Should I Ice an Injury? The Debate Continues…

By Sonia Rafferty, Co- founder Safe in Dance International

The debate on whether icing an injury is help or hindrance to the healing process continues.

At the International Association for Dance Medicine and Science (IADMS) Annual Meeting in Houston, Texas in October 2017, a “duel”, entitled “Cryotherapy: Help or harm” was organised to try to persuade or dissuade therapists and dancers regarding the use of icing as a technique to manage injury.

Two physical therapists, Valerie Williams (PhD) and Rosie Canizares (DPT) were charged with putting forward evidence both for and against respectively. Arguments on both sides drew on research studies to support the different viewpoints.

The case FOR icing from Valerie Williams:

  • A decrease in pain, swelling and inflammation following injury is a positive thing
  • Swelling prevents the negative by-products of the injury leaving the site of the injury
  • There is less restriction caused by the increased and accumulated fluid in the injured joint
  • Intermittent application sustained over a few weeks (for example 6 weeks for an ankle sprain) decreases the speed of nerve conduction which increases tolerance to pain
  • Ice application decreases swelling over this 6-week period.

So her advice is:

  • An ice pack, crushed ice or an ice massage has benefits but….
  • The time and dose of cooling application can vary
  • 10 to 20 minutes is enough to reduce pain and swelling AND monitor the outcome.

The case AGAINST icing from Rosie Canizares:

  • Studies on the application of cryotherapy have been inconsistent, often based on anecdotal evidence, using small sample sizes and frequently done with animals – even the human subjects used have been healthy
  • There are many cryotherapy interventions but with so many unknowns, can it really be safe?
  • Ice should not be used on everyone, such as people with allergies, for example those who can suffer from cold uticaria (a mild or severe skin rash in reaction to cold), or individuals who suffer from Raynaud’s disease (a condition that causes reduced blood flow to certain parts of the body in response to cold or stress)
  • Ice can mask injury due to loss of pain sensitivity
  • Ice could actually increase swelling rather than reduce it due to increased permeability of tissues when damaged
  • Studies have shown that icing has a negative effect on strength, endurance and performance outcomes, such as reduced jump height
  • If people are icing on their own, do they really understand what they are doing?

So her advice is:

  • Dancers should be educated in the protocols before administering ice themselves
  • Consider more carefully when ice could be applied rather than simply using it as standard solution to any injury
  • Use re-warming periods after ice application

The question persists – can we continue to use ice safely or is cryotherapy counterproductive to the body’s natural processes?

Many studies supporting a detrimental effect on the body tissues are basing their findings on studies that involve cooling periods of 20 minutes or more. Systematic reviews of these studies on the effects of topical cooling (cold application directly to the injury) are directing that, until definitive evidence is available, short cooling applications with a progressive re-warming period are advised (Bleakly et al, 2012).

In sports, fitness and therapy articles and blogs, much has been made of the fact that the originator of the RICE (Rest, Ice, Compression, Elevation) procedure, Dr Gabriel Mirkin, has now recognised that both ice and complete rest may delay, instead of assisting, healing (Mirkin, 2016).

While he agrees that there are now pertinent questions raised regarding the efficacy of ice application following injury, a personal appraisal of the recent studies has led Dr Mirkin to make the following recommendations:

  • Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs
  • Apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10-minute application once or twice
  • There is no reason to apply ice more than six hours after you have injured yourself (Mirkin, 2016).

