Safe in Dance International at IADMS 

October 28th – 31st 2022 Limerick Ireland

We are looking forward to the IADMS annual conference in Limerick, Ireland at the end of October. The SiDI Team will be attending and would love to meet with you.  Our stand will be manned throughout the conference.  Sonia, Maggie, Tina and Beth will be in and out of the presentations and ready to chat to you

SIDI is also thrilled to have been invited by IADMS to present our first pre-conference event.

Dancing & Dance Science: The symbiotic relationship between dance research and practitioner wisdom

Thursday October 27th 2022

In person at the Irish World Academy Music and Dance, Limerick

& online

2.30 – 5.30pm GMT+1

BOOK NOW

About the event:
This afternoon of interactive presentations and information-sharing invites educators, researchers and practitioners to ‘stir the pot’ and interrogate how their work strands interact to support the integration of emerging dance science knowledge into everyday dance practice.

SiDI is delighted to confirm that these respected colleagues will be joining us to give us personal perspectives and provocations from physiological, psychological, sociological and practical viewpoints:

Dr Liliana Gomes da Silva Araújo: Assistant Professor, Schulich School of Music, McGill University, Montreal, Canada
Zahra Carpenter, BFA: Dance Educator, Director-at-Large, IADMS Board of Directors
Andrea Downie, Hon BFA and PHD Candidate: Founding Director of EnhanceDance, Founding Member of Healthy Dancer Canada
Professor Emma Redding MBE: Director, Victorian College of the Arts, Melbourne, Australia

Following a discussion on each of these threads, Maggie Morris and Sonia Rafferty, co-founders of SiDI, will propose that we move away from the notion of “translating” or “trickling down” dance science research and instead see this in a less hierarchical structure. We invite participants to share their own personal perspectives and reflections.
At the end of the session, SiDI will outline how our Core Principles©, Continuing Professional Development and partnerships have facilitated the dissemination of healthy dance principles up to this point. We will share how we support other organisations in assessing dance wellness/healthy dance practice, and how our team of Registered Providers work in the wider international community. There will be an opportunity to learn more about working with SiDI, take discussions further, and network with a complimentary drink following the event. Registered attendees will receive a discount on application to complete any of SiDI’s CPD Certificates and/or a discount on application to become a SiDI Registered Provider.

For those joining us in person, there will be a post-event complimentary drink, for discussions to continue informally and a chance to learn more about the opportunities and benefits of working with SiDI.

Outcomes:

  • Knowledge exchange with key professionals and practitioners
  • Endorsed Continuing Professional Development for all participants
  • Introduction to Safe in Dance International, their Core Principles© and Registered Provider Status
  • Discount on application to complete any of SiDI’s CPD Certificates (awarding recognised endorsement of healthy dance practice)
  • Discount on application to become a SiDI Registered Provider

There’s still time to sign up for this event which is both in-person and virtual.

Attending the IADMS Conference?
In Person: There are just a few places left for those attending the conference. Sign up now through the usual Conference Registration portal on the IADMS click here
Price: $80 USD in person

BOOK NOW

SPECIAL DEAL
Not attending the IADMS Conference?
If you are not able to attend the IADMS conference in person this year, you can still sign up for our session as a separate independent event.  There is limit for on-line participants. If you would like to attend just this event, please email Sutton Anker at conference@iadms.org
Price $80 USD

We hope to see you there. Learn more about SiDI and our IADMS partnership here.

Returning to the Studio – Useful Guidance from Around the World

The news changes from day to day within every country of the world and we all bounce between lock down and slowly moving back into the studio.  We have colleagues who are back in the studio already as well as some who are planning to go back to teaching soon, or to a blended, on site & online delivery. Of course, the preparation you need to undertake and how you manage your students and teaching when you do return to the dance studio changes, or indeed if you can return at all depends where you are in the world.

Please, always remember, that guidelines, rules and laws will vary depending on where you live in the world, so it is important to follow the recommendations and requirements of your own government /state and use the information below as it is relevant to your own country’s position.

In this newsletter we share with you links to some of the organisations that are providing information about returning to dance and the studio following Covid19 and addressing ways to support your mental health when returning and adapting to the ‘new normal’.  Much of the advice below is common sense and wisdom but most importantly it is information produced by experts in the field of dance teaching, dance and dance science, following their own country specific guidance.

