an acute inflammatory process. So acute inflammation is different than chronic inflammation inflammation, um, where acute inflammation only lasts for a few days, maybe a couple weeks, versus chronic inflammation. And that's the normal inflammation. So that's what we want because that's the healing process versus chronic inflammation is something that's like more prolonged over months, maybe even years. And that's something that we don't really want. Um, because then your body is kind of like in a heightened state of like stress. But I'm not gonna this is like a complicated topic, so I obviously I'm not gonna go over chronic inflammation. The um the emphasis or focus of today's episode is on acute inflammation. So when you hurt yourself, your body undergoes uh it goes through the acute inflammatory process around the injury, and so that's the start of the healing process itself. So right after the injury, um your blood vessels around the injury get bigger and allow for uh to allow for oxygen, nutrients, cloning factors, and like immune cells to go to the injured area, to the injured tissue. So normally, like all of this stuff is just kind of circulating in your uh in your blood vessels, like in your circulatory system. And then when you get injured, that's when it's like, oh, we need to go over there now. And so the blood vessels, not in your whole body, but the blood vessels around that the injury site are going to get a little bit bigger so that all of these immune cells can kind of come over and start that healing process. And so the blood vessels getting bigger or the vasodilation is what leads to like the area becoming super red and warm because you have all this blood flow over here. And so from there, um with the blood vessels getting bigger, it also allows cells and molecules responsible for healing to move from your bloodstream into that injured tissue. So all of these like cells and stuff are moving to the tissue. As they're doing that, they're also bringing with it fluid. And so now you have a little bit more, so that this is what leads to swelling because you have all this fluid now moving into tissues that don't normally have all this fluid and like other cells and things like that. But it's important because otherwise, how else are the cells that are responsible for healing you going to get there to the injury? Um, so now it's like, okay, this is why if you roll your ankle or whatever, it gets red, warm, and swollen. So as these immune cells do their job and heal the injury, the waste byproducts of the healing process are then taken away through your circulatory system. So it goes the opposite way, like they're taken away, going back to your uh blood vessels so that you can take it to your kidneys and stuff and get processed and you pee it out. Um, and then eventually, once it's like healed for the most part or healed enough, the immune cells um, or when it's healed enough that it doesn't need as many immune cells and stuff, um, then all of that leave the area and then eventually the swelling redness and warmth decrease, and then you're it goes back to normal. So, I mean, this doesn't happen all at once, obviously. If you've ever sprained your ankle, um I've never uh knock on, I don't have any wood around here, but um hopefully I I don't I don't really want to experience that. But I have seen people sprain their ankle and treated people with sprained ankles. Um, like you'll notice it gets super swollen and red, and even in like slowly the redness and the warmth and the swelling goes down over the next few days and or weeks. And so that's the acute inflammatory process in a nutshell. Um, and aside for any temporary temporary nerve damage caused by the injury itself, the healing process can also trigger pain signals from the nerves, uh, through either pressure from swelling, so like that swelling putting pressure on the nerves and sending the pain signals, or through chemical signals from the waste byproducts. So the the waste byproducts, like obviously we don't want that to stay there. And so that's why it's gonna continue, like if it just kind of stays stagnant and is not being taken away, it's going to continue to send out these chemical signals saying like about like, oh, this doesn't belong here. It's just signaling your body, like there's something here that we don't want, we need it to be taken away. Um so that's basically what the like the chemical signals from the waste byproducts is. Um and so when it comes to use using ice or anti-inflammatory medication, like that's going to that's how it slows the process because if you're gonna use ice, then like ice is a vasoconstrictor. So during the healing process, the uh blood vessels vasodilate, so they get bigger, but ice is gonna constrict the blood vessel. So the it's gonna be it's gonna make it a little bit harder to for those immune cells to get to that area, it's gonna make it a little bit more difficult for for them to get where they need to go. And then the same thing with anti-inflammatories. I mean, it's in the name, um, it's trying to decrease that swelling, that whole process, um, which I mean, ice and anti-inflammatories have a place, but it's not necessarily the first thing that we want to reach for when it comes to the healing process. But of course, you know, theoretically that's all fine and good, but like I mentioned, you're probably gonna have some sort of pain. And so when it comes to this, we want to find a good compromise between decreasing the pain that you're feeling without slowing down the healing process too much. Because I mean, it's like, it's like, okay, it's all well and good, like theoretically, like, oh, ice is bad. Like, let's not use ice. But then, you know, as my