處理軟組織損傷不僅僅是短期的損傷控制。與其他損傷相似，臨床醫生應著眼於長期的結果。無論處理腳踝扭傷還是韌帶拉傷，我們希望這篇“Bolg @ British Journal of Sports Medicine”上的這篇“Soft tissue injuries simply need PEACE & LOVE”文章，能鼓勵臨床醫生給和平（PEACE）一個機會，或許所有的軟組織損傷都需要愛（LOVE）。
參考文獻：
[1] van den Bekerom MPJ, Struijs PAA, Blankevoort L, et al. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults. J Athl Train, 2012;47: 435-43.
[2] Bleakley CM, Glasgow PD, Phillips N, et al. Guidelines on the management of acute soft tissue injury using protection rest ice compression and elevation. London: ACPSM, 2011.
[3] Bleakley CM, Glasgow P, MacAuley DC. Price needs updating, should we call the police? Br J Sports Med,2012;46: 220-1.
[4] Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline. Br J Sports Med,2018;52: 956.
[5] Doherty C, Bleakley C, Delahunt E, et al. Treatment and prevention of acute and recurrent ankle sprain: An overview of systematic reviews with meta-analysis. Br J Sports Med,2017;51: 113-25.
[6] Duchesne E, Dufresne SS, Dumont NA. Impact of inflammation and anti-inflammatory modalities on skeletal muscle healing: From fundamental research to the clinic. Phys Ther Sport,2017;97: 807-17.
[7] Yerhot P, Stensrud T, Wienkers B, et al. The efficacy of cryotherapy for improving functional outcomes following lateral ankle sprains. Ann Sports Med Res,2015;2: 1015.
[8] Singh DP, Barani Lonbani Z, Woodruff MA, et al. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Front Physiol,2017;8: 93.
[9] Hansrani V, Khanbhai M, Bhandari S, et al. The role of compression in the management of soft tissue ankle injuries: A systematic review. Eur J Orthop Surg Traumatol,2015;25: 987-95.
[10] Bleakley CM, O’Connor SR, Tully MA, et al. Effect of accelerated rehabilitation on function after ankle sprain: Randomised controlled trial. BMJ,2010;340: c1964.
[11] Kim TH, Lee MS, Kim KH, et al. Acupuncture for treating acute ankle sprains in adults. Cochrane Database Syst Rev,2014;6: CD009065.
[12] Lewis J, O’Sullivan P. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Br J Sports Med,2018;epub ahead of print, 25 June 2018.
[13] Graves JM, Fulton-Kehoe D, Jarvik JG, et al. Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain. Health Serv Res,2014;49: 645-65.
[14] Webster BS, Choi Y, Bauer AZ, et al. The cascade of medical services and associated longitudinal costs due to nonadherent magnetic resonance imaging for low back pain. Spine,2014;39: 1433-40.
[15] Khan KM, Scott A. Mechanotherapy: How physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med,2009;43: 247-52.
[16] Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: Systematic review. Br J Sports Med,2019;Epub ahead of print; 2019 Mar 2.
[17] Roy JS, Bouyer LJ, Langevin P, et al. Beyond the joint: The role of central nervous system reorganizations in chronic musculoskeletal disorders. J Orthop Sports Phys Ther,2017;47: 817-21.
[18] Briet JP, Houwert RM, Hageman MGJS, et al. Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury,2016;47: 2565-9.
[19] Bialosky JE, Bishop MD, Cleland JA. Individual expectation: An overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain. Phys Ther,2010;90: 1345-55.
[20] Sculco AD, Paup DC, Fernhall B, et al. Effects of aerobic exercise on low back pain patients in treatment. Spine J,2001;1: 95-101.