 

Until studies show definitely one way or the other, SiDI’s advice is similar to that offered the previous 2016 blog:

SiDI says:

  • Use ice with caution and question WHY, HOW and HOW OFTEN you are applying it
  • Follow recommendations more carefully rather than simply grabbing an ice pack and using it as a quick fix “solution” when something hurts
  • Apply ice for up to 10 minutes immediately following an injury to initially slow down the blood flow to the area to limit swelling and reduce pain Remove the ice for 20 minutes so that the blood flow can return to the area and the body’s natural healing response can take over to remove waste and excess fluid
  • Repeat the whole procedure (10 minutes on, 20 minutes off) once more
  • Progressive re-warming of the body part is advised but….
  • Remember, don’t return to dancing immediately following application of ice or use ice to numb pain so that you can continue working!
  • Take advice from your therapist as to how the application of ice will affect your specific type of injury in the short and long term. This implies that you have followed the PRICED recommendations and taken action to get a Diagnosis, something that, for several reasons, dancers are often reluctant to do!
  • If ice is freely supplied in your school or studio for injury management purposes, ensure that everyone who has access to it understands and can put into practice these recommendations.

 

References

Bleakly, C.M, Costello, J.T & Glasgow, P.D. (2012). Should athletes return to sport after applying ice? A systematic review of the effect of local cooling on functional performance. Sports Med, Jan 1:42 (1), 69-87.

Mirkin, G. (2016). Why Ice Delays Recovery. Retrieved from http://www.drmirkin.com/fitness/why-ice-delays-recovery.html

Williams, V. & Canizares, R. IADMS “DUELS”: Cryotherapy: help or harm? IADMS Annual Meeting, Houston, TX, USA, October 2017.

Supporting safer dance

Following the launch of People Dancing and Safe in Dance International (SiDI)’s new online learning course, SiDI’s Co-Founders, Maggie Morris and Sonia Rafferty, explain how safe dance practice is vital for optimising performance, minimising risk and supporting the wellbeing of every dancer
Lots of people see ‘health and safety’ as a set of rules that are necessary to protect workers but nevertheless can be restrictive and stifling. Certainly, in terms of artistic and creative practice, there are worries that overtly focusing on safety may be detrimental to innovation and risk-taking. But healthy and safe dance practice is so much more than industry regulations; it is the best way to optimise performance and to reduce injury risk.

In the 21st century, there is the research and the technology to move beyond tradition and look deeply into how we dance in order to be more effective practitioners and dancers. Dance leaders benefit from a greater understanding of the different types of dancing body and how the needs of dancers change with their development, level of participation and the stylistic demands of an ever-growing range of genres. We now know more about physiologically effective ways to warm-up and cool down, when and how best to stretch in order to recover and improve flexibility and how to support our bodies with proper nutrition and hydration. By understanding how to structure dance sessions from a physiological perspective, we can enhance the dancer’s learning and experience, making it not only safer but more productive. Effective communication will help to nurture a positive environment.

Health and safety guidelines for the physical environment are also important to protect people and this includes knowing how to prepare the spaces in which we dance, ensuring that the facilities used for dance are suitable: the temperature right, floors sprung and so on.

Everyone involved in dance should be able to train, teach, rehearse or perform in a physiologically and psychologically safe and supportive environment. Rather than limiting creative risk, healthy and safe dance practice will support the artform as it continues to develop, enhance performance and, most importantly, support the wellbeing of every dancer.

To keep up to date with the latest recommendations, all dance practitioners – including choreographers, artistic directors and managers as well as teachers and dancers – can refresh their safe practice through continuing professional development (CPD) activities that have distilled research into knowledge that can be applied to everyone’s everyday dance practice.

With this in mind, Safe in Dance International (SiDI) and People Dancing recently launched their new interactive online learning programme, Preparing for Safer Dance Practice, at the Jerwood DanceHouse in Ipswich during the first regional meeting in the UK of the International Association for Dance Medicine & Science (IADMS). Held in partnership with One Dance UK and DanceEast, the event focused on The Adolescent Dancer and was a perfect venue and setting to launch this new initiative.

Available to all dance practitioners internationally, Preparing for Safer Dance Practice is relevant to those delivering or dancing in any dance style, from classical ballet and ballroom to Hip Hop and Zumba. It works for anyone – teachers, choreographers, directors and dancers – working in any context and at any level, with children or adults, beginners or professionals.