brother-in-law, who is an athletic trainer, has said before, like, he's not gonna, if a kid rolls or sprains his ankle during a football game, like he's not gonna be like, oh, ice is bad, I'm not gonna give you ice. Like, he's not gonna withhold ice from a kid who's in pain. He's gonna give him the ice. Similarly, like, I'm not gonna tell a patient fresh out of surgery, like not to use ice, if, again, if they're having a lot of pain. Like, ice is definitely very, very effective for pain. However, if that pain is at a more tolerable level, um, like going back to that surgery um example, like if the pain medication is helping like that ice be at a more uh tolerable level and like the swelling is not out of control or anything, like maybe we're going to avoid using the ice, or maybe we're going to go for longer periods of time between using ice so so that way we can still control that pain. Like, we don't want you to be miserable, but we also want to try to um maximize that healing process. We don't want to slow it down too much. We want, you know, we want your body's healing process to do its job. Um, so there are other strategies you can use besides ICE and pain medication to help with the pain, and then I'll address them uh in a little bit um when I go over the that new uh the acronym Peace and LOVE. Um, so yeah, so again, peace and love are meant to encompass both the acute and subacute phases. So let's go over what each letter means. So the letters um so the peace part is for the acute phase, so like the few days right after, so right after, and then like a few days um after like spraining your ankle, for example, and then the love portion is for the subacute phase. So that's when it's like okay, it's starting to feel a little bit better, swelling is going down, um, stuff like that. So for the peace, um, the letters stand for so P is for protect, and then E is elevate, A avoid anti-inflammatories, so that includes like medication and ICE, and then C is for compression, and E is for educate. So going back, so we're gonna go through each individually. So P for protect. So I mean this is seems uh I think it's a little self-explanatory. You're just you're gonna um in the article, so I'm I'm gonna link the article for um when uh doctors are they doctors? Um says Mr. So when Mr. Dubois and Esculier, they're from Quebec and Canada, um, when they came up with um the Peace and Love acronym, I don't know if they're doctors or not. Hopefully I'm not um miss uh hopefully I'm not missing up their titles, but anyway, the the article is gonna be linked in the show notes. But so peace for protect, self-explanatory. You're gonna if you sprain your ankle, you're gonna protect the ankle. So um you, you know, you're gonna restrict movement, you're not gonna move your ankle around all kinds like the first few days. Um, you're not gonna walk on it, like you want to protect the injury the side of injury um to again reduce risk of like worsening the injury or aggravating it or anything. Um so that's a little self-explanatory. Um but protect is not the same as rest, though. So um the rest is taken out. Uh I think it'll be a little bit more um self-explanatory. That's not the word. I think it will be become make a little bit more sense as we go over the other acronyms. But so we want to protect, but we're not gonna like rest your entire body. So again, going back to the ankle sprain, if you sprain your ankle, yeah, you're gonna put put the your ankle, like maybe you're gonna wrap it, that's that's in the like the compression part, but you're gonna like put some sort of base on it, you're not gonna walk on it, but that doesn't mean you can't do something like an arm bike or you know, work out your arms or something. You can still protect your ankle, but work out the rest of your body, is what I mean. Or do something, um be active with the rest of your body while protecting your ankle. So that's P. E for elevate. So again, self-explanatory, similar to the previous acronyms. You're going, um, there's actually apparently, according to this article, there's weak evidence to support its use for um decreasing swelling, but it it does seem to help um prevent the swelling from becoming too painful and from becoming out of control. So elevation. The limb higher than the heart to promote interstitial fluid flow. So again, the good swelling is still going to happen, like the immune cells going to the site, but elevating it is going to help get those byproducts out, is what the theoretical what the theory is. A, avoid anti-inflammatory modalities. So that includes medication and ice. So again, I kind of already went over it with my explanation of the acute inflammatory process. So obviously, we want to try to find a good compromise. Like if somebody is in a lot of pain, we're not going to be like, oh well, too bad you don't get ice. Like we know for sure ice helps with pain. It's just we don't want to become over-reliant on it. And also we want to get away from the idea that the ice is actually healing because it's not. It's doing the opposite of well, not the complete opposite, but it's not helping the healing process actually. Um and so in the article, they kind of mention like, okay, you can use ice, but like try to limit the time that you're using the ice. So maybe instead of like 20 minutes, you're gonna do like 10 minutes. Um I think Dr. Merkin in like on his website, he um in 2024, he did write a like a blog post about like, oh, actually I was wrong. He recommends like five minutes or ten minutes or something. There's no scientific like basis behind the time. So again, it's just finding a good compromise, like, oh, okay, using the ice for just enough time so that the area is less painful, it's like numb