From RICE to PEACE & LOVE: Your Fastest Path to Recovery

Discover why the traditional RICE method (Rest, Ice, Compression, Elevation) for treating soft tissue injuries is now considered outdated. This episode explores the modern PEACE & LOVE protocol that promotes faster healing through early, gentle movement and improved blood flow to injured areas. Learn what the research shows, when to use each approach, and special considerations for women in perimenopause and menopause who may experience more frequent injuries. 

Main points discussed: 

1. Why RICE is Outdated 

2. The PEACE & LOVE Protocol Explained

3. When Not to Use PEACE & LOVE 

4. Nutrition for Healing 

5. Special Considerations for Perimenopause/Menopause 

Episodes Discussed:

• S23E5 One hidden piece to helping your chronic pain puzzle
• S23E15 The Maximizing & Optimization Myth: Finding Grace in Your Health Journey
• S24E8 6 Ways to Take Care of Your Future Self (especially in perimenopause)
• S23E11 Nutrition Essentials in Perimenopause and Beyond

The ONLY foam roller I recommend: MELT Method Soft Body Foam Roller

https://thesportjournal.org/article/the-r-i-c-e-protocol-is-a-myth-a-review-and-recommendations/

https://bjsm.bmj.com/content/54/2/72

https://experiencelife.lifetime.life/article/the-problem-with-using-the-rice-protocol-to-treat-a-soft-tissue-injury/

My latest recommended ways to nourish and move your body, mind and spirit: Nourished Notes Bi-Weekly Newsletter

30+ Non-Gym Ways to Improve Your Health (free download)

Connect with Amy:
GracedHealth.com
Instagram: @GracedHealth
YouTube: @AmyConnell

Transcript

From RICE to PEACE & LOVE: Your Fastest Path to Recovery

Graced Health Podcast

Host: Amy Connell

One of the things I love doing is sprinting. I know that makes me so weird—I mean, at a minimum, right? But I do love that feeling. As I've gotten older, I am not able to do it as much. Several years ago, the whole family went to some multi-purpose fields in my neighborhood. We are so very fortunate—we have turf-covered multi-purpose fields in my neighborhood that anyone can go use. My family and I went out there and we were all doing kind of our own thing. My younger son, who ran track at the time, was doing longer distances because he was more of an 800-meter and 1600-meter guy. My older son, who played basketball, would do short intervals. My husband—I don't remember what my husband was doing, I'm sorry—but I was doing some 50-yard intervals.

This is a bit shorter than what I typically do. And in general, the shorter the distance, the faster you want to run. This is why when you're watching the Olympics, or really any track event, you can't take a 100-meter time and multiply that times four to receive your estimated 400 time. The longer you go, the slower you're going to go. Not necessarily really slow, but it does slow down.

So I'm out there on the 50-yard line, and I think I was doing like running for 50 yards and then resting only maybe 20 or 30 seconds. Not recommended. Do not do this. And I'm doing a lot of sets. I'm just kind of going and going and going, and all of a sudden I hear and feel this pop in my left leg. It was up in my upper hamstring, lower glute. My son, who was running not next to me but somewhere close to me, said, "Oh my gosh, Mom, I heard that. Are you okay?"

So I can barely walk. I'm holding that area right under my rear, just limping to the car. We were all kind of done by then anyway, and I go home. I pull out the ice pack. I sit on the ice for about 20 minutes. I stick it back in the freezer for about 20 minutes. I pull it back out. I sit on it for 20 minutes, and I don't do anything for a while. That is what is traditionally called RICE, or at least several elements of that.

You have probably heard of RICE as it relates to injury, so that's rest, ice, compression, and elevation. That's the acronym: RICE—rest, ice, compression, and elevation. And this was kind of like the gold standard in treating acute injuries, in treating soft tissue injuries. This used to be what we did. If you rolled your ankle and it started to swell up, what did you do? You went home, you got on the couch. You maybe took out your ice bandage, you wrapped it around your ankle, you put it up, you put some ice on it, and you didn't move. You had people bring things to you because that was the recommended course of action: rest, ice, compression, and elevation.

Current research is actually now showing that that may slow healing, believe it or not, and it's not the universally recommended approach anymore. Now the protocol is—and of course it's an acronym because who doesn't love an acronym—PEACE and LOVE, which focuses on early protected and gentle movement, on vascularization, which is basically like getting that blood flowing and getting your blood vessels dilating more so it can take the blood to the affected areas, and also just education, rather than extended rest and frequent icing.

