[Abstract] When it comes to running injuries, the old “rest, ice, compression, elevation” (RICE) method is no longer the whole story. In this post, I share my own knee injury experience and explore the modern PEACE & LOVE framework, which blends strategic symptom management with active recovery principles. Drawing on both personal rehab and current research, we’ll unpack why inflammation is a necessary part of tissue healing, how to navigate the acute and subacute phases of recovery, and why shifting from passive rest to progressive movement is key for a safe, lasting return to running.

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Hey Reader,

If you read last week’s newsletter you know that, after taking most of July off to spend time with family, I came back to work with an unexpected twist—quite literally.

While at a mountaintop sleepaway camp with my five-year-old son, William, I tried to show him that the camp's floating water obstacle course wasn’t scary… and I failed at my attempt, literally and figuratively. I attempted to run across slippery, lily pad–style floats. One wrong step, a twist, a pop, and a plunge into the water later, I knew I’d done something serious to my knee.

An MRI the following week revealed that nothing was torn (thankfully). I had partially dislocated my kneecap, aggravated the tendon on one side, and sustained a couple of bone bruises.

This whole experience prompted me to revisit the shift in injury management approaches, from the classic RICE method to the more modern PEACE & LOVE framework, and how both still have value.

If you’d prefer to listen to this instead of read, check out my most recent Women’s Running Lab Podcast episode, Rethinking Recovery from Injury with PEACE & LOVE.

Revisiting the RICE Method

RICE (Rest, Ice, Compression, Elevation) has been a staple of sports injury management since the 1970s. The logic is simple: reduce swelling, ease pain, and protect the injured area. Ice can help numb pain, and compression/elevation assist in draining excess fluid.

However, newer research on inflammation has reframed our understanding. Inflammation isn’t the enemy; it’s a necessary part of tissue healing.

The Body’s Natural Healing Process

When you injure tissue, the body’s immune system responds with more than just swelling. It’s also recruiting valuable immune cells to the injury site, like neutrophils and macrophages. These cells clear debris, remove damaged tissue, and release growth factors that signal the next stages of repair.

After the initial acute phase (the first few days), the proliferation phase begins where new cells arrive, like fibroblasts and endothelial cells, to produce new collagen fibers and create new capillaries to bring in oxygen and nutrients.

The above healing phases depend on the chemical signals generated during the inflammatory process. Suppressing inflammation too aggressively can blunt these signals, leading to weaker or delayed tissue repair.

From here we enter the remodeling phase where collagen fibers align along lines of stress and the tissue gradually regains its strength. This phase benefits from progressive loading (missing from the RICE protocol), and it wouldn’t occur as effectively without the earlier inflammatory process steps.

Why Over-Suppressing Inflammation Can Backfire

• NSAIDs (non-steroidal anti-inflammatory drugs): While they can reduce pain and swelling, some studies show that prolonged NSAID use post-injury can reduce the recruitment of those new cells to the injury site and impair healing.
• Excessive Ice Use: Prolonged icing can constrict blood vessels, potentially slowing the delivery of oxygen and nutrients needed for tissue repair. Short bouts for pain control are fine, but constant cold exposure can delay the inflammatory and proliferative stages.

Prolonged is underlined here for a reason!

The goal is not to eliminate inflammation entirely, but to manage it so it doesn’t become chronic or excessive.

• Productive inflammation is localized, time-limited, and transitions naturally into the proliferation phase.
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• Problematic inflammation is prolonged, widespread, or excessive leading to delayed tissue healing.

Practical takeaway: initial pain and swelling management using traditional techniques like ice and NSAIDs can still play a small role if paired with early, gentle movement and appropriate loading help modulate inflammation, improve lymphatic drainage, and guide tissue remodeling.

Read: The main fault in RICE is not the ice, its overemphasis on rest. Prolonged immobility can delay healing because our tissues (muscles, tendons, even bones) require gradual loading to remodel and strengthen. Early, gentle movement promotes circulation, helps flush out swelling, and supports tissue repair.

While ice may slightly delay some aspects of tissue healing, this effect is minimal if paired with a comprehensive recovery plan. This is where PEACE & LOVE come in.

Introducing PEACE & LOVE

PEACE & LOVE is a more recent injury management framework that divides recovery into two phases:

• PEACE: The acute phase (first few days post-injury)
• LOVE: The subacute phase (from there through returning to progressive loading and return to training)

Let’s break down PEACE, which guides care in the first 1–3 days:

P – Protection
​Avoid activities that worsen pain, but keep moving within your comfort zone. Complete immobilization is rarely necessary in the case of soft tissue injury.

E – Elevation
​Keep the injured area raised to help fluid drain away from the tissue and prevent excessive swelling.

A – Avoid Anti-Inflammatories
​NSAIDs like ibuprofen may slow tissue healing if used heavily or for extended periods. Short-term use for severe pain or to facilitate sleep may be reasonable, but overuse can be detrimental.

C – Compression
​Use wraps or braces to reduce swelling, support circulation, and create a sense of safety around the injury. This is important for both physical protection and calming the nervous system.