軟組織損傷處理的新原則：PEACE 和 LOVE
軟組織損傷的康復過程是複雜的。多年來，指導軟組織損傷的康復方法從ICE到RICE，又從PRICE到POLICE。儘管這些康復方法眾所周知，但支援這些方法的證據是有限的。ICE/RICE/PRICE側重於急性治療，忽略了組織癒合的亞急性階段和慢性階段。
我們提出了兩個新的略寫詞來進一步最佳化軟組織損傷的康復過程。我們的方法包括急性護理期 PEACE（和平）原則和後續管理的 LOVE（愛）原則。PEACE & LOVE概述了健康教育和心理社會因素對康復的重要性。此外，雖然消炎藥對疼痛和功能的恢復有好處，但我們認為其對組織的修復具有潛在的有害影響，因此我們不建議使用它們來促進軟組織恢復。
在軟組織損傷的急性階段，應該使用PEACE原則來進行處理。
P-保護
停止或限制運動1-3天，以減少出血，防止受傷肌纖維的腫脹，並減少受傷加重的風險。儘量減少休息時間，長時間的休息會使組織力量和效能下降。依靠疼痛訊號來移除保護“設施”並逐步恢復運動。
E-抬高
將患肢抬高到高於心臟的位置，以促進組織液從組織中流出。儘管支援這種方法的證據不足，但考慮到其較低的風險/收益比值，仍建議抬高患肢。
A-避免使用抗炎藥物
抗炎藥物可能對組織的長期癒合有害。不同階段的炎症有助於軟組織更好的再生。不推薦使用藥理學方法抑制此過程，因為這可能損害組織癒合，特別是使用較高劑量時。
我們對低溫療法存有質疑。儘管在臨床醫生和相關人群中冰塊被廣泛使用，但沒有高質量的證據表明冷凍療法對軟組織損傷的效果。即使冰塊主要用於鎮痛，但其也可能破壞炎症、血管生成和血管再通，延緩中性粒細胞和巨噬細胞浸潤，增加未成熟肌纖維，導致組織再生受損和膠原合成過剩。
C-加壓
使用膠帶或繃帶產生的外部機械性壓力有助於限制關節內水腫和組織出血。儘管有相互矛盾的研究，但踝關節扭傷後施加壓力似乎可以減輕腫脹，改善生活質量。
E-教育
治療師應告訴患者積極康復的好處。與主動療法相比，損傷後早期的被動療法，如電療、手法治療或針灸，對疼痛和功能的影響微不足道;從長遠來看，被動療法甚至可能適得其反。事實上，養成“需要被修復”的習慣會對治療師產生依賴性，最終會對結果產生消極的態度，從而導致症狀的持續。好的健康教育和負荷指導將有助於避免過度治療，過度治療會增加藥物注射或手術的風險，以及由於失能補償（例如腰背痛）而增加的醫療成本。在技術和高科技治療方法可供人們選擇的時代，我們對患者康復時間的設定應切合實際康復時間，而不是追求神奇快速的治療方法。
在急性期之後的後續階段，應該使用LOVE原則了進行處理。
L-負荷
積極的運動和鍛鍊有益於大多數肌肉骨骼疾病患者。應儘早地增加機械應力，在症狀允許的情況下儘快地恢復正常活動。最佳的負荷（不產生疼痛情況下）可透過機械應力來促進肌肉、肌腱和韌帶的修復、重塑以及組織耐受能力的建立。
O-樂觀
大腦在康復干預中起著關鍵作用。災難性事故、抑鬱和恐懼等心理因素可能會阻止恢復，與病理生理學相比，心理因素更能解釋踝關節扭傷後的症狀和侷限性。患者的悲觀預期也與次優的結果和較差的預後有關。從實際出發的同時，醫護工作者應鼓勵患者保持樂觀，進而提高最佳恢復的可能性。
V-血管形成
包括有氧運動在內的身體活動是肌肉骨骼損傷管理的基石。雖然在運動劑量方面尚需進一步研究，但無痛的有氧運動應在受傷幾天後就開始，以提高動力，增加受傷結構處的血流量。早期的動員和有氧運動可以改善肌肉骨骼疾病患者的功能、工作狀態，減少對止痛藥的需求。
E-活動
有大量的證據表明活動可以治療踝關節扭傷並減少複發性損傷的機率。活動有助於損傷後早期運動能力、力量和本體感覺的恢復。應避免疼痛，以確保在恢復的亞急性期中得到最佳修復，可以用疼痛指導運動。
處理軟組織損傷不僅僅是短期的損傷控制。與其他損傷相似，臨床醫生應著眼於長期的結果。無論處理腳踝扭傷還是韌帶拉傷，我們希望這篇“Bolg @ British Journal of Sports Medicine”上的這篇“Soft tissue injuries simply need PEACE & LOVE”文章，能鼓勵臨床醫生給和平（PEACE）一個機會，或許所有的軟組織損傷都需要愛（LOVE）。
參考文獻：
[1] van den Bekerom MPJ, Struijs PAA, Blankevoort L, et al. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults. J Athl Train, 2012;47: 435-43.
