From RICE to PEACE & LOVE: Rethinking Injury Management in Modern Sports Medicine

It’s 2025 and we still act like we can’t accept we information, that is valid, backed by science and, especially those in our educational communities.

For decades, if an athlete sprained an ankle, pulled a hamstring, or tweaked a knee, the universal advice was simple: apply RICE—Rest, Ice, Compression, and Elevation. Athletic trainers (ATCs), coaches, and even parents turned to this trusted acronym, believing it would speed up recovery. An ice pack became as symbolic to sports medicine as tape on a wrist or water on the sideline.

But as sports science has advanced, we now know that while RICE may reduce pain and swelling in the short term, it can actually interfere with the body’s natural healing process. Specifically, the use of ice and excessive rest may impair tissue remodeling, angiogenesis, and long-term recovery.

In response, clinicians have introduced a modern framework: PEACE & LOVE. First published by Blaise Dubois and Jean-François Esculier in the British Journal of Sports Medicine in 2020, this model addresses both the acute and long-term phases of soft-tissue injury recovery. It emphasizes protection, education, early loading, and even the psychological dimensions of healing.

This blog will dive into:

• The history of RICE and why it still persists.

• The biological reasons ice can delay recovery.

• The evolution to PEACE & LOVE.

• Practical applications for athletes, coaches, and clinicians.

The Rise of RICE

The RICE method was first introduced in 1978 by Dr. Gabe Mirkin in his book The Sportsmedicine Book. At the time, it was revolutionary. The acronym was easy to remember, easy to apply, and offered a sense of control over the unpredictable process of injury recovery.

RICE quickly became the gold standard because it appeared to address the main concerns of acute injuries:

• Rest: Prevent further damage by avoiding movement.

• Ice: Reduce swelling and numb pain.

• Compression: Prevent excess fluid accumulation.

• Elevation: Improve drainage and reduce swelling.

The method spread rapidly in sports culture and medical education. Trainers on sidelines handed out ice packs, athletes expected to “ice it down,” and parents viewed ice as an essential part of first aid.

Even as new research emerged, RICE remained deeply embedded because of its cultural weight and the comfort it provided—both physically (via numbing) and psychologically (something was being “done”).

The Problem with Ice and Rest

1. Inflammation is Necessary for Healing

The body’s inflammatory response is not a mistake—it’s essential. In the acute phase of injury, macrophages flood the site to clear damaged tissue and release insulin-like growth factor 1 (IGF-1), a critical signal for repair and remodeling.

Prolonged icing suppresses this process by limiting blood flow and reducing macrophage activity, thereby slowing the cascade needed for tissue repair (Takagi et al., 2011).

2. Vasoconstriction Delays Nutrient Delivery

Ice constricts blood vessels. While this may reduce visible swelling, it also reduces oxygen and nutrient supply to the injured tissue, potentially delaying transition from inflammation to the proliferation phase of healing (Mackey & Kjaer, 2017).

3. Impaired Collagen Alignment

Collagen fibers need controlled loading and circulation to align properly. Ice interferes with angiogenesis (new blood vessel formation), which delays remodeling and weakens tissue quality long-term.

4. Neuromuscular Impairment

Cold therapy decreases muscle spindle sensitivity, blunts proprioception, and reduces motor control. For athletes, this can make early rehab exercises less effective and increase risk of re-injury once activity resumes.

5. Even Dr. Mirkin Reversed His Stance

In 2015, Dr. Mirkin publicly stated that both ice and total rest could delay recovery:

“Applying ice to injured tissue shuts off the blood flow that brings in the healing cells of inflammation. Inflammation is needed to heal injuries.” (Mirkin, 2015)

It’s 2025 and Why RICE Still Persists…

Despite strong evidence, RICE hasn’t disappeared overnight. Reasons include:

• Tradition: It has been taught for over 40 years in medical and coaching settings.

• Immediate pain relief: Ice numbs pain quickly, giving short-term comfort.

• Perception of care: An athlete with ice looks like they’re receiving treatment.

• Sideline practicality: Ice is fast, cheap, and visible.

• Liability concerns: Doing “something” is often seen as safer than doing nothing.

This is why many ATCs still keep ice in their toolkit—not necessarily as a recovery enhancer, but as a way to manage pain and fulfill expectations.

The Emergence of PEACE & LOVE and why we find this to have better long term outcomes.

