Keeping Dancers Dancing: “Help I Have An Injury – What Do I Do?”

by Jan Dunn, MS

So you have a dance injury?  What do you do….????

Last month we covered the various causes of dance injuries, and I’m hoping that information is helping you to stay injury-free.  But hey, it can still happen, despite our best preventative efforts. So, the next piece is knowing what do if / when an injury occurs.

1. First off, you have to be sure you recognize that it IS an injury….i.e, knowing the difference between “good” and “bad” pain.  This may sound like first-grade language (it is), but it’s the easiest way to understanding the signals your body may be giving you:

-“good” pain is the discomfort we feel when we are doing a new activity our body is not used to, like taking a jazz dance class for the very first time, when all your training has been ballet.  It’s the normal response of our muscles / joints to the new movements, and is characterized by:

-a dull aching discomfort (not what we usually call ‘pain”) which is wide-spread through the body area you were using in a new way. For example, in a jazz class you use the ribs / pelvis in very specific non-balletic movements, and the next day you may feel over-all sore in those areas.

-“bad” pain is when your body is saying very clearly “STOP!  I am HURT!”, and  is characterized by:

-pain in a very specific place, much more localized than the discomfort described above.  It may be in that one spot constantly, or only when you use the body part / joint in a specific way.  It is usually a sharper type of pain than the “good”kind, but the key point is that it’s NOT wide-spread, but much more in one place.

2. Ok, so you’ve recognized that you have a “bad” pain, an injury —what do you do?  The very first step is often abbreviated as PRICED (we used to say “RICE”, but you’ll see below where the “P” is now added in:

-P = Protection: Protect the injured area from additional harm. Stop dancing, and remove yourself to the side of the studio.

-R = Rest the injured area —-don’t dance on it!  This is HARD for dancers to do, but so necessary, to aid in the healing process.

-I = Ice.  NEVER heat in the first stages (the “acute” phase) of an injury. Ice helps to decrease the swelling, which helps to decrease the pain, and helps speed up the healing process.  Heat early on can actually be detrimental to the injured area, increasing the swelling and slowing down the healing time. Points to remember when using ice are:

-on soft tissue (muscles), recommendations vary, but a good suggestion is either 20 min. every two hours, or 8-10 minutes every hour. A good guideline is to ice until the area feels numb to the touch.

-on bony areas, like ankle / elbow, usually about 5 minutes –or again, until it is numb.

-If the ice pack does not have a built-in fabric or protective coating (many do), be sure to put a lightweight cloth between you and the ice —i.e, never directly on your skin (it can cause an “ice burn”).

-C =Compression, usually with an Ace wrap. This is most useful with a limb injury, although ribs / hips can also wrapped.  The pressure from the bandage / wrap  helps to decrease the swelling and to speed up the healing process.  An important side note regarding Ace bandages that are pre-shaped for the knee / ankle, etc.:

These are designed for compression, not for support.  Dancers often put these on thinking it will offer support for a “bad” knee / sprained ankle, etc.  It doesn’t; if you have an injury which needs support, it needs to be professionally taped (with athletic tape).  The elastic knee / ankle variety are useful for compression only.

-E = Elevation.  This is for limb injuries, and the idea to is elevate the leg / arm above heart level.  This slows down the swelling, and helps the healing process.

-D = Diagnosis by a medical professional, if called for (see below).

Have you noticed a couple of common factors here?  1) decrease swelling, and 2) aid in  the healing process, are the two main things you may picked out.  The physiology of injuries / healing is complex and we won’t go into that —but the main thing to remember is that you want to keep the swelling down, because that will help overall for the injury to get better faster.

3. Your next question might well be: When do I seek professional medical help?  Here are some guidelines:

Any acute injury should be looked at by a professional, especially if it involves:

-immediate swelling or bruