Why You Should Stop Icing Your Running Injuries: PEACE & LOVE Is the New Standard

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You twist your ankle on a trail run. Your calf seizes up at mile six. Your knee starts aching after a long run. What do you do?

If you're like most runners, you reach for an ice pack and ibuprofen, elevate the leg, and rest until the pain goes away. That's the RICE protocol: Rest, Ice, Compression, Elevation. It's been the go-to advice for sports injuries since 1978.

There's just one problem. The doctor who coined RICE has since said it was wrong. And a growing body of research shows that icing and complete rest may actually delay your recovery, not speed it up.

Where Did the RICE Protocol Come From?

Dr. Gabe Mirkin introduced RICE in his 1978 book The Sports Medicine Book. It became the default treatment for acute soft-tissue injuries worldwide. Coaches taught it. Doctors recommended it. First-aid courses built entire modules around it.

But in 2014, Mirkin himself published a retraction. He wrote that both ice and complete rest may delay healing rather than help it. His reasoning? The inflammatory response that ice suppresses is actually your body's primary repair mechanism.

That retraction didn't get the attention it deserved. Most running websites, coaching programs, and even medical training materials still recommend RICE. But the science has moved on.

Why Does Ice Actually Slow Down Healing?

When you get injured, your body launches an inflammatory response. Blood vessels dilate. White blood cells rush to the area. Specialized cells called macrophages arrive to clean up damaged tissue and release a hormone called IGF-1 that kickstarts repair.

This inflammation is not a bug. It's the healing process itself.

When you apply ice, you constrict those blood vessels. That slows the arrival of the macrophages and other inflammatory cells that do the actual repair work. A 2017 study in the Frontiers in Physiology journal found that icing delayed the infiltration of inflammatory cells, reduced the expression of growth factors needed for new blood vessel formation, and slowed muscle regeneration after injury.

Ice does reduce pain temporarily. Nobody disputes that. But pain relief and healing are not the same thing. If you're trading faster healing for 20 minutes of numbness, that's a trade most runners wouldn't make if they understood what was happening.

Should You Take Ibuprofen After a Running Injury?

The same logic applies to anti-inflammatory medications like ibuprofen and naproxen. These drugs work by blocking inflammation. And in the acute phase of an injury (the first 1 to 3 days), that inflammation is exactly what your body needs.

Research shows that NSAIDs (non-steroidal anti-inflammatory drugs) can inhibit tissue repair when taken during the acute phase. They suppress the same cellular processes that ice interferes with, just through a different mechanism. The result is the same: slower healing.

This doesn't mean you should never take pain medication. It means the first 72 hours after a soft-tissue injury are the worst time to suppress inflammation. If pain management is needed, talk to your doctor about alternatives that don't block the inflammatory pathway.

What Is the PEACE & LOVE Protocol?

In 2019, researchers Blaise Dubois and Jean-Francois Esculier published a paper in the British Journal of Sports Medicine that proposed a new framework: PEACE & LOVE. It covers both the acute phase (the first 1 to 3 days) and the recovery phase that follows.

Here's what each letter stands for and what it means for you as a runner.

PEACE: The First 1 to 3 Days

• P - Protection. Reduce or stop loading the injured area for 1 to 3 days. This minimizes bleeding and reduces the risk of making the injury worse. But keep the protection period short. Prolonged rest weakens tissue.
• E - Elevation. Elevate the injured limb above the heart when possible. This uses gravity to help drain excess fluid from the area and reduce swelling.
• A - Avoid anti-inflammatories. Skip the ice and the ibuprofen. Inflammation is not the enemy in the acute phase. It's the repair crew. Suppressing it can delay tissue healing and reduce the quality of the repair.
• C - Compression. Use bandages or taping to limit swelling and provide mechanical support. External compression helps control edema without suppressing the internal inflammatory response.
• E - Education. Understand your injury. Learn what's happening in your body and what the expected recovery timeline looks like. Patients who understand their injury make better decisions and recover faster.

LOVE: After the First 72 Hours

• L - Load. Start reintroducing normal movement as soon as symptoms allow. Pain-guided loading (staying below the threshold where it hurts) promotes better tissue repair than staying off your feet. Your body rebuilds tissue along the lines of stress it experiences. If you don't load the tissue, it heals weaker.
• O - Optimism. Your mindset matters more than most runners realize. Research consistently shows that psychological factors significantly affect recovery outcomes. Catastrophizing (expecting the worst) is associated with slower healing and worse pain. Confidence and realistic optimism are associated with faster recovery.
• V - Vascularisation. Get your heart rate up with pain-free cardiovascular exercise. This could be cycling, swimming, or easy walking. Increased blood flow delivers oxygen and nutrients to the injured tissue and accelerates repair.
• E - Exercise. Restore mobility, strength, and proprioception through targeted exercises. This isn't just about getting back to running. It's about rebuilding the tissue to be resilient enough to handle running loads again. A structured return-to-running protocol prevents re-injury.

Does Complete Rest Actually Make Injuries Worse?

One of the most important shifts in the PEACE & LOVE framework is the move away from rest as the default treatment. For decades, "stay off it" was the standard medical advice for any soft-tissue injury. But the research tells a different story.

When you completely rest an injured tissue, several things happen. The tissue heals, but it heals in a disorganized pattern because there's no mechanical stress telling the new fibers which direction to align. Muscles surrounding the injury weaken. Joint range of motion decreases. And when you finally do start moving again, the tissue is less prepared for the demands of running.

Controlled early loading solves this problem. When you apply gentle, pain-guided stress to healing tissue, the new collagen fibers align along the lines of force. The result is stronger, more functional repair tissue that's better prepared for the loads of running.

This doesn't mean running through pain. It means replacing "don't move at all" with "move carefully and progressively." There's a massive difference between the two approaches, and the outcomes reflect it.

How Does Your Mindset Affect Injury Recovery?

The "O" in LOVE stands for Optimism, and it might be the most overlooked component of injury recovery in all of running.

Research on soft-tissue injury outcomes consistently shows that psychological factors predict recovery timelines as strongly as the physical severity of the injury itself. Runners who catastrophize ("I'll never run again," "this is going to take forever") tend to experience more pain, slower healing, and longer time away from running.

This isn't about "thinking positive" in a vague self-help sense. It's about understanding that your brain plays a measurable role in tissue repair. Stress hormones like cortisol interfere with healing. Fear of movement leads to guarding and compensatory patterns that create secondary problems. Education about your injury (the "E" in PEACE) directly combats catastrophizing by replacing uncertainty with understanding.

Good sleep quality also connects here. Poor sleep elevates cortisol, increases pain sensitivity, and slows tissue repair. Managing stress, staying informed about your injury, and maintaining realistic confidence in your recovery are not "soft" recommendations. They are physiologically meaningful interventions.

What Does This Look Like for a Real Running Injury?

Let's walk through what PEACE & LOVE looks like in practice. Say you roll your ankle on a trail run.

Days 1 to 3 (PEACE):

• Stop running immediately. Protect the ankle from further loading.
• Elevate it above your heart when sitting or lying down.
• Skip the ice pack and the ibuprofen. Let the inflammation do its job.
• Wrap it with a compression bandage to control swelling.
• Learn about your injury. Understand that ankle sprains typically take 2 to 6 weeks for full recovery, and that early movement (not rest) leads to better outcomes.

Days 3 onward (LOVE):

• Start gentle weight-bearing as pain allows. Walk before you run.
• Stay optimistic. Most soft-tissue injuries heal well with proper management. This is a setback, not a permanent loss.
• Get your heart rate up with pain-free activity. Cycling, swimming, or upper-body work all promote blood flow to the healing area.
• Begin targeted exercises for ankle mobility, calf strength, and balance. Progress toward a structured return-to-running protocol as symptoms allow.

The entire approach is active rather than passive. You're not waiting for the injury to heal. You're actively participating in the healing process.

Is There Evidence That PEACE & LOVE Works Better Than RICE?

A 2025 narrative review published in PMC evaluated the evidence for PEACE & LOVE since its introduction. The review found that the active approach (early loading, targeted exercise) consistently produces faster healing and better functional outcomes than passive rest.

The evidence against ice specifically continues to grow. A clinical commentary in the Journal of Contemporary Chiropractic reviewed the existing literature on cryotherapy and concluded that there is limited high-quality evidence supporting ice for soft-tissue injuries, while there is growing evidence that it may impair the healing response.

That said, researchers note that more controlled human trials are needed. Much of the evidence against ice comes from animal models. But the direction of the evidence is consistent: inflammation is necessary for healing, ice suppresses inflammation, and early movement promotes better tissue repair than rest.

For runners, the practical takeaway is clear. The old approach of ice, pills, and complete rest is being replaced by a more nuanced system that works with your body's healing response instead of against it. And the results, based on the evidence we have, are better.

How Does Injury Prevention Fit Into This Picture?

PEACE & LOVE is a treatment protocol, not a prevention strategy. But understanding why it works changes how you think about injury prevention too.

If active loading is better than rest for recovery, it follows that consistent, well-managed training load is protective against injury in the first place. This aligns with what we know about the warm-up and recovery research: tissues that are regularly loaded and properly recovered are more resilient than tissues that are either underloaded or overloaded.

The same principle applies to your training plan as a whole. Sudden spikes in training load are a primary injury risk factor. Consistent, progressive loading builds tissue tolerance. And when injuries do happen, the PEACE & LOVE framework gets you back to that consistent loading faster and with better outcomes than the old rest-and-ice approach.

References

• Dubois, B. and Esculier, J.F. (2019). "Soft-tissue injuries simply need PEACE and LOVE." British Journal of Sports Medicine, 54(2), 72-73. PubMed.
• Singh, D.P. et al. (2017). "Effects of Topical Icing on Inflammation, Angiogenesis, Revascularization, and Myofiber Regeneration in Skeletal Muscle Following Contusion Injury." Frontiers in Physiology. PMC.
• PMC Narrative Review (2025). "Review of PEACE and LOVE: the new era of RICE in acute soft tissue injury management?" PMC.
• Mirkin, G. (2014). "Why Ice Delays Recovery." DrMirkin.com. Retraction of the original 1978 RICE protocol.
• Dubé, M.O. et al. (2021). "Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?" World Journal of Orthopedics. PMC.