This is an excerpt from my book -

More than likely, whatever musculoskeletal issue you're going through is not a death sentence. Not likely going to be a thing that completely ruins your life. More than likely, it's a chronic musculoskeletal injury that your body has adapted to and we need to give it the right conditions to heal within. And once we do that, the pain will take care of itself and your life will get better. I often tell my patients on their first visit that most of what physical therapy is, is loosen the tight stuff and strengthen the weak stuff. If you imagine those two things on either side of a seesaw, once we balance out that seesaw, the pain, the issue usually takes care of itself. It's my job as your physical therapist to identify where the weak spots are and where the tight spots are and then start to give you strategies to loosen the tight ones and strengthen the weak ones.

Most likely, the musculoskeletal issue you’re going through is not a death sentence. If we can rule out the ‘scary stuff’ (heart attack, stroke, paralysis), and understand that your pain truly is coming from a muscle, tendon, ligament, or bone, then we can proceed with what we now call “PEACE & LOVE”.

You may have heard the old adage RICE - to rest, ice, compress, and elevate the injured area immediately after it’s been hurt. Research in the last 5-10 years has thrown that adage out the window. When we say rest, what we actually mean now is don't aggravate that tissue any further. But absolute, complete rest slows down blood flow in the body and can actually prolong a healing time.

So, as best you can, you want to keep moving. Moving encourages circulation. Circulation improves blood flow. Blood has good healing stuff in it. If we can improve the circulation, we can improve the feeling and the healing times.

That's tremendously important. The new guidelines that are out from all the orthopedic journals and articles now are peace and love.

• P – Protect: Avoid activities that increase pain or risk re-injury.

• E – Elevate: Raise the injured limb above heart level when possible.

• A – Avoid anti-inflammatories: NSAIDs and ice can slow the normal inflammatory process your body uses to heal.

• C – Compress: Use bandaging or sleeves to help limit swelling.

• E – Educate: Learn what’s happening, what’s safe, and what to expect. (That’s what we’re doing here!)

LOVE (Sub-Acute / Ongoing Phase)

• L – Load: Begin gentle, pain-free movement and weight-bearing as soon as it’s safe.

• O – Optimism: Your mindset influences recovery. Staying positive matters.

• V – Vascularization: Do pain-free cardio or light exercise to get blood flowing.

• E – Exercise: Gradually progress mobility, strength, and function as healing allows.

This comes from the relatively new guidelines from a 2020 article from the British Journal of Sports Medicine titled “Soft tissue injuries simply need PEACE & LOVE.

Let’s take it letter by letter

Protect - stop doing the thing that’s making those tissues mad. If it hurts to walk up and down the stairs, find another way to do it. Modify that activity so there’s less pain or none at all. You might look funny. That might involve going 1 at a time, or sideways or backwards. If that’s impossible to do, temporarily take the elevator until that tissue has calmed down. But do not throw yourself in a wheelchair. Do not avoid stairs altogether. You have to move, just in a way that protects that immediate area.

Elevate - yes, we’re still elevating. This is to help your lymphatic system (more on that in the anatomy section) get rid of the cellular waste products that are accumulating after an injury. We want to use good old gravity to our advantage and have it help move the fluid through those lymph nodes that are basically the cleanup crew of your body.

Avoid anti inflammatories - Going back to that lymphatic system and introducing your immune system (again, more on that later), anti inflammatory medications are supposed to alter your body’s response to illness or injury. I always liken it to putting on earmuffs or noise-suppressing headphones. Your body is trying to tell you something by being in pain or going numb or bleeding. If we ignore or mute that message, we may go do something dumb and further aggravate that injury. My 1 caveat is that if the pain is so significant that you cannot sleep, go ahead and take something or ice it. But then GO TO SLEEP. Do not take 2 advil and then go play 18 holes of golf or 3 hours of pickleball.

Compress- back to our lymphatic system - compression helps use mechanical force to limit the congregation of waste products in the injured area. We WANT an immune response and lymphatic response to happen in our body, we DON’T want it to linger (think of every construction site you’ve ever driven by. There’s 1 guy digging a hole and 3 guys watching. Now I’m sure those 3 guys have important safety roles…but they appear to me to just be hanging around…we don’t want that happening with the cells and response to injury in your body).

Educate - don’t freak out. Go learn what structures are in that area, what might have been affected by the event or trauma, Learn about tendons, muscles, bones, ligaments, blood vessels, nerves, and your inflammatory response (head to the section on anatomy in this book as a great place to start). And, THIS IS CRITICAL - PAY ATTENTION TO WHO YOU’RE LEARNING FROM AND WHERE THEY GET THEIR INFORMATION.

Be careful of sources that quickly sell you ‘solutions’ or require your email or any money to unlock their information.

Honestly, go to the library and pick up a book on anatomy, or head to my YouTube channel and look up ‘anatomy of…’ - I do 3-5 minute videos by body part so people can actually see the structures and scaffolding that make up your body.

In the ongoing/subacute phase (usually 3 days - 6 weeks after injury)

LOAD - your body needs a stimulus in order to offer resources to any of it’s areas. It’s REALLY GOOD at conserving energy and resources (thanks, evolution!) unless they’re absolutely necessary. When we load a tissue, we send all kinds of hormones and signals to your brain, which in turn releases the necessary resources to deal with the issue. That’s why we have to load up (gently and with precision) those tissues and the areas around them.

Optimism - I swear, I’m not making this up. Our psychology plays a tremendous role in our capacity to heal. Anecdotally, when my patients walk through my door and I ask how they are, the ones who tell me, ‘I’m grateful and blessed’ get better MUCH faster than those who tell me ‘I’m miserable’. I’m not going to change who a person is (some people just love being miserable). If I can show them with evidence that their attitude matters, especially around injury healing, then maybe they’ll shift their attitude and energy towards ‘I’m grateful and blessed’.

Vascularize - I will say it 50 times in this book until I’m proven otherwise. Blood has good, healing stuff in it (go to the anatomy chapter). We NEED that good healing stuff circulating in order for it to infiltrate the bones, muscles, nerves, ligaments and tendons that are affecting our quality of life (not to mention our heart, lungs, organs, brain, and skin). That being said, we need to actually make sure our blood IS carrying good healing stuff, so foods that are nutrient dense, oxygen from deep breathing, stress management so we can reduce the amount of cortisol coursing through our veins, and WATER so the VOLUME of blood creates enough pressure to actually infiltrate the tissues.

Exercise - When we exercise, our heart rate increases. When your heart rate increases, you circulate more blood faster throughout your body (see above). Exercise also allows your brain to have some control and say over the healing process. You become an active participant in your recovery vs. a passive bystander, and that in turn allows you to be OPTIMISTIC (See above).