In this episode, we're going to cover why RICE is now considered outdated, what the research is showing, the modern protocol—and I will tell you what PEACE and LOVE stands for—and of course, because I like to give a wide variety of things, some pushback on PEACE and LOVE in favor of RICE and arguments supporting the continued use of RICE, when PEACE and LOVE is most appropriate and when not to use it. And of course, because everything on this show is done with a lens of women in perimenopause and menopause, we're going to talk about special considerations if you are in that age group. If you happened to just land here and you are not a woman in perimenopause or menopause, then welcome. Most of what we're talking about will apply to you as well. But just be aware that this is a channel where we are not afraid to talk about perimenopause and menopause.

So let's go back up to the top. Why is RICE now considered outdated? Well, basically studies have shown that rest and ice—that R-I part—can hinder recovery by reducing your blood flow, which blood is what brings the nutrients. And we'll talk about that here at the end. And then it also suppresses that normal inflammatory response that the body uses for healing. A swollen ankle is no fun, but there is a reason that our body swells up, because that's like, "Hey, alert, alert, this is where we need you to go." And so that inflamed area is your body sending things to the area to heal it.

Also, prolonged rest—that R—can decrease your muscle strength and your range of motion. And icing may delay healing by constricting your blood vessels and limiting the delivery of the nutrients to your injured tissues. Your tissues have to heal using nutrients.

One thing I love about research is it allows us to evolve and to learn more, even with things that we used to think were true. Maybe we need to think about things a little bit differently. There are some more recent high-quality randomized trials that show insufficient evidence for significant benefit from RICE, especially the ice and the strict rest. And instead, studies are favoring early mobilization and exercise therapy after injuries. And this can actually improve your recovery time and prevent your chronic issues.

So what this means is, instead of RICE-ing it, we are, in a very controlled manner, working on moving the affected area, strengthening when appropriate, and paying attention to that so that it doesn't get stiff and you lose your muscles and we're not getting any nutrients to the area. And what I found interesting in my research is Dr. Gabe Mirkin, who first coined RICE, actually reversed his support of that in 2014. So he just said, "You know what? Movement and avoiding ice better promote healing."

So the modern protocol right now is PEACE and LOVE. Let me tell you what that acronym stands for, and then I will expand on that. So P stands for protect, E stands for elevate, A is avoid anti-inflammatories, C is compression, and E is education. And then LOVE: L stands for load, O is optimism, V is vascularization, and E is exercise.

So P being protect is restrict movement just briefly to minimize your bleeding or any other issues, but avoid long immobilization. This actually makes me think of my older son, who tore his meniscus twice—once in middle school, and I feel like a terrible mom because I can't remember if it was seventh grade or eighth grade, but it was at the very end of his basketball season. And then once on the opening day of his very first game as a high school player in ninth grade. Oh, it just broke our hearts. We felt so bad for him, and to this day, anytime I watch any kind of player get injured, I go back to that day of him texting and saying, "I'm pretty sure I just tore my meniscus again." It breaks my heart for any of these kids who get hurt playing.

Anyway, when he had surgery both times, they immobilized that for maybe a day. I think he wore a brace for—oh gosh, I wish I could remember—but it was just like a day or two. And then they had him walking within a few days because they wanted his legs, they wanted his knee to be moving, to be carrying the nutrients to the joint and to the knee so it could heal. So it was protected for a short amount of time, and then that actually moved more into the LOVE, which I'll get into in a second. But that's protection.

E for elevate. Again, this is going to be more in the short-term window, and it is still recommended for swelling, but it's not as central. You don't need to be doing this four days after an injury. Maybe do it on the first day, maybe on the second day. So elevate it to kind of help with the swelling, but this is not something that you're doing long-term.

With our A, that's avoiding anti-inflammatories and ice, which depending on how you feel about NSAIDs—which is Advil, Aleve, that kind of thing—that may be a non-issue for you. I have one friend and she does not want to take any medication. She'd be like, "Yeah, I'm not going to take any." But for others, if we're hurt, we pop an NSAID, we pop an Aleve or an Advil. And I know this seems counterintuitive, but what the research is showing and what the guidelines are saying is to let your natural healing and inflammation just kind of run their course.

