PEACE & LOVE, 6 Years Later: The 2025 Review of the Protocol That Replaced RICE

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For decades, the go-to advice for any soft tissue injury was RICE: Rest, Ice, Compression, Elevation. Sprain your ankle? RICE. Pull a hamstring? RICE. It was simple, universal, and repeated so often that most people assumed it was backed by strong evidence.

It wasn't. And in 2019, a team of researchers proposed something better: PEACE & LOVE. Now, a 2025 narrative review published in PMC has evaluated six years of evidence. The verdict? The active approach wins, and it's not close.

What Is PEACE & LOVE and Why Did It Replace RICE?

PEACE & LOVE is a two-phase framework for managing soft tissue injuries. The first phase, PEACE, covers the first one to three days after injury. The second phase, LOVE, guides the recovery period that follows.

PEACE (days 1-3):

• Protect: Reduce or stop movement for the first few days to prevent further damage
• Elevate: Raise the injured area above the heart to reduce swelling
• Avoid anti-inflammatories: Inflammation is the body's natural repair process, and suppressing it can slow healing
• Compress: Use bandages or wraps to limit swelling
• Educate: Learn about your injury and recovery timeline so you can make informed decisions

LOVE (after the acute phase):

• Load: Gradually start putting weight and stress on the injured area, guided by pain
• Optimism: Stay positive and confident about recovery
• Vascularization: Get the blood flowing with pain-free cardiovascular activity
• Exercise: Restore mobility, strength, and proprioception through targeted exercises

The biggest shift from RICE? Instead of resting passively and hoping the injury heals on its own, PEACE & LOVE asks you to become an active participant in your recovery. It treats the injury as something to work through, not something to hide from.

Does the 2025 Review Actually Support This Approach?

The 2025 narrative review, published in PMC, assessed the evidence accumulated since the original 2019 proposal. Its conclusion was clear: PEACE & LOVE is a promising alternative to RICE for acute soft tissue injuries. The active approach of early loading and exercise consistently leads to faster healing and better outcomes than passive rest.

This matters because PEACE & LOVE was originally a proposal based on emerging evidence. Six years later, the evidence has caught up. The framework holds.

But the review also highlighted something important: not all parts of the protocol carry equal weight. Two components stood out as the most impactful.

Why Is Education the Most Underrated Part of Injury Recovery?

The "E" in PEACE stands for Educate. It sounds like a throwaway compared to the physical components. But the 2025 review identified it as one of the most important factors in recovery outcomes.

Why? Because what you believe about your injury changes how you behave. If you believe that any pain means damage, you'll avoid movement. If you believe that rest is the only path to healing, you'll stay on the couch. Both of those beliefs slow recovery.

Research on fear-avoidance beliefs supports this. A 2024 systematic review published in Cairn.info found that re-injury anxiety and kinesiophobia (fear of movement) are major barriers to recovery in athletes. Athletes with high fear of re-injury had worse outcomes and were less likely to return to their sport. The key intervention? Education combined with exercise, which produced significant decreases in fear-avoidance behavior.

When runners understand that controlled loading actually helps tissue repair, they're more willing to do it. When they know that some discomfort during rehab is normal and not a sign of new damage, they push through the uncomfortable middle phase instead of retreating to full rest. Education doesn't just inform. It changes behavior.

How Does Early Loading Speed Up Healing?

The "L" in LOVE stands for Load. It's the component that feels most counterintuitive. Your body is injured. Why would you put stress on it?

Because mechanical loading is one of the strongest signals your body uses to guide tissue repair. When you apply controlled force to healing tissue, you're telling it what it needs to become. The cells that rebuild tendons, ligaments, and muscles respond to mechanical stress by organizing along the lines of force. Without that stress, the new tissue forms in a disorganized pattern that's weaker and less functional.

The 2025 review confirmed what sports medicine researchers have been finding for years: early mobilization and weight bearing accelerates recovery. Prolonged rest, on the other hand, can delay healing and cause healthy tissue to weaken. You lose muscle strength, joint mobility, and proprioception (your body's sense of where it is in space) during extended rest periods.

For runners, this is especially relevant. A common soft tissue injury like an ankle sprain or mild calf strain doesn't require weeks of total rest. After the initial protection phase (one to three days), gradual loading guided by pain is not just safe. It's the faster path back to running.

What Role Does Your Mindset Play in Recovery?

The "O" in LOVE stands for Optimism. It might sound like motivational fluff. It isn't.

The 2025 review highlighted that PEACE & LOVE successfully integrates psychosocial factors into physical injury management. This is a significant development. Traditional injury protocols treated the body as a machine: something broke, so fix the broken part. PEACE & LOVE recognizes that your brain is part of the healing system.