We hope you find it useful.


NIDMS and One Dance UK Weekly Webinars

One Dance UK and NIDMS are running weekly Return to Dance Q&A webinars, co-hosted by the Dance Medicine and Science Expert Panel.The series of webinars are available to catch up on their website and the following topics have been covered:

Webinar 1: Returning to Dance, what you need to know to get back to the studio.
Webinar 2: Preparing to Return to Dance – Risk assessment, legality,
responsibility when hiring a venue, and cleaning.
Webinar 3: Social Distancing in dance, part 1 Fixed groups and bubbles,
indoor exercise, ventilation and face coverings.
Webinar 4: Social Distancing in dance, part 2: Specific dance activities and risk,
class structure, floor work and contact.
Webinar 5: Considerations for vulnerable groups (BAME/BIPOC, Disability)

LINK TO WEBINARS


IADMS: Performing Artist’s Mental Health and Covid-19 – Webinars Series

The International Association for Dance Medicine and Science, is offering free weekly webinars on mental health for performing artists, and the multidisciplinary professionals who work in performance science, medicine, education and psychology.
Experts in mental, and performance health and well-being provide insights, practical tips and sage advice for those helping performers and for performing artists themselves.
In the webinar series:
Webinar 1: How is COVID-19 affecting us?
Webinar 2: Why am I feeling this way? And what can I do?
Webinar 3: Stress and Coping
Webinar 4: To Sleep, Perchance to Dream, During COVID-19
Webinar 5: Sensitive and Resilient: Two Sides of the Same Coin
Webinar 6: Re-Entry: Navigating the New Normal with COVID-19
Webinar 7: Psychological Readiness: Navigating the New Normal with COVID-19
COMING SOON
Webinar 8: Depression: Dark Night of the Soul
Webinar 9: Loss and Grief

LINK TO WEBINARS


Performance Medicine (Australia)

Performance Medicine are a leading rehabilitation and treatment centre in Australia, catering to the full spectrum within the performing arts industry. They have shared their guidance on returning to dance safely, with four key points in a simple and effective way to apply scientific loading principles and research to your dance studio, so that your dancers can return to dance in a safe and sustainable way:
1. Dance Questionnaire
2. Dance Specific Baseline Profile
3. Check in
4. Graduated approach to dance and training in the studio

Check out their blog post HERE


Healthy Dancer Canada

If you are a dancer in Canada, Healthy Dancer Canada are one of our partners and have a very useful resource page HERE and they have also advised us that Canadian Dance Assembly (CDA) are providing a lot of information for Canadian dancers HERE

Most of the discussions in Quebec, on Zoom and online directly, are happening with the Regroupement Québecois de la Danse, and some information on this can be found HERE


The Dance Docs

The Dance Docs podcast answers questions from the treatment table to help dancers better understand their bodies, and most recently covering topics like Dancing in a Mask, Coping with Covid-19 and Facing the Unknown. This is hosted by Dr. Kat Bower PT and professionals from the dance medicine community.
This podcast is for everyone from health-conscious dancers, teachers, dance medicine professionals, or anyone in between. The Dance Docs want to inspire, educate and fuel your dance journey.

LINK TO EPISODES


We hope you find all of this useful and will help answer some of the questions you have or anxiety about returning to dance and the studio. We are still running the ‘Ask SiDI’ programme so please do send us any questions and we will answer them, or refer you to someone who can.

Stay safe and best wishes
The SiDI Team

#ASKSiDI

#ASKSiDI QUESTION:
I’ve been applying my state’s guidelines for gatherings at gyms…which still allows only one-on-one training. I have a 400 sq ft studio and 8 students plus myself in there. Is it advisable to go back to the studio yet for classes? We do have the option of opening a window. #AskSiDI

ANSWER:
At the moment there is a wide range of different advice being collated around the world. Of course the first thing that anyone needs to do is to follow state or country specific guidance. We are currently collating information including links and resources that we hope will be helpful as many people are asking the same question as you. Of course advice could change rapidly as the virus is unpredictable. Watch out for our post in a short while. Please sign up to our newsletter for up to date information. We will also be linking to some useful dance specific guidance on social media.

NEWSLETTER MARCH 2020

Dear friends and colleagues around the world

At this time when so much in our lives is changing and we are all experiencing a new world existence, we at SiDI send you our love and thoughts.