And before you ask, I did wonder because I use this: What about arnica? Arnica can reduce pain and swelling after certain surgeries or soft tissue issues, which is what we're talking about here, in some patients. But the overall effect is small and it's not always statistically significant. I think sometimes—and we'll talk about this here in a second—in our head, we're like, "This is going to help." And you know what, if you think it's going to help in your head, then that is not to be discounted.

There was another large meta-analysis that found that arnica only had a small effect size compared to the placebo for bruising, swelling, and pain after surgery, with benefits comparable to anti-inflammatories but missing statistical significance. So for whatever it's worth, if you're like, "What about arnica then?" that is what I did find about arnica. But anyway, moving on. That is your PEA: protect, elevate, avoid anti-inflammatories.

C is compression. So yes, this is kind of a holdover from the RICE—just gentle compression, but not for as long. You can use that compression initially, but don't rely on that for an extended period of time.

And then E is education. You know, in my world, I talk more and more about women and the importance of strength training as they're getting older. And I was talking with a friend one time and she said, "Okay, but you're telling me that I need to strength train and you're telling me that I need to do pulling exercises, but I want to know the why, because if I know the why, then I'm more likely to do it." This is kind of the same thing—let's educate on the PEACE and LOVE so that there's going to be a better chance of compliance.

As far as LOVE, L is load. So let's take that sprained ankle example. You can gently, in a protected way, start to put load or weight on that ankle. It's okay to walk around on it. You're not going to hurt it, because what that does—and I'm going to skip ahead to V, vascularization—what that does is that gets, as I've said I think five times so far, the blood flowing to the affected area. Because when you start moving that, then that's going to help get all of the nutrients to the area that you need.

O stands for optimism. And I think actually when I said this earlier, I said optimization, which is kind of ironic because I just a few weeks ago did an episode on like, before you optimize and do all of these 1% things, then these are the six ways that you need to take care of yourself. So I'll put that in the show notes if you need it. So I am laughing at myself. O stands for optimism, not optimization. Optimism.

So same thing with our head. We have got to think that we will get better and that it is not going to stay this way forever. I admit that can be hard, especially as we're getting older and it takes longer to heal. And there's actually a decent amount of research that goes along with that. I did an episode back in season 23, episode five, called "One Hidden Piece to Helping Your Chronic Pain Puzzle." So if you are dealing with some chronic pain and if you want to understand how the mind can help with pain and healing, then go listen to that, because that connects some dots between the six inches between your ears and the rest of your body.

And then E stands for exercise. I kind of skipped around with that LOVE acronym, but it's load, optimism, vascularization, and exercise. So exercise and vascularization kind of go hand in hand, but that's basically moving. And you can repeat it with me because I've said it six times now—seven, I don't know—because we want to get nutrients flowing to the affected area, because that is what helps heal your issue.

Now in full disclosure, I will say that there is some pushback against the shift away from icing acute injuries. And I want to take just a second and delineate between acute injuries and more chronic injuries. An acute injury is you walk out on the back deck of a friend's house and there's a step down that you didn't realize was there, and you roll your ankle and it swells up. That is more of an acute injury, and I use that example because I remember one of my mom's friends doing this. I mean, I was probably in elementary school, she was probably younger than I am now, but I just remember her going, "I just stepped off and it just rolled." And of course she was in a boot because that's what we were doing then—we were immobilizing things and not letting our joints move. But that would be more of an acute thing, like I know exactly when this happened.

Something more chronic is that niggling pain that you may have when you are exercising. Something kind of flaring up and you're like, "Eh, it's fine." And it starts as that little tap, tap, tap on the shoulder, and then it kind of gets into more of a full five-finger, you know, tapping on you, and then it becomes a slap, and then all of a sudden you're like, "Oh my gosh." I can't tell you how many times I have had that type of issue. I have had the popping for sure a couple times, but my story is more about something small and I ignore it and it just grows. I am learning from my mistakes—learning, not learned, because it's definitely a process. But just to take that time out of like acute versus chronic.

Icing can be beneficial for acute injuries, and particularly it can numb the injury, which you may need for pain control. It can control excessive swelling. It will probably still swell some, and that's normal. And now that we're learning, okay, that's all right, especially after significant trauma or joint injuries or something like that. Research is actually questioning the impact on the healing speed. But look, if it helps the pain, then put the ice on for a little bit. And if you're at that point, you probably need to see a doctor.