Dance injuries can happen to anyone at any time but they don’t have to be inevitable. Of course, being safe is not just about injuries – being healthy in dance also means having the best experience possible. Simple things such as dancing on the right kind of floor, warming up properly, or maintaining a safe environment, both physically and mentally, will all help. In this way, any dancer, whether a professional performing to thousands on stage, a three year old at her weekly local dance class or an older adult dancing for their health and enjoyment, will be able to get the most from their dancing. Preparing for Safer Dance Practice will help all dance leaders provide an effective and enjoyable experience for all those who dance, regardless of age or experience, at the same time as being mindful of injury risk.

Anna Leatherdale, Producer at People Dancing, describes the new learning package as “every dance leader’s passport to safer dance practice”. She says, “This is all about ensuring dancers’ safety and wellbeing, creating and managing hazard-free environments, being risk aware, becoming familiar with safety laws and regulations and always upholding the principles of safe practice, including when conditions may be less than ideal.

“In joining forces with Safe in Dance International we have pulled together the knowledge and experience of both organisations to ensure that this online course is universally relevant and integrates the most recent dance science research into practice.”

The programme puts safe practice at the heart of all dance contexts and is built on four key learning units:

  • Preparing the Dance Space
  • Protecting the Dancer
  • Protecting the Dance Leader
  • From Preparation to Application.

The course can be used as a stand-alone learning resource or to support practitioners when registering for the Preparation for Healthy Dance Certificate (PHDC), which is administered by SiDI. The PHDC gives any practitioner an international professional evaluation of their knowledge and understanding of preparation for healthy dance. It gives the practitioner evidence for parents, employers and students that they can prepare effectively and safely for leading or delivering dance. The evaluation also offers a unique CPD opportunity – the course plus evaluation awards six hours of CPD from SiDI as endorsed by the Council for Dance Education and Training.

Preparing for Safer Dance Practice is available online at an introductory offer of £59.50. The course and evaluation, awarding six hours of CPD, and the Preparation for Healthy Dance Certificate is now being offered for only £84.50.

To sign up, visit www.safeindance.com/preparing-for-safer-dance-practice or www.communitydance.org.uk/saferdance

Info


maggie@safeindance.com
sonia@safeindance.com

PDF Available here:
This article, first published in the Summer 2017 edition of Animated magazine, is reproduced by permission of People Dancing. All Rights Reserved. See www.communitydance.org.uk/animated for more information.

Stretching by Guest Blogger and SiDI Provider Janine Bryant

Guidelines for Stretching

– Warm up first. Never stretch a cold muscle!
– By warming up first, the delivery of oxygen and nutrients are increased thus preparing muscles for strenuous activity.
– Warming up should not be too tiring, but just enough to begin perspiring.
– Usually a light jog for 5-7 minutes is sufficient.

This tip connects the idea of aging well and dance career longevity to current studio practices. The idea that, what we do now in the dance studio directly affects how our bodies age and perform later, is one that I often talk about within the bounds of my own research on aging and range of motion (ROM).

Perhaps one of the most controversial subjects for dancers and those who train them is the subject of stretching. Which types of stretching to do and when, during an active day, is a conversation happening across the sports industry offering multiple perspectives that often conflict.
For dancers, most of us have developed as artist-athletes without adequate information on this subject. Many can recall entering the dance studio, dropping the huge bags and plopping down on the floor into the widest second position the legs could make and forcing chests down. This practice and others like it still occur in studios everywhere. However, there is a growing hunger, thankfully, for more adequate and up-to-date information being driven by new and old generations of dancers alike who are also scholars and athletes.

While increasing ROM is sometimes considered a task for younger dancers, the idea of increasing or simply maintaining ROM as a dancer ages is sometimes abandoned because the pain of stretching is too great. Further, dancers who have sustained serious injuries due to overworking and overstretching during their active careers will find it difficult to participate in a stretching program, especially if those stretching activities only include the traditional ‘hold and stretch’ movements, more aptly known as static stretching. Complicating things further is the fact that many dancers are have ‘hypermobility syndrome’, which can increase the need for strength training in addition to a stretch program to ensure adequate musculoskeletal balance. The order is tall but dancers, who are by nature high achievers, are up to the task!