The threat of transmitting the Covid-19 virus is increasing daily worldwide. The governments of individual countries are providing direction on how to minimise the likelihood of infection and all independent dance schools, training institutions, teachers, choreographers, managers and dancers have been familiarising themselves with the general guidelines and trying to stay abreast of the public health announcements in their own locations.  For most of us, live dance activities have already been reduced or stopped, with many consequences for training and employment.

We have heard from some of our colleagues around the world and it’s become clear that whilst some countries have national dance and arts organisations who are providing excellent recommendations at this time, such advice is not available everywhere.  We’ve included some valuable links to our partners below, along with messages from other national and international dance and arts organisations, all of whom are releasing information to support dance practitioners. Please do keep checking these websites for further advice, which is continually being updated.  We’ve also added links to some interesting articles.

Online dance classes: “I used to dance around my living room…” (A Chorus Line)

Over the past couple of weeks we have seen a sharp rise in the provision of classes online and this is only going to increase. SiDI has developed some thoughts and guidance regarding dancing and teaching in this way, which we’ll share through our newsletter and social media platforms in the next few days, so please look out for these.

Stay well everyone.

Maggie, Sonia, Matthew, Pippa and all The SiDI Team

 

 

Useful Websites and Guidance about Covid-19

Dance Related

International Association for Dance Medicine & Science (IADMS):
https://bit.ly/3blwuOr

Healthy Dancer Canada circulating this advice:
http://bit.ly/2TUf31r

Council For Dance Drama and Musical Theatre (CDMT):
https://bit.ly/2xeT4JG

One Dance UK:
https://bit.ly/2UrQWGz

People Dancing:
http://bit.ly/3d0ybCh

Other Dance Resources:

Dance Magazine:
http://bit.ly/3aTvSiw

Dance USA:
http://bit.ly/2IOdr2T

General

World Health Organisation: 
http://bit.ly/2x1r6kI

Centres for Disease Control and Protection: 
http://bit.ly/38WQWmR

#TopTipTuesday

Rest…

Are you over pressured by exams, rehearsals and performances? trying to get the best out of yourself or your dancers?  Remember it is important to rest as well as work hard –

There is often pressure to do as much as we can to become more proficient dancers but more is not always better. Are you aware of the difference between overload and overtraining or overwork? Overload is a positive training principle, which means gradually challenging the dancer so that they can develop the physical capacities to dance efficiently and effectively. Overwork or overtraining is a negative consequence of training schedules that are too full and demanding, coupled with lack of rest and recovery. It will actually result in the dancer’s performance becoming less effective. Yes, work hard but rest too!

Audition and Performance Anxiety

The first three months of the year can mean only one thing for dance students, auditions for summer intensives, for stage shows, dance projects and for small and large dance companies.  Every weekend of last month and the coming two months are packed with auditions.  I wonder how many dancers, including you have packed in as many auditions over the past weekends as is humanly, or even beyond humanly possible?

Why do we do this? Fear of losing out?  Fear of not getting to the Summer Intensive, company or show that’s favourite? Fear of not going where other dancing friends are going? Fear of failure? Fear of rejection? Fear, fear, fear.

Fear is the operative word here and because many of the situations we find ourselves in are not actually life threatening it can be useful to remember this phrase:

False

Evidence

Appearing

Real

Anxiety is linked with fear and is part of the ‘Fight and Flight’ system that helps us deal with dangerous situations it’s linked with our most ancient survival instincts.

Anxiety increases your awareness to enable you to be prepared for the unknown, making you hyper-alert and focused.  Adrenalin floods into your system to help you run or fight, your heart pounds, you feel agitated and your stomach’s filled with butterflies.  This is, in general terms, how anxiety affects us although we all respond in different ways.

Remember, anxiety isn’t always detrimental, apprehension and excitement have their roots in the adrenaline rush.

If you’ve grown up with an anxious family background, you’re more likely to be susceptible to situational or even chronic anxiety.  Situational anxiety is based only on a single event, even if that situation reoccurs occasionally. Chronic anxiety will have been constant for more than 6 months, it seriously interferes with a person’s life.  Situational anxiety can become chronic if not dealt with.