The research on psychosocial factors in injury recovery is extensive. Runners who catastrophize their injury ("I'll never run again," "this is going to take forever") recover more slowly. Runners who fear re-injury avoid the loading and exercise that would speed their recovery. And runners with low self-efficacy (doubt about their ability to recover) are less likely to follow through on rehab exercises.

This isn't about positive thinking as a cure-all. It's about removing psychological barriers that interfere with the physical work of recovery. A runner who understands that their injury is manageable, that recovery follows a predictable timeline, and that controlled loading is helping rather than hurting will do the rehab. A runner who is scared and uncertain won't.

Should Runners Still Use Ice on Injuries?

This is probably the most controversial part of the PEACE & LOVE framework. The "A" in PEACE stands for "Avoid anti-inflammatories," and ice falls into that category.

Ice provides short-term pain relief. Nobody disputes that. The question is whether it helps or hinders the healing process. Inflammation, which ice is designed to reduce, is the body's primary repair mechanism. It delivers immune cells, growth factors, and nutrients to the injury site. Suppressing inflammation may feel better in the moment but can slow the repair timeline.

The 2025 review acknowledged that ice remains a topic of debate. The evidence doesn't conclusively prove that ice is harmful. But it also doesn't show that ice improves long-term outcomes. The review's position is consistent with the original PEACE & LOVE framework: if you're going to use ice for pain relief, keep it brief and don't rely on it as a treatment strategy.

For runners dealing with acute soft tissue injuries, the practical takeaway is: ice for 10-15 minutes if you need pain relief, but don't build your recovery plan around it. Active recovery strategies like gentle movement and pain-free cardiovascular exercise will do more for your healing timeline.

How Does This Apply to Running Injuries Specifically?

Runners face a specific set of soft tissue injuries: calf strains, hamstring pulls, ankle sprains, Achilles tendon issues, and plantar fascia problems. Most of these respond well to the PEACE & LOVE approach.

The return-to-running process after any of these injuries follows the same general pattern:

1. Days 1-3 (PEACE): Protect the area. Reduce load. Compress. Elevate. Learn about your specific injury and set realistic expectations for recovery.
2. Days 3-7 (early LOVE): Begin pain-guided loading. Walk normally if you can. Start pain-free cardio like cycling or swimming. Do basic range-of-motion exercises.
3. Week 2+ (progressive LOVE): Increase loading progressively. Add strengthening exercises. Begin walk-run intervals when pain allows.
4. Return to running: Follow a graduated return-to-running protocol that rebuilds mileage conservatively.

The key insight from the 2025 review is that this process works better when the runner is educated about it from the start. Knowing what to expect at each stage reduces anxiety, increases compliance with the rehab plan, and leads to faster return to full training.

What Changed Between 2019 and 2025?

The 2025 review isn't a revolution. PEACE & LOVE hasn't been rewritten. What's changed is the weight of evidence behind it.

In 2019, PEACE & LOVE was a well-reasoned proposal backed by emerging research. By 2025, six years of clinical use and additional studies have confirmed its core claims:

• Active approaches consistently outperform passive rest for soft tissue injuries
• Education is not optional. It's a core driver of outcomes.
• Psychosocial factors (fear, beliefs, confidence) measurably affect physical recovery
• The framework is practical and applicable across a wide range of injury types

What the review also acknowledges is that some components have stronger evidence than others. Loading and education have the most robust support. The recommendation to avoid anti-inflammatories, while physiologically logical, still generates debate. And the psychosocial components (optimism, education about prognosis) are supported by research from adjacent fields like pain science and sports psychology, even though direct PEACE & LOVE studies are still limited.

The Bottom Line for Runners

If you get injured, don't just rest and wait. Protect the injury initially, then start moving. Learn about your specific injury so you know what's normal and what isn't. Stay confident in your recovery. Get your blood flowing with pain-free activity. And do the rehab exercises, even when they feel tedious.

The 2025 review validated what runners and clinicians have been discovering in practice: the active approach works. PEACE & LOVE isn't just a clever acronym. Six years and a formal review later, it's the evidence-based standard for how to handle soft tissue injuries.

The old advice was to sit still and ice it. The new advice is to move smart and heal faster. The science is on the side of movement.

References

• Marinta, Y. (2025). "Review of PEACE and LOVE the new era of RICE in acute soft tissue injury management? A narrative review." Orthopaedic Journal of Sports Medicine. PMC.
• Dubois, B. & Esculier, J-F. (2020). "Soft-tissue injuries simply need PEACE and LOVE." British Journal of Sports Medicine, 54(2), 72-73. PubMed.
• Forsdyke, D. et al. (2024). "Determinants and definitions of re-injury anxiety, fear of re-injury and kinesiophobia: a systematic review." STAPS. Cairn.info.
• Journal of Burn Care & Research (2025). "Rehabilitation Interventions for Fear-Avoidance Beliefs and Behaviors in Sudden Onset Musculoskeletal Conditions: A Scoping Review." Oxford Academic.