All of this begs the questions: What types of stretching are there and which ones are the most effective for increasing and maintaining ROM? And, more importantly, why is stretching a cold muscle bad? These are great questions, the answer for which every dancer old and young would benefit from knowing.

First, let’s take a look at the different types of stretching:
Some of these terms are commonly confused and misused.

Static Stretching

Static stretching means a stretch is held in a challenging but comfortable position for a period of time, usually somewhere between 10 to 30 seconds. Static stretching is the most common form of stretching found in general fitness and is considered safe and effective for improving overall flexibility. However, many experts consider static stretching much less beneficial than dynamic stretching for improving range of motion for functional movement, including sports and activities for daily living.

Dynamic Stretching

Dynamic stretching means a stretch is performed by moving through a challenging but comfortable range of motion repeatedly, usually 10 to 12 times. (for dancers, leg swings, fall and recovery activities, etc.) Although dynamic stretching requires more thoughtful coordination than static stretching (because of the movement involved), it is gaining favor among athletes, coaches, trainers, and physical therapists because of its apparent benefits in improving functional range of motion and mobility in sports and activities for daily living.
Note that dynamic stretching should not be confused with old-fashioned ballistic stretching (remember the bouncing toe touches from PE classes?). Dynamic stretching is controlled, smooth, and deliberate, whereas ballistic stretching is uncontrolled, erratic, and jerky. Although there are unique benefits to ballistic stretches, they should be done only under the supervision of a professional because, for most people, the risks of ballistic stretching far outweigh the benefits.

Passive Stretching

Passive stretching means you’re using some sort of outside assistance to help you achieve a stretch. This assistance could be your body weight, a strap, leverage, gravity, another person, or a stretching device. With passive stretching, you relax the muscle you’re trying to stretch and rely on the external force to hold you in place. You don’t usually have to work very hard to do a passive stretch, but there is always the risk that the external force will be stronger than you are flexible, which could cause injury.

Active Stretching

Active stretching means you’re stretching a muscle by actively contracting the muscle in opposition to the one you’re stretching. You do not use your body weight, a strap, leverage, gravity, another person, or a stretching device. With active stretching, you relax the muscle you’re trying to stretch and rely on the opposing muscle to initiate the stretch. Active stretching can be challenging because of the muscular force required to generate the stretch but is generally considered lower risk because you are controlling the stretch force with your own strength rather than an external force.

Stretching Techinque

Every stretch is static or dynamic and passive or active, as illustrated in the examples shown in table 1.1 above.
You might hear or read about other techniques and terms used in stretching (especially by coaches and athletes), such as proprioceptive neuromuscular facilitation (PNF) stretching. PNF techniques attempt to alter neural input thereby influencing muscle extensibility to improve flexibility. One common version, contract/relax, utilizes a 10-second contraction of the muscle followed by 10-seconds of relaxation, during which the same muscle is passively stretched. This procedure is generally executed three times and a static stretch of 30 seconds or more is added at the end. PNF techniques can be particularly useful for dancers having difficulty improving their flexitility.{2}

Most of the stretches you see and do are likely static-passive stretches. Static-passive stretches are the most common stretches and the easiest to perform. If executed with good technique, these stretches are effective in improving flexibility and range of motion.
However, most experts now agree that although static-passive stretches have many benefits, it’s best to do more dynamic-active stretches. Because dynamic-active stretches require you to use and build your own strength while moving through the stretch, they are more helpful for improving functional movements used in everyday life and in sports. In addition, because dynamic-active stretches are movement oriented, these stretches can help generate heat, which can make the muscles more pliable. Finally, evidence suggests that because dynamic-active stretches require muscle activation and contraction, the muscles being stretched are triggered to relax even more than they might during a static-passive stretch, thereby reducing the risk of injury while increasing the functional benefit.