Self-talk is often a factor in anxiety,  “I’m not good enough,”  “I’m not thin enough,” “(s)he’s better than me,” “I’m not tall enough, I’m ugly,”. The vital thing to remind yourself is that we’re all unique.

Go into an audition telling yourself that you’ll do your very best. Knowing that the artistic director/choreographer is looking for a specific type of dancer and it has nothing to do with your own talent if you’re not chosen, will help you feel more at ease. Artistic directors and choreographers are fickle people, so don’t worry if you don’t get in, it probably wasn’t right for you.  Remember you are the most important person in your life, look after yourself.

Do not compare yourself with anyone else.  Now write 100 lines…………

Speaking of writing, write down your intentions of what you want in the next year.  Write it in positive terms, so don’t write “I don’t want….etc., only write what you want.

Also, on a practical note, only go for the auditions that you know you want and the ones you know that you can attain the standard that they are looking for, your time and energy are limited, use them wisely.

Preparing for the audition:

Visualisations work well when rehearsing or practising aspects of dance that you find difficult. Close your eyes, visualise yourself actually dancing whatever you want to improve on.  What you visualise must be what you want it too look like – you doing it perfectly.  Do this over and over again as if you are in rehearsal or class.  Every time you imagine yourself doing it perfectly, turns perfect, balances perfect, jumps and batterie perfect.  Do the visualisations on the bus, train and before going to sleep. No physical energy is expended but your brain is getting you used to  dancing that piece perfectly.  Then your mind and body work together when you actually get to dance it.

Good luck with your auditions.

Terry Hyde MA MBACP

 

www.counsellingfordancers.com

Facebook and Instagram

@counsellingfordancers

Twitter

@counselingdance

 

Terry Hyde MA MBACP

Psychotherapist/counsellor

Terry started dancing at age 6, joining the Royal Ballet age 18.  He moved to London’s Festival Ballet (now ENB) as a soloist and performed in West End musicals, Film and TV.

Terry attained an MA in Psychotherapy validated by Middlesex University in 2012 and in 2017 set up the website www.counsellingfordancers.com, specifically to address the mental health needs of dancers.

Terry is in a unique position to understand the mental health needs of dancers and uses that, not only in his one to one therapy sessions, but also in his mental health self-care workshops.

First delivery of ISTD/SiDI collaborative Dance Science Unit

SiDI Registered Provider (RP)  Janine Bryant stepped in to deliver the ISTD Unit on Dance Science in August.  This unit has been written by Erin Sanchez (also a SiDI RP) on behalf of Safe in Dance International and the ISTD. The Unit, part of the ISTD level 6 teaching qualification, covers all of Safe in Dance International’s 10 Core Principles.  Janine travelled from her base in Pennsylvania to deliver the unit in London.  Kath Bye from the ISTD’s Education and Training Department said: “Janine’s lectures were insightful, dynamic and clear for the learners to understand. Janine’s approach looked at the important principles of Dance Science in particular looking at Safe Dance Practice core principles and ensuring that the learners were given the opportunity to explore topics that related to their own dance practice.”

Earlier this year Co-Founders of SiDI Maggie Morris and Sonia Rafferty delivered three separate tutor training days to the ISTD tutors delivering their Safe Practice Unit for their new Level 4 teaching qualification.

We are looking forward to continuing this positive collaborative partnership with the ISTD.

Janine and students from the ISTD

Spreading the word: The contribution of the dance floor in creating a safe environment for performing arts. By Mark Rasmussen

Mark Rasmussen and the Scottish Ballet

Harlequin Floors’ Mark Rasmussen is a familiar and friendly face at global performing arts events where he regularly lectures and advises architects, school administrators, local government, unions and teachers about creating a safe environment for dance and performing arts.

In his article below for SiDI, he answers some key questions and outlines the advice he gives to the dance world about the important role the floor has in contributing to safe practice.

Is it difficult to lecture and advise when you’re also representing a commercial organisation?

Not at all, Harlequin work closely with our friends such as you guys at Safe in Dance International, One Dance UK’s Healthier Dancer team and the wider international dancers’ health community to ensure that the advice we give is backed both by the latest research and, just as important, supported by health professionals who look after the needs of injured artists.

It’s also vital that our advice is neutral in tone as the people I’m presenting to are professionals who want information, not a sales pitch! It’s my job, even in a short presentation, to deliver some important “take home points” which enables people to ask the right questions when they find themselves in the position of specifying a space for dance, drama or musical theatre.