And this is a great segue into something I was going to say later, and I will probably say again: Listen to your doctor. When in doubt, go see a health professional. That can be, but not limited to, urgent care, your primary care, an orthopedic specialist, physical therapist. If you are in a state that allows you to just go see a physical therapist, an exercise therapist—I have an exercise therapist, y'all. He is the best. He stops short of waving pixie dust and just makes everything—I can't even tell you how many times he has made my body feel so much better. Get creative in a healthcare professional. Maybe you go to someone who focuses more in trigger point therapy. Maybe you try cupping. Maybe you try massage therapy. Again, including but not limited to. You can be creative in who you see.

I will say if you fall and your bone is sticking out, go to urgent care at a minimum. I mean, I think you know this, but I feel like I've got to CYA here—I've got to cover myself. I'm just giving this to you for information, and then you know your body and use your wisdom and discernment on what is best for you in the circumstance. And keep in mind, ice is not going to make it worse, but prolonged use of it may delay healing. Even though it may feel better because you're icing it, it just might not help you heal as fast.

In general, PEACE and LOVE is recommended for most people with soft tissue injuries. Again, I'm not talking about broken bones here, because it supports that biological healing, it supports early movement, and the psychological factors that are crucial in long-term healing. What we think impacts our body, whether we like it or not. Start thinking either healing, optimistic thoughts, or at a minimum, avoiding the catastrophic, like, "Oh my gosh, I'm never going to be able to do this again." And I say this—it's so funny. When I plan for these episodes, I don't expect all of the random memories to come into my head as I am talking. And so the memory that I just had was I was training for a half marathon, and about 10 days before the half marathon I stubbed my toe—or my toe hit something—and I went down. And my very first thought was, "This better not keep me from running this race," because I had worked too hard to get to that point. And thankfully it didn't. It just took a minute. I always have to do a system check—I just get real still. Don't talk to me, don't ask questions, just system check. Just top down and then bottom to top. And then I'm like, "Okay, we're going to be okay." And it hurt for a little bit, but then it was okay.

So what does that have to do with optimism and not catastrophizing? I guess maybe I was optimistic. I don't know, because I did catastrophize for a little bit, and then I was like, "Oh no, we're not going there." Not to say that I'm the best at all of that. However, think your good thoughts in your head. It does matter.

Let's talk a little bit about when not to use PEACE and LOVE, because as with almost everything, there is not like black and white always yes, always no. There is a lot of nuance in things. PEACE and LOVE is not universally appropriate. You know, ice and anti-inflammatories might still be appropriate in specific cases. So that's when you have major ligament tears, if you have fractures, suspected bone injuries, or like physical trauma requiring urgent care or emergency care. I mean, look, if you land in the doctor's office and they're telling you what to do, then—and if they say, "Take the anti-inflammatories," then take the anti-inflammatories. They are up on this. They have to do their continued education. They probably know RICE and PEACE and LOVE, and so trust them. Trust your physicians.

Also, if you have very active bleeding, like if you are bleeding a lot, then ice may be indicated to slow bleeding, or if you're having rapidly expanding swelling. Again, if that's the case, if you're like bleeding out, go to the doctor. You know this, you know this. And then if you have post-surgical care, then do what your surgeon recommends. If they want you taking anti-inflammatories, take it. If they want you icing the area, take it. If they want you resting, then rest. Trust them. They have all of the pieces of information about what's going on with that injury, and so trust them.

I will say if you are in perimenopause or menopause, then I do want you to be aware of a few considerations. Number one is our bone health can degrade with age. If you have osteopenia or osteoporosis, then you are at increased risk for bone density loss, fractures, slower healing, and so of course see a doctor about that. If you suspect a hip break, please get that checked out. Number two is if you have chronic conditions that will impact your healing, then it's absolutely time to get your medical professional on board so they can again have the whole picture and guide you.