This does not mean you should avoid or minimize static-passive stretching. Just be aware that there appear to be quite a few advantages and benefits to dynamic-active stretching and that you should include these types of stretches as often as is comfortably and conveniently possible for you. {1}

Experts are also recommending that dynamic stretches be performed BEFORE the first plie in class or prior to a performance and that static active and static passive stretching is best for recovery at the end of the dance day. Stretching cold muscles predisposes dancer-athletes to power loss and injury. Solomon et al suggest a warm up for 5 to 10 minutes before starting flexibility training. The resultant elevation in body temperature will make stretching more effective and comfortable and reduce the possibility of injury. Room temperature should be warm and focus on correct form and alignment stressed, as benefits of any exercise are greatly diminished when performed improperly as risk of injury increases. {2}

Other things to consider: Dancers who are naturally flexible should be monitored closely during stretching activities for form and hypermobility tendencies. Dancers desiring to simply maintain ROM could also benefit from bone-building resistance training alongside ROM flexibility training. Dancers in the midst of an active performance career need to time their flexibility programs wisely during their dance day with consideration for room temperature, strength preservation and injury prevention.

Until next time, friends, dance healthy, long, strong, and warm up before stretching!

Janine Bryant

1. Blahnik, J., Full Body Flexibility, Second Edition, Human Kinetics, 2011.
2. Solomon, R., Solomon, J.,Minton, S.C., Preventing Dance Injuries, Second Edition, Human Kinetics, 2005.

So What is Safe and Healthy Dance Practice?

Obviously, we at SiDI use those terms all the time, but what are we actually talking about?  Are we the health and safety police?  Do we want to spoil dancers’ fun?  Do we want to stop people taking artistic and creative risk?  Definitely not!

Lots of people think of “health and safety” as a set of policies that are put in place to protect workers – necessary but also maybe restrictive and stifling.  But healthy and safe dance practice is so much more than industry rules and regulations.  It’s the best way to reduce injury risk and to enhance performance.

There’s no getting round the fact that dancers get injured. Injury rates are high in our profession.  So what can we do to minimise the risk of becoming injured without limiting the scope of what we want to do as creative, imaginative beings?  How can we apply new knowledge to optimise performance and help dancers get the most out of their dancing?  In the 21st century, there is now the research potential and the technology to move beyond tradition and thoroughly interrogate how we dance, looking at more effective ways to approach learning and practice.

This isn’t just about making sure that we have a safe, warm space to work in with a good, supportive floor and knowing where the first aid kit and the fire exits can be found.  The principles of safe practice are more substantial than these simple fundamentals.  They deal with the interplay of environmental, physical, and psychological factors that can have an impact on how effective our dancing can be and should be applied to all dance styles, all levels of ability or participation, and all age groups.

We can benefit from the greater understanding of different dancing bodies and how the needs of dancers change with their development, level of participation and the stylistic demands of an ever-growing range of genres.

If our own postural anomalies, or changes due to the specific demands of our dance style, result in deviations from anatomically effective alignment, we need to recognise this and address any possible negative effects.

We now know more about physiologically effective ways to warm-up and cool down, when and how best to stretch to recover and improve flexibility, and how to support our bodies with proper nutrition and hydration.

By understanding how to structure dance sessions from a physiological perspective, we can enhance dancers’ learning and experience, making it not only safer but more productive.

Communicating effectively will help to nurture a positive environment so that all dancers are respected and safeguards can be put in place.

Finally, those health and safety guidelines are important to protect people, including knowing how to prepare the environment in which we dance and to mediate risk with injury documentation and insurance.

SiDI says……

The more we know about safe and healthy practice, the more we’ll know about how the body (and mind) works, understand how much to push, be aware of why and how we need to recover and ultimately promote enjoyment, satisfaction and longevity in dancing.