What sort of “take home points” do you give?

Initially, I point out the requirements for a space focusing on everything from ceiling height, barres, mirrors (including the arguments for and against), suitable sound systems and then, not surprisingly, floors. Various studies have shown that the wrong kind of floor is an injury risk and so, with current research highlighting that the majority of dance injuries are from overuse, a floor providing the right amount of force reduction is a vital contribution to the long-term health of the performer, student or teacher.

We put great emphasis on consistent force reduction rather the “trampoline effect”. Force reduction is key and we work from around 60% up to 70%. If you imagine how often a dancer will jump (or otherwise impact the floor) in their career, that level of force reduction will reduce the risk of impact injuries such as shin splints and stress fractures.

My second point is that floors for performing arts, particularly dance, and floors designed for sport, are not the same. Sadly, some architects, school managers and producers don’t know there are big differences between a sprung floor for performing arts and, say, a basketball court. This problem can be even harder to address when some floor manufacturers will confuse the market by taking products “suitable for sport”, and then, almost as an afterthought, adding “and dance”.

What isthe difference between sports floors and floors for dance?

In a nutshell, floors for sport tend to be harder or stiffer than floors for dance. They need to be because sports floors are designed to give adequate “ball bounce”, in fact “ball bounce” is one of the standard tests for a sports floor, a requirement that is irrelevant to dancers and performers.

According to Sport England surfaces designed for sports can be found with force reduction as little as 25% or less and still be considered suitable for single sports applications (e.g. Tennis and Bowls) although such hard floors do fall outside the standard which starts at >25%.

Even when a floor designed for sports is properly sprung, DIN standards start at around 46%, which is still too hard compared to the softer 60-70% I mentioned earlier.

In sport, the impact of harder or stiffer floors is offset because most users of sports floors are supported by cushioned footwear whilst performers regularly rehearse and perform in bare feet, socks, ballet or character shoes which don’t offer any protection at all.

What other points do you make when you present?

A floor needs to be consistent with a force reduction variation of no more than +/- 5%. Dr Luke Hopper and his colleagues have researched force reduction variation – he tested a stage floor where a company was experiencing greater than usual injuries and found that, depending on where you landed on the stage, the force reduction could vary between slightly above 20% to around 60%. “This creates a problem biomechanically for the dancer” he explains, because the performer is pre-stressing their body to what they expect the surface to be”. I like to use the analogy of what happens when you land and you were expecting feathers and hitting concrete instead, which will send the shock of impact through your lower body.

Finally, I help to explain what the different types of sprung floors and vinyl performance surfaces are, and why you would specify one over another. For example, some vinyl surfaces have a cushioned foam backing which makes the floor more forgiving to the elbows and knees of contemporary or street dancers with their rigorous floor work, but that same cushioning will dampen the sound if used for percussive dance such as tap, flamenco and Irish dance.

Classical dancers tend to divide between the two surfaces with some preferring a cushioned surface and some preferring a floor without so we encourage companies to either test a sample first or visit some of our previous installations.

 

For further information, you can connect with Mark on LinkedIn www.linkedin.com/in/mark-rasmussen-ukor find details of your local team at www.harlequinfloors.com

 

References

https://www.sportengland.org/media/4553/floors-for-indoor-sports.pdf

Hopper, L.S., Allen, N., Wyon, M., Alderson, J.A., Elliot, B.C. & Ackland, T.R.  (2014). Dance floor mechanical properties and dancer injuries in a touring professional ballet company. J Sci Med Sp, Jan, 17 (1), 29-33.

 

Building Healthy Boundaries in Creative Processes

This article by Stuart Waters, covers some important questions that are being posed about the safeguarding of the dance artist, most specifically within the pressures and demands of the creative process. The article was originally commissioned by Disability Arts Online,  www.disabilityarts.online.

Stuart Waters is a UK based performer, choreographer and teacher who recently presented at the Once Dance UK Healthier Dancer Conference held at TrinityLaban Conservatoire of Music and Dance (November 2017). His session “Mental Health and Issue-based Work” proposed the development of support mechanisms for dancers when using emotional triggers in the creative process.