enough, and then you know, then you can take the ice off and then let your body do its thing. Um, I know um a few athletic trainers, because I've never used this. I think we kind of went over it when I was in school, but obviously as a regular outpatient physical therapist, like I don't see people in an acute enough um phase. Like I don't I see people a few days after they injure themselves, like not right after. So I personally have not used it uh except for in school or outside of school. But um, I know like some athletic trainers have said like, yeah, they've used like the cold sprays are really um worked really well for this, so at least they get some of that numbing, that pain relief without like the detrimental effects of actual like cold um from ice. So that's an idea. And then yeah, like you don't need to take Tylenol Um or uh ibuprofen, what is that, alleve, um for the swelling, because like taking those medications are not gonna help with healing. But if like you're in a lot of pain, again, we're not gonna be like, oh, too bad. Like you can take the anti-inflammatory medications, but just know this is more for pain relief, not for healing. So like if they if like you know, if the medication wears off and you're like, oh, actually this is a tolerable amount, like you don't need to keep taking the pain medication. Um and again, I'm not uh I'm not suggesting you to take medication because I can't, because I'm a physical therapist, but um in general, that's kind of like the general idea for anti-inflammatories. Okay, so next is C for compress. So again, same as before. You want to um um kind of use like an ace bandage or something, or maybe like a compressive brace to kind of help. It helps with the protection. Um, it kind of helps to that compression also theoretically helps prevent the byproducts from building up. So the healing tissue uh the healing like it's still gonna swell a little bit, but then at least it helps to compress the byproducts out. Um and E is for educate. Um, and I'll talk about it in a little bit as well. But um, so the educate is kind of confusing uh if you're looking at it from a patient perspective. You're like, okay, what do I do? And it ease educate. It's like, do I educate myself? So this is more for the um healthcare practitioners. Um so this is more for us to educate, to to remind us to educate patients that like uh viewing recovery as more of an active thing and not just like, oh, I'm just gonna rot on the couch type of thing, um, is actually more beneficial. So um if that wasn't clear, like taking an active approach to recovery um has been found to be more beneficial than just rotting on the couch, which is what Rice used to suggest. Um and so I think a lot of times people would be like, oh, I need all of these things. And this is specifically from the article, they're saying like passive modalities, so I'm quoting directly now, passive modalities such as electrotherapy, manual therapy, or acupuncture, aka or slash dry needling, because at least in Nevada we do acupunctur, or we don't do acupuncture. Physical therapists and chiropractors do dry needling, we don't do acupuncture, um, early after injury have insignificant effects on pain and function compared with an active approach. And this is, they quote a scientific article and and may even be counterproductive in the long term. So where they're kind of getting at is that if we if we go into or how do I say this? If we're saying like, oh, you we need to do these passive, like things that are done to the patient, like you know, like the ESTEM, I mean, arguably as a patient, you can buy an ESTEM machine yourself. Like I have one, it's called the Mark Pro brand, uh, it's the Mark Pro brand, but there are other brands too. Um, but yeah, ESTEM manual therapy, dry needling, like all of that stuff, like might seem helpful, uh might be a little bit helpful, but in the long run, they're not like they're not absolutely necessary, and can sometimes um give the idea that like if somebody sprains their ankle, they need somebody to fix them versus when that's not necessarily the case. Um and so Dr. or um Mr. I guess Dubois and and uh Mr Dubois and Esculier um are kind of um arguing, I don't know if that's the right word, but they're kind of arguing that um telling people that they need these passive treatments can lead to over-treatment because we're like having people continuously come back for these treatments when in reality like they can they can help themselves, basically. Like they don't need us to do these things to them. Um so that's what the educate uh is for, or that's what that means. Um so that's the end of the acute phase. So basically, uh for me, like a healthcare provider, it's like P for protect, E for elevate, A for avoid anti-inflammatories, more uh anti-inflammatory modalities, so that's medication and nice. Uh C for compress and E for educate. I guess for uh a patient, so a normal person that's not a healthcare provider, they would do like peace but without the E. I guess they can educate themselves, like I don't need manual therapy. Um, so that's an acute phase, and then the subacute phase is once that ankle is starting to feel better, it's not as like huge and like red and warm. Um so we're going to the subacute phase, and that's love. So L is for load, O for optimism, V for vascularization, and E for exercise. So L for load. Obviously, we're not saying like, okay, once it feels better, walk on it. Um, it's saying that people are going back to Rice, the rest component would cause people to rest their ankle. We're staying with this ankle sprain example for way too long. And then once uh once they start to be able to walk again, they realize their ankle is a lot weaker. And