“Should I use ice or heat?” It is one of the most common questions we hear in the practice. You tweak your back, roll your ankle, or pull a muscle, and the first thing you want to know is what to put on it.
The honest answer? Neither one matters as much as what you do next.
For decades, the standard advice was RICE: Rest, Ice, Compression, Elevation. It has been the go-to since Dr Gabe Mirkin coined the term in 1978. But the science has moved on. In 2014, Dr Mirkin himself admitted that the evidence behind RICE had significant gaps. And in 2020, a new approach called PEACE & LOVE was published in the British Journal of Sports Medicine that better reflects what we now know about how the body heals.
This is not just a catchy acronym. It changes the way we think about injury recovery, moving away from passive rest and towards getting you back on your feet sooner.
What was wrong with RICE?
RICE was a good starting point, but it had a few important limitations.
“Rest” was too vague. It implied that you should stop moving entirely. We now know that staying still for too long can weaken muscles, stiffen joints, and actually slow your recovery.
Ice may delay healing. This is the most surprising part for most people. While ice reduces pain and swelling in the short term, some swelling is actually a necessary part of healing. Your body sends repair cells to the damaged area, and blocking that process too aggressively may slow things down. Research by van den Bekerom and colleagues (2012) found limited high-quality evidence that ice actually helps soft tissue injuries heal. A review by Bleakley and colleagues (2004) reached similar conclusions.
No guidance on getting back to normal. RICE only covers the first few hours or days after an injury. It says nothing about how to return to activity, rebuild strength, or prevent re-injury.
PEACE: The first 1 to 3 days
PEACE covers the early stage after an injury. The goal is to look after the injured area while still letting your body’s natural healing process do its thing.
P: Protect
Ease off for the first one to three days to avoid making things worse. This does not mean complete bed rest. It means avoiding activities that increase your pain. A little rest helps, but the goal is to start moving again as soon as you comfortably can.
E: Elevate
Raise the injured area above your heart when possible. This helps reduce swelling by letting fluid drain away naturally. It is one of the few pieces of the original RICE advice that still holds up well.
A: Avoid anti-inflammatories
This is the big one. Try to avoid anti-inflammatory medications (like ibuprofen) and too much icing in the early stages. Inflammation is not the enemy. It is your body’s natural way of starting repairs. Anti-inflammatory drugs can take the edge off the pain, but they may also slow down healing if you take them too early.
This does not mean you should never use them. It means reaching for them automatically after every injury may not be the best idea, especially in the first few days.
C: Compress
Use a bandage or compression sleeve to help manage swelling. Compression limits excess fluid building up around the injury without getting in the way of healing.
E: Educate
Learn about your injury. Know what to expect and how long recovery might take. Try not to over-treat with too many appointments or unnecessary scans. People who understand what is going on with their body and take an active role in their recovery tend to do better.
LOVE: Getting back to full strength
Once the first few days have passed, it is time to shift from protecting the injury to gradually building it back up. This is where LOVE comes in.
L: Load
Start reintroducing normal movement gradually, guided by your pain levels. Gentle, controlled activity helps the injured area heal and get stronger. Tendons, ligaments, and muscles actually need some stress to repair properly. A gradual return to what you normally do, guided by what your body can handle, works far better than prolonged rest.
O: Optimism
Your mindset matters more than you might think. Research shows that fearing the worst and being afraid to move are linked to slower recovery. Staying positive and trusting your body’s ability to heal is not just feel-good advice. It is backed by evidence.
V: Vascularisation
Get your blood flowing with pain-free exercise like walking, cycling, or swimming. Better blood flow brings more oxygen and nutrients to the injured area, which helps speed up recovery. The key is choosing something that does not aggravate the injury.
E: Exercise
Getting back to exercise is the most important part of recovery. This means gradually rebuilding strength, flexibility, and balance. A structured rehab programme helps restore full function and significantly lowers your risk of getting injured again.
This is where working with a professional can make a real difference. A chiropractor or physiotherapist can put together a plan tailored to your specific injury and what you want to get back to doing. Whether that is a sports injury, a sore knee, or a shoulder problem, the approach can be adapted to suit.
When to get it checked out
Many soft tissue injuries heal well with the PEACE & LOVE approach, but some situations need a professional opinion:
- Severe or worsening pain that does not improve when you ease off activity
- You cannot put weight on it or use it normally
- Swelling keeps getting worse after the first 48 hours
- You felt a “pop” or snap at the time of injury, which could mean a ligament or tendon tear. This is common in knee and shoulder injuries
- No improvement after a few days of looking after it
- Numbness or tingling in or around the injured area
If you are not sure, it is always better to get it looked at early rather than wait and hope for the best.
So when is ice actually useful?
Ice still has a role. In the first 12 hours after an injury, it can help ease pain and limit any further damage to the surrounding tissue. If you need short-term relief to get through the night or take the edge off, a brief application of ice is perfectly reasonable.
The difference is that RICE treated icing as the centrepiece of recovery. PEACE & LOVE treats it as a small, optional tool in a much bigger picture. The real gains come from a more active, movement-based approach: early, gradual loading, targeted exercise, and a structured return to what you were doing before. That is what leads to better long-term results.
The bottom line
Short-term protection matters, but it is only the first step. The real progress happens when you start to move, load, and strengthen your way back to full function.
Your body is built to repair itself. The key is to support that process rather than get in its way: protect it early, then gradually get moving again. This approach consistently leads to better results, a faster return to the things you enjoy, and a lower chance of re-injury.
If you are dealing with a sprain, strain, or soft tissue injury and want help with your recovery, get in touch or book an appointment. We are here to help you get back to doing what you love.
References
- Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 2020;54(2):72-73.
- Mirkin G. Why Ice Delays Recovery. 2014.
- van den Bekerom MPJ, Struijs PAA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GMMJ. What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults? Journal of Athletic Training. 2012;47(4):435-443.
- Bleakley CM, McDonough SM, MacAuley DC. The Use of Ice in the Treatment of Acute Soft-Tissue Injury: A Systematic Review of Randomized Controlled Trials. American Journal of Sports Medicine. 2004;32(1):251-261.