By considering safe and health dance practice principles, we will be able to:

  • take into account the specific needs of different groups of dancing bodies
  • include a physiologically sound warm-up and cool down in our practice
  • recognise good functional alignment appropriate to our specific dance style and be able to strive towards it without pushing beyond individual capacity
  • understand why, when and how the different types of stretching can be used productively
  • encourage fit, well-nourished and healthy bodies that are ready to dance
  • balance workload and rest in our classes, rehearsal and schedules
  • foster mutually respectful relationships between dancers and dance leaders, using clear communication to ensure instruction and feedback is framed positively and appropriately.

How can dancers gain core stability safely AND effectively?

The term “core stability” is used frequently in the media and fitness world and increasingly in dance training, but what does it actually mean for dancers and why do they need it?

The core is generally thought of as the centre of the body (the part between the sternum and the knees) and stability is about gaining control of the spine and pelvis to support torso movement and coordinate the action of the limbs. A good functional core helps to connect the upper and lower body in order to produce a refined and efficient dynamic alignment when dancing.

To engage the core effectively, dancers need to understand the relevant groups of muscles that are involved and the way they can be accessed. Sometimes instructional cues and execution are unfocused and dancers might spend a lot of time on supplemental exercises that are not as helpful in increasing their core stability as they could be. Dancers do not only need to know which muscles to locate but clear instruction on how to find them. Giving the direction simply to “use your core” in class is not very beneficial!

Rather than simply seeing the core as the front of the body (abdominals), it might be helpful to think of it as a cylinder, incorporating the back muscles and also the diaphragm at the top and the pelvic floor at the bottom. To stabilize the core requires a team of muscles, each one playing a role in organising and coordinating the body. “Global” muscles support mobility and effective orientation in the spine – these have been identified as the rectus abdominis, the lateral fibers of the external obliques, the psoas major and the erector spinae muscles. “Local” muscles, including the multifidi and the quadratus lumborum, help with inter-segmental stability because of their short length and their attachment to the vertebrae. Primarily, the transversus abdominis (TA), and the multifidi are seen as key, as they have been shown to be the first muscles to contract in order to stabilize the movement of an extremity, but through their connection to the thoracolumbar fascia, the internal obliques additionally contribute to the cylindrical support. The diaphragm and pelvic floor also play their part in spinal and pelvic stability while helping to reduce the strain on the abdominal and back muscles.

To improve the core, it is important to train all of the contributing muscles collectively – inefficient local muscles can cause compensation of the global muscles, negatively affecting overall stability.  The local muscles must be able to maintain isometric contractions continuously, working at lower grade intensities, but in a coordinated way. For the general population, there are often recommendations made for sit-ups and crunches to improve the look of the abdominals (see the “ripped” six packs advertised by fitness magazines!). However, this emphasis solely on the superficial abdominals, using repeated flexion of the spine and hip joints when performing sit-up exercises can often lead to overwork and imbalance without achieving functional efficiency. Instead, it has been suggested that a combination of endurance, strength, power and proprioception training is the most effective way to achieve the synergetic motor patterns that will benefit dancers. This can be done using dynamic exercises that challenge balance and use resistance to maintain control against the disruption of stability.

SiDI says……

  • While research suggests that core stability work is effective in enhancing general fitness and helping to prevent lower back pain, training should avoid exercises that place increased compressive loads on the lumbar spine.
  • Be aware that an emphasis solely on the superficial abdominals can negatively affect the strength and flexibility relationship between the front and back of the torso, potentially leading to muscle imbalance and back pain.
  • To work safely and effectively, dancers should avoid routinely engaging in overly strenuous abdominal workouts and instead try to identify the weaker links in their combined core musculature, both local and global, to gain better dynamic control.

 

Bibliography

Abdallah A., Beltagi A. (2014).  Effect of core stability exercises on trunk muscle balance in healthy adult individuals. World Academy of Science, Engineering and Technology, International Science Index 89, International Journal of Medical, Health, Pharmaceutical and Biomedical Engineering 8(5), 231-237.

Behm, D.G. & Colado Sanchez, J. C. (2013). Instability resistance training across the exercise continuum. Sports Health, Nov, 5(6): 500–503.