[2] Bleakley CM, Glasgow PD, Phillips N, et al. Guidelines on the management of acute soft tissue injury using protection rest ice compression and elevation. London: ACPSM, 2011.
[3] Bleakley CM, Glasgow P, MacAuley DC. Price needs updating, should we call the police? Br J Sports Med,2012;46: 220-1.
[4] Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline. Br J Sports Med,2018;52: 956.
[5] Doherty C, Bleakley C, Delahunt E, et al. Treatment and prevention of acute and recurrent ankle sprain: An overview of systematic reviews with meta-analysis. Br J Sports Med,2017;51: 113-25.
[6] Duchesne E, Dufresne SS, Dumont NA. Impact of inflammation and anti-inflammatory modalities on skeletal muscle healing: From fundamental research to the clinic. Phys Ther Sport,2017;97: 807-17.
[7] Yerhot P, Stensrud T, Wienkers B, et al. The efficacy of cryotherapy for improving functional outcomes following lateral ankle sprains. Ann Sports Med Res,2015;2: 1015.
[8] Singh DP, Barani Lonbani Z, Woodruff MA, et al. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Front Physiol,2017;8: 93.
[9] Hansrani V, Khanbhai M, Bhandari S, et al. The role of compression in the management of soft tissue ankle injuries: A systematic review. Eur J Orthop Surg Traumatol,2015;25: 987-95.
[10] Bleakley CM, O’Connor SR, Tully MA, et al. Effect of accelerated rehabilitation on function after ankle sprain: Randomised controlled trial. BMJ,2010;340: c1964.
[11] Kim TH, Lee MS, Kim KH, et al. Acupuncture for treating acute ankle sprains in adults. Cochrane Database Syst Rev,2014;6: CD009065.
[12] Lewis J, O’Sullivan P. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Br J Sports Med,2018;epub ahead of print, 25 June 2018.
[13] Graves JM, Fulton-Kehoe D, Jarvik JG, et al. Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain. Health Serv Res,2014;49: 645-65.
[14] Webster BS, Choi Y, Bauer AZ, et al. The cascade of medical services and associated longitudinal costs due to nonadherent magnetic resonance imaging for low back pain. Spine,2014;39: 1433-40.
[15] Khan KM, Scott A. Mechanotherapy: How physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med,2009;43: 247-52.
[16] Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: Systematic review. Br J Sports Med,2019;Epub ahead of print; 2019 Mar 2.
[17] Roy JS, Bouyer LJ, Langevin P, et al. Beyond the joint: The role of central nervous system reorganizations in chronic musculoskeletal disorders. J Orthop Sports Phys Ther,2017;47: 817-21.
[18] Briet JP, Houwert RM, Hageman MGJS, et al. Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury,2016;47: 2565-9.
[19] Bialosky JE, Bishop MD, Cleland JA. Individual expectation: An overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain. Phys Ther,2010;90: 1345-55.
[20] Sculco AD, Paup DC, Fernhall B, et al. Effects of aerobic exercise on low back pain patients in treatment. Spine J,2001;1: 95-101.