Recognizing the limitations of RICE, clinicians Blaise Dubois and Jean-François Esculier introduced PEACE & LOVE in 2019 (published in BJSM in 2020).

Unlike RICE, which focuses only on the acute inflammatory stage, PEACE & LOVE provides a framework that spans both immediate and long-term care.

• PEACE applies in the first few days post-injury.

• LOVE applies in the weeks and months following, when tissue remodeling and return-to-play strategies matter most.

Breaking Down PEACE

P = Protect

Short-term rest (1–3 days) may prevent further aggravation. But prolonged immobilization weakens tissue, reduces strength, and delays recovery.

E = Elevate

Keeping the limb above the heart may modestly reduce swelling. While evidence is limited, it’s a safe and low-risk strategy.

A = Avoid Anti-inflammatories and Ice

This is the most radical departure from RICE. Both NSAIDs and prolonged icing suppress natural inflammatory pathways critical to repair (Dubois & Esculier, 2020).

C = Compress

Elastic bandages and taping limit excessive swelling while still allowing mobility.

E = Educate

Perhaps the most important step: athletes must understand their injury and the role of active recovery. This avoids dependency on passive treatments and builds trust in the healing process.

Let’s get into breaking down LOVE…

L = Load

Early, progressive loading (within pain tolerance) stimulates mechanotransduction, collagen synthesis, and tissue resilience.

O = Optimism

A positive mindset influences recovery outcomes. Fear and catastrophizing can slow return-to-play, while confidence accelerates it.

V = Vascularization

Pain-free aerobic activity (cycling, swimming, walking) boosts blood flow, prevents deconditioning, and accelerates repair.

E = Exercise

Tailored rehab restores mobility, proprioception, and sport-specific strength. This reduces risk of recurrence and prepares athletes for performance.

The Science Behind the Shift

1. Cryotherapy impairs macrophage activity and delays IGF-1 release (Takagi et al., 2011).

2. NSAIDs inhibit prostaglandin synthesis, which reduces healing of bone and tendon tissue (Mackey & Kjaer, 2017).

3. Loading drives collagen alignment and tissue resilience. Controlled mechanical stress is essential for proper remodeling.

4. Psychosocial factors such as optimism, education, and self-efficacy are directly linked to faster and more complete recovery.

Practical Applications for ATCs and Coaches

• Use ice only for short-term pain relief, not as a core recovery strategy.

• Educate athletes that swelling is not the enemy—it’s part of healing.

• Transition athletes quickly from protection to controlled, progressive loading.

• Integrate aerobic exercise as early as tolerated.

• Address the mental side of injury—confidence and optimism are key.

For youth athletes, the framework is even more critical:

• Their tissues are highly responsive to loading and remodeling.

• Early education sets a foundation for lifelong healthy practices.

• Teaching parents the difference between symptom relief (ice) and long-term healing (load, exercise) is essential.

The shift from RICE to PEACE & LOVE represents a major evolution in sports medicine. While RICE focused on suppressing symptoms, PEACE & LOVE embraces the body’s natural healing response, promotes movement, and acknowledges the power of mindset.

For athletes, coaches, and clinicians, the takeaway is simple: Recovery is active, not passive. The days of “just ice it” are over. The future belongs to PEACE & LOVE.

References

• Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine, 54(2), 72–73. https://doi.org/10.1136/bjsports-2019-101253

• Mirkin, G. (2015). Why Ice Delays Recovery. DrMirkin.com

• Takagi, R., Fujita, N., Arakawa, T., Kawada, S., Ishii, N., & Miki, A. (2011). Influence of icing on muscle regeneration after crush injury. Cryobiology, 63(3), 210–221. https://doi.org/10.1016/j.cryobiol.2011.08.003

• Mackey, A. L., & Kjaer, M. (2017). The breaking and making of healthy adult human skeletal muscle in vivo. Skeletal Muscle, 7, 24. https://doi.org/10.1186/s13395-017-0142-x

• Orchard, J., Best, T., & Verrall, G. (2005). Return to play following muscle strains. Clinical Journal of Sport Medicine, 15(6), 436–441.

• Bleakley, C. M., Glasgow, P., & MacAuley, D. C. (2012). PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine, 46(4), 220–221. https://doi.org/10.1136/bjsports-2011-090297