Kline, J.B., Krauss, J.R., Maher, S.F. & Xianggui, Q. (2013). Core strength using a combination of home exercises and a dynamic sling system for the management of low back pain in pre-professional ballet dancers: A case series. Journal of Dance Medicine and Science, 17(1), 24-33.

Philips, C. (2005). Stability in dance training.  Journal of Dance Medicine and Science, 9(1), 24-28.

Quin, E., Rafferty, S. & Tomlinson, C. (2015). Safe dance practice: An applied dance science perspective. Champaign, IL: Human Kinetics.

Sharrock, C., Cropper, J, Mostad, J., Johnson, M. & Malone, T. (2011). A pilot study of core stability and athletic performance: Is there a relationship? International Journal of Sports Physical Therapy, Jun; 6(2): 63–74.

Simmel, L.  (2014). Dance medicine in practice: Anatomy, injury prevention, training. London, England: Routledge.

Should I ice an injury?

Research in any field is constantly evolving and in time, the important findings will filter down to everyday practice. Recently in the popular press, several articles have suggested that putting ice on an injury may in fact have little beneficial effect or even delay the healing process. These suggestions aren’t new – we’ve known for some time that the evidence for the effectiveness of cryotherapy (cooling of injured tissue by ice application) on muscle injuries is limited. The question mark is over whether we should interfere with the body’s natural response to injury (inflammation) by trying to reduce it.

Looking at the responses in the literature, there are mixed reactions. Some researchers state that as much of the research was done on animal subjects (mainly anaesthetised mice following induced soft tissue injury) we should be wary of simply transferring the findings to the human body. Also, there may be differences in the response of different types of tissue (muscle, ligaments, tendons) to cryotherapy. All of the researchers advise that much more investigation into the potential positive and negative effects of ice is needed.

So, what do we advise for dancers? In the light of these research studies, should we abandon our recommendations for dancers to use the PRICED procedure (Prevent/Protect, Rest, Ice, Compression/Elevation/Diagnosis) immediately following an injury?

SiDI says……

  • Don’t suddenly stop using ice altogether, but follow recommendations more carefully rather than simply grabbing an ice pack and using it as a quick fix “solution” when something hurts.
  • Limit the application as directed as there is some evidence that prolonged use of ice may have detrimental effects. Use ice immediately following an injury (the first 24-48 hours) to initially slow down the blood flow to the area and limit tissue damage but make sure that the ice is not applied for longer that 20 minutes (less for some injuries) so that the body’s natural healing response can take over to remove waste and excess fluid. Ice can be re-applied after about 60 minutes, but again, limit the number of re-applications.
  • As applying ice usually means you need to stop dancing and sit down, simply thinking about icing will encourage rest and prevention of further injury. Ice also has a pain-relieving (analgesic) effect.
  • Don’t return to dancing following application of ice and don’t use ice to numb pain so that you can continue working!
  • Take advice from your therapist as to how the application of ice will affect your specific type of injury in the short and long term. This implies that you have followed the PRICED recommendations and taken action to get a diagnosis, something that, for several reasons, dancers are often reluctant to do!

Bibliography

Bleakly, C., Costello, J.T. & Glasgow, P.D. (2012). Should athletes return to sport after applying ice? A systematic review of the effect of local cooling on functional performance. Journal of Sports Medicine, Jan 1;42(1):69-87.

Bleakly, C. & Davison, G.W. (2010). Cryotherapy and inflammation: evidence beyond the cardinal signs. Physical Therapy Reviews 12; 15(6).

Caldwell, C. (2001). Dance and dance injuries. Chichester, England: Corpus.

Comfort, P & Abraham, E. (2010). Sports rehabilitation and injury prevention. Chichester, England: Wiley and Sons.

Quin, E., Rafferty, S. & Tomlinson, C. (2015). Safe dance practice: An applied dance science perspective. Champaign, IL: Human Kinetics.

Russell, J.A. (2010). Acute ankle sprain in dancers. Journal of Dance Medicine and Science, 14(3), 89-96.