then that kind of like leads to this uh almost myth, I guess, that like, oh well now that and like that's how people end up spraining their ankle uh multiple times, is because they've never kind of rehabbed their ankle. Um well that that's kind of more for like a discussion for like the exercise section, but um load is more like as soon as your ankle is able to tolerate it, you're gonna start like putting some load on it, putting like maybe not putting some weight on it, but um just slowly loading the ankle in a pain-free way. So that's the key here. I feel like a lot of people, uh like the people in the comments of the Washington Post uh carousel, it's like they thought it meant like, oh, walk on it right away, but that's not what this means. It means that once you're able to, like you're going to maybe like instead of having it elevated and like floating, so to speak, when you're sitting, you're just going to have it rest on the ground. Like the ankle and the injury area need some sort of stimulus, especially if you have uh a tendon injury or a ligament injury, which an ankle sprain is, like the tendon and lig those tendons and ligaments need some sort of like load stimulus in order to continue healing. Um however, we don't want to put too much load on it. So again, finding that good balance between loading but not triggering pain or irritating that area. So that's what um, and so it helps heal through mechanotransduction, which I kind of talked about in um, I think it's in my Achilles, definitely in anything that I talk about, like tendons, um, my episodes. Um, so that's L for load, O for optimism. So again, this acronym was made for clinicians. So as a patient, this seems kind of weird, but the optimism is basically like we as clinicians are gonna try to um help the patient like look at the look at this with optimism. That sounds that sounds so corny, but um I'm just gonna read from the article. It says optimistic patient expectations are associated with better outcomes and prognosis. So psychological factors such as catastrophization, depression, and fear can represent barriers to recovery. Beliefs and emotions are thought to explain more of the variation in symptoms following an angle sprain than the degree of pathophysiology. So basically, what it means is like don't be like, uh what's that, what's that term? Don't be toxically positive, but basically it's like encourage the for us as clinicians, we want to encourage the patient, because especially if you've ever been injured, you'll probably have been in that phase, like I again I talked about it, that messy middle phase, but you've probably been like been at a point where it's like, oh, I still can't do anything. I'm you know, like my ankle still hurts, like whatever. And then it's like it feels like you're never going to get better. Um, and so if you if someone gets into that spiral, it makes it definitely makes it a lot harder to rehab and get back to normal versus trying to have a more optimistic mindset, definitely still acknowledge, like, yeah, this sucks. Like, we don't want to like ignore that. So that's where like we don't want to be toxically positive. We still want to acknowledge that it sucks. But we want to remember that like it will get better, like it sucks right now, but it's going to get better. I just, you know, need to be patient, like maybe distract myself with like TV or something. But eventually, like you're not gonna be like this forever. It will get better. So that's what the optimism is. Like us as clinicians trying to help the patient um stay optimistic about their um ankle instead of I mean, we're never like saying like you'll never get bit. Well, I take that back because I feel like some are like that because for lack of a better term, they're dumb, but but for the most part, like maybe some people don't um like this is where like we use what's called a biopsychosocial model where it's like we're taking like three components of like a person. And so even though like optimism isn't necessarily like like a biological factor, like it's a little bit abstract, it is something like your attitude towards your recovery is still something that's really, really important for a successful uh recovery. So that's O V-vascularization. So this is basically um adding cardio. So this goes back to when I was saying earlier, there are other strategies for decreasing pain without using ice. Um and so if you remember, sometimes those byproduct uh the byproducts of the healing um the healing process can kind of build up and make the swelling worse. So some swelling is gonna happen when the the cells like go to the tissues, but sometimes the swelling gets worse because the byproducts of that healing process kind of um stay stagnant and like accumulate. And so cardio, uh, so sub uh or steady state cardio or um I don't want it's not like subacute. Yeah, I forgot what it was called, but like yeah, steady state cardio is really good to increase your blood flow and get some of that, those byproducts out. So I think I started kind of talking about this when I was uh I know I don't think I was talking about this, but um similar to the elevate, so when you're elevating the the your leg, for example, your ankle, like your your circulatory system is still going to, you're still gonna have some uh swelling because your circulatory system is still trying to get like those healing cells to the area, but the elevation, at least like when it takes the byproducts out, it like helps the byproducts like come back to your um the blood vessels so that it can be taken away. And so that's what cardio, like steady state cardio. So you're not going out and doing sprints like arm bike sprints or whatever, but something that's going