” Safeguarding the artist, the studio and the creative process” by Stuart Waters

Photo: Joe Armitage

My personal “rock bottom” was a near death experience, ironically, when I was at the peak of my dance performance career. It was a period of 35 days in ICU and 8 months recovery, during which my new dance theatre piece, ROCKBOTTOM, was born.

But I am not alone, and I challenge us to consider mental health in the dance sector. Are people working with awareness, balance and wellbeing or do people work to the point they feel stressed, demoralised and emotional? Are dance works devised with compassion or by harvesting personal experiences in an exploitative manner?

At a time when mainstream media discusses mental health, it is also time to examine what we expect from our dance artists in the 21st century and how they are treated in the name of art. How does the artist find time to do excel professionally and look after their mental health?

As I approached my “rock bottom”, my vulnerability was being used as a theatrical tool for authentic moments in creation and performance. I was peaking professionally but imploding as an individual. As I experienced the extreme highs and lows of creation and touring, I became increasingly vulnerable as a member of society. When I returned from tours I felt an emptiness. Over time this led to increased feelings of isolation, loneliness, anxiety and bursts of depression. I turned to unhealthy coping mechanisms in order to deal with the growing confusing feelings that were rising inside me. You could argue this lead to additive and self-harming behaviours that only made everything worse.

But whose responsibility was my safety? Was it mine? The choreographer’s? The office staff? My colleagues?

Why was it so hard to discover my illness then to disclose my struggle to my employers, especially when we were working so closely and intimately and knew each other well? Then when I did disclose my situation, even though they worked hard to support me, why didn’t it work? Ultimately, how could the worst have been prevented?

Why do we need and want vulnerability from artists? What does it achieve and how? Does it create great art or are dancers needlessly suffering because the choreographers don’t have the skills to get that material any other way? Is the cost of these explorations worth it?

In January 2017 I began exploring these questions creatively when ROCKBOTTOM gained Research and Development funding from Arts Council England. I wanted to use my experiences, but I knew it would be an emotional process, diving head first into vulnerability as I revisited what had happened. How would I keep both myself and my collaborators safe?

I developed a safe guarding model to protect our emotional and mental well being during creation, curious to see if these measures resulted in a deeper exploration, enabling us to safely push the boundaries. These included:

  1. Skype sessions with a therapist to support trigger moments and overwhelming anxiety. We were surprised by how much we were triggered so this was a private and safe way for us to gather fresh perspective without being consumed or creating anxiety in each other.
  2. Each day began and ended with a “check in” and “check out” that helped us understand where we were emotionally, strengthening the sense we were held in a safe space. Every rehearsal finished with reflection and meditation together. This became invaluable as it gave us closure on the emotions that had been ignited through the day, enabling us to leave the work in the studio and not be haunted by it when we were alone.
  3. Selecting and editing our stories so we could choose when truth needed to bend and flex to serve the art and keep us safe.
  4. Some creation took place in retreat like environment, deep in the countryside. Free from traffic jams and in a protective bubble we felt private and safe to re-visit trauma in a productive way.

Now Arts Council England is funding the creation of ROCKBOTTOM. The strategies I initially devised have been developed further and the choreographic process feels empowering, with a light feeling that is joyful, clear, honest and safe. It has informed the participation sessions I lead, creating an empowering approach that evokes profound responses in participants that surprise everyone with their clarity and revelations.

Far from compromising the quality of the art work I am creating, working with compassion is enabling us to reach depths I never thought was possible. I am proving you can keep artists safe whilst creating great art that is thought provoking and at times shocking. I now want the dance industry to join me, and pledge to:

  • Develop and embed protocols for safeguarding emotional and mental well being in artists
  • Value maintaining good mental health on a par with maintaining good physical health
  • Ensure dancers have awareness and skills to do this through training and support
  • Interrogate how dance work is created and challenge when methodology is exploitative
  • Develop communication between dancers and organisations/directors and ease the fear of being replaced if you are honest about a difficulty
  • For dancers to feel its ok to say no; to be able to say “I’m not in the right place for this today”

Some of these changes are small and simple but have an impact on the working atmosphere, happiness and well being of an artist. If I can put these alterations into my art then so can large companies and organisation. Together we can evolve with the times and be a better inclusive place. Art is a great platform for this and dance could lead the way.

For more information about Stuart and Rock Bottom please go to: https://www.facebook.com/rockbottomdancetheatre/

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.