So let's go back to the example I used of my mom's friend who just stepped off the back porch or something like that, rolled her ankle. What should happen now with that? Well, first, let's get that protected. Okay? We don't want to be vulnerable. Let's not be walking around in high heels or anything that's going to make it more vulnerable. If it's already in a sensitive state, we want to gently move it. So put your Hokas on, put your Brooks on, put some comfortable, supportive shoes on and walk gently on it. If you cannot put any weight on it, then it may be worse than you think it is and it's worth getting checked out. But if it's just tender and it kind of hurts, then gently walk on it. I am not saying go walk five miles on it, but I am saying you can go down to the end of the street and back and get your blood flowing because, again, nutrients to the affected area. You want to avoid those anti-inflammatories. You can do some compression initially, but not for too long. And then of course, watch your thoughts. Let's make sure that we're thinking good thoughts about that.

Now, I can't finish out this episode by not addressing nutrition. How many times have I said you've got to get the nutrients flowing to the affected area? Well, that's going to happen with three things.

Number one, you've got to have enough water, so increase your water so your blood is flowing. Some people are fine with drinking plenty of water. I feel like there are two camps of people, one who get plenty of water, they drink a lot, and then the other who just never have water. There are people in my world who are like this and it does not compute. I do not understand because I'm going through a 42-ounce Stanley twice a day. That's just—I mean, I just can't get enough. I can't do an interview without drinking lots of water. If you're one of these people, I love you and I don't get you, but that's okay, because I still love you. But if you do not naturally drink a lot of water and you get injured, please try to increase your water.

The second element to nutrition is protein. Protein helps rebuild your muscles and it helps heal injuries. I am not saying you need to have 200 grams of protein in a day. I am saying the research suggests that increasing your protein will help the healing process. And at a minimum, make sure that you are getting enough. If you're like, "I don't know about protein, people. There's been so much—" I did a four-part series on protein. That was back in season 22, episodes one through four, and I'm going to give you the cheat: go listen to episode three, which gets more into the weeds and will give you the soundbite on how much protein you should be having on a normal basis, and then increase that a little bit. Or if you perpetually don't get enough, then at least get the minimum recommended amount. And I cover all of that in that episode.

And finally, nutrients. So look, there are a ton of different nutrients out there. There are macronutrients, of which protein is one of them, in addition to carbs and fat. And then there are micronutrients, and those are your B vitamins, your magnesium, your potassium, your sodium, your calcium—all of those other things that will work together to help heal your issue. Which means while I do not think there are good and bad foods, I do think that if you are healing from an injury, if you are healing from surgery, in the interest of healing as well as possible, try to eat lots of colorful plants. We don't need to get legalistic about this. We don't need to get obsessive about it, but can you add in more plants? And yes, plants are vegetables, but they're also fruits, seeds, nuts, legumes, grains. I mean, anything—if it came from something with a root, then that is going to be helpful to you.

And if you are looking for some clarity and more simple nutrition guidance, I did an episode in season 23, episode 11, called "Nutrition Essentials for Perimenopause and Beyond." I tried to really break it down simply, because again, the wellness industry is crazy out there and there's so much out there. So if you're like, "Just tell—I just need it. I need not so much noise and I don't want to get all of my information from Instagram," then I would highly recommend that you go listen to that. And I feel like it shares more succinctly.

So the bottom line is: Number one, trust your healthcare provider. If the injury is acute, go get it checked out. If it's something that has been bothering you for a while, or if it's just kind of a rolled ankle and you're like, "I don't know that this is really going to do much," then try PEACE and LOVE rather than RICE. You can eat the rice, that's fine. That's a grain. But PEACE and LOVE approach. Protect, elevate, avoid anti-inflammatories, compression, education, and load, optimism, vascularization, and exercise.

And hey, if you found this episode helpful, would you do me a favor and share it with a friend? You can either take a screenshot of it or just share it from your podcast player or from YouTube if you're watching there. Sharing this show is—you have no idea how helpful it is. There are a lot of podcasts out there, and I like to say that I am the most grace-filled corner of the wellness industry. So if you know someone who's looking for a little grace with science-based research-approved protocol and having good physical, mental, and spiritual health, then just send them this way. Send them to this little corner. I like the corner. I don't like to be in the middle of everything. I just kind of like to be in the corner. So anyone is welcome to join me in the corner. But I'm not—I'm just not going out there much. That's just not my thing.

And of course, if you're watching on YouTube, then hit the like button and be sure to subscribe wherever you are listening to this. Okay, that is all for today. Go out there and have a graced day.