E – Education
​Understand what’s actually going on with your injury. Seek appropriate medical evaluation with your doctor, physical therapist, or sports medicine professional. Accurate diagnosis helps avoid both under- and over-treatment.
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Again, while PEACE removes ice from its acronym, I believe it can still have a place in the acute phase, if used sparingly (about 10 minutes at a time) and paired with a comprehensive swelling-reduction plan (more on this below). Ice is a powerful analgesic.

It’s important to remember that movement, blood flow, and progressive loading are what ultimately rebuild tissue resilience. This is where that transition to LOVE is necessary as soon as safe.

LOVE is a more active and intentional process. The timeline for entering this phase depends on your specific injury, but the principles remain the same.

L – Load
​The first priority is the gradual reintroduction of movement and strength.

Using my knee as an example, this began with regaining range of motion in both extension and flexion. I started with gentle knee extensions and slow bending, aiming to increase range just a little more each day. Once I had safe mobility, I introduced light resistance with bands, very slowly and deliberately.

This is where professional guidance is invaluable. A referral to a good physical therapist is worth its weight in gold. They can target exercises for your specific injury, help you identify appropriate load and progress, and prevent wasted time or missteps.

O – Optimism (and the Nervous System)
​While the acronym calls for optimism, I see this “O” as being less about blind positivity and more about nervous system safety. Healing and tissue restoration happen in the parasympathetic state, our body’s “rest and repair” mode, which is only possible when your bodies feel safe.

This is often difficult post injury. Many people experience significant guarding around the injury site. That’s why gradual, pain-limited movement is so important: it sends the message that it’s safe to move again. Even ice can still have a role here, not to halt inflammation entirely, but to reduce pain enough to turn those alarm bells down a little bit.

One fascinating moment in my own recovery came when working on knee flexion, which has been progressing slower than extension. The motion compresses my irritated tendon making it uncomfortable. However, when I closed my eyes and removed the visual cue of how far my knee was bending, I found I could move further without pain. Removing my awareness of how far I bent took away the input from my brain that said "danger this is where it hurt last time you tried.” Removing some of that fear element helped my body trust the movement.

V – Vascularization
​This step focuses on increasing blood flow to the injured area through pain-free cardiovascular activity. Compression can still be useful (just not so tight that it limits movement). Any cardio that doesn’t aggravate the injury can help. Biking, swimming, elliptical, etc. are all options outside of running.

This has been tricky for me. All of the above load my knee too much right now (I’m about 2 weeks post injury). Swimming without kicking, using a pull buoy has been my only option. An upper body ergonomic machine might be a good option from a seated position if I had ready access to one.

E – Exercise
​The final piece is progressive, intentional exercise to restore mobility, strength, and function. This is an ongoing process. The aim is a gradual return to full function, then to your previous training load.

At just two weeks post-injury, I’ve been focusing on assisted squats to regain squat pattern mobility and strength. Step-ups and stair work will come later, as that range of motion is still currently quite challenging.

Missing From PEACE & LOVE Directly - Supporting Physiologic Swelling Reduction

Swelling is the part of the inflammatory response that we do want to reduce as much as possible. When a joint swells it inhibits sensitivity of proprioceptors (decreasing the natural movement of the joint) and inhibits flow of waste (away from the injury site) and nutrients (toward the injury site).

The body has a built in system for doing this - your lymphatic and vascular systems! And there are some simple techniques for helping move it along through visceral and lymphatic massage.

The simplest is The Big Six, developed by Dr. Perry Nickelson. It involves stimulation of specific “sticking points,” done in a specific order, to promote flow of nutrients into and waste away from the tissue, reducing problematic, wide-spread swelling and improving healing.

If you are looking for a higher level approach to this, geared more directly to acute injury, check out my friend Anna’s Swelling Reduction Protocol. I'm so grateful to have Anna in my corner during this recovery process. I’m currently doing a blend of these two protocols myself.

The Big Shift: Passive Recovery to Active Healing

This is where PEACE & LOVE diverges from the classic RICE method. RICE emphasizes resting and managing symptoms; PEACE & LOVE moves you toward active participation in your healing from the very start.

It’s not about demonizing ice or rest. They can both have a place. It’s about recognizing that recovery isn’t something done to you. It’s something you actively do with your body.

That means using rest, ice, compression, and elevation strategically in the early phase, then transitioning toward movement, gradual loading, and nervous system safety to promote lasting recovery.

Healing isn’t just about waiting for your body to recover—it’s about working with it every step of the way.

I’m trying my best to embrace the process. Getting nerdy about it with ya’ll definitely helps ❤️!

Your Coach,
Alison

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PS. On a completely unrelated note, registration for our Compatible with Life Virtual 5k on October 18th is still open! We’d love for you to join us this year to help us race fund, awareness and advocacy for children with Trisomy 13 and 18.

​Click here to learn more and register now.​

​And click here to learn why this race is so important to me personally.​

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Alison Marie Helms, PhD Certified Personal Trainer and Running Coach Unlock your full running potential through physics and physiology. ​Work with me.​