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.