to like increase your heart rate just a little bit to help with the blood flow can help with um taking away those byproducts so that it can uh so that it's not sending like chemical signals to your nerves and like causing pain. Um and aside from that, it also helps to bring new blood and like newer, like it just in general it helps with your uh circular like uh circulatory system with blood flow and then bringing like the fresh cells to the area, fresh immune cells, and then taking away the byproducts. Um that's V and then E for exercise. So again, when people hear exercise, I think the first thing a lot of times people think about is like I'm gonna use like sprints or something, or like squats, like hard exercises. But this exercise is just means like, again, with the ankle sprain, like maybe starting with alphabets. So if if you've never sprained your ankle before, then this is when it's like once you're you know moving the ankle feels relatively okay, like you kind of with your foot trace the letters of the alphabet, and it's just kind of meant to move your ankle in the different ranges of motion. And so that way, so again, ligaments and tendons need load to be able to heal properly. So, like moving the ankle is kind of like helping to trigger some of that. Um, and then it also again kind of improves the circulation a little bit and kind of pushes out some of the byproducts that we don't want there anymore. Um, and um starting out with these low-level exercises and like steadily progressing as you're able as it heals more and you're able to tolerate more, um, also helps with being able to return to like you know, every day everyday activities, but also um like sports. So um, so again, I started talking about this a little bit in the loads section, but this exercise section is really important as well. They're really similar. It's really important because I um I feel like a lot of times when people were just using rice um and assuming that the rest and the ice is what was doing most of the healing, they assumed that once they were pain-free, they their ankle is back to 100% when and then so they would go out, do like their sport again or whatever, go running again, and then roll their ankle again. So then it becomes like they end up having chronic ankle sprains. Like they roll their ankle like so many times. And part of it is that after the injury, like even though it's so again, going back to like pain does not equal damage type of thing, so then people think like, oh, there's no more pain, so that means I'm healed 100%, but that's not the case. Like, yes, the tissues are healed, but now this new healed tissue isn't used to the loads that you were putting on it before. It wasn't used to like pivoting, it wasn't used to running like really fast or whatever. Um, and so now you have to retrain the muscles and the tissues in your ankle to be able to tolerate those forces again. That and there's also like other stuff with like proprioception in your ankle, um, because that is also affected when you injure your ankle. Um, so all of this stuff that needs to be retrained through rehab. Um, and so like people would skip that rehab process and go right back and then sprain their ankle again. Um, so that's the so that's what the exercise stands for, and so that's what peace and love stand for. I so I'll be honest, I don't exactly love this acronym because it's so long. Um, it is hard to remember what each letter stands for. I mean, it's obviously not as punchy and memorable as RICE was. Um and again, even though these these acronyms were meant for clinicians, but I mean, like with rice, like it eventually became something for patients to remember as well. It's like doctors would be like, oh, like, you know, rice, you know, rest, ice, compression, elevate, like, and then send you on your way. Um and so that's another reason why I don't really love this acronym, because again, like I mentioned, like the E for educate and the O for optimism, like, yes, it makes sense to remind clinicians to do their job, I guess. Um, but it like seems out of place if you're a patient looking at this. Like if I told you, like, okay, peace and love, uh, and like, well, first told it to you as the acronym for treating your ankle sprain, like you'd probably be like, E for educ, like what am I educating myself? And then the optimism is also uh it just seems out of place. It seems weird. Um but even though I don't necessarily love it, like it's the best one we have so far. It's very comprehensive, it has more nuance. Um, and I don't really have any other suggestions for an acronym. Um, I mean, the only suggestions I have are like taking out the E and the O. And then I would also argue like combining the L and the E and love for like the load and the exercise, because like I mentioned, like I started explaining the exercise when I was trying to explain the load. To me, they're they're kind of they like they go hand in hand. Um so yeah, I don't have any suggestions. So this is the best we have. So hopefully if you or hopefully you don't get injured, but if you ever do get injured after hearing this episode, hopefully you remember peace and love instead of rice. And so that will help you be able to recover better from your injury, um and without having to I mean, and then it like theoretically without having to see a health, like if it's a minor sprain or something, then theoretically without having to go see a healthcare professional. But if you need help with like the exercise part of peace and love, then obviously you can reach out um to a physical therapist to help with that. But otherwise, thank you so much for listening and I hope you found this helpful. And I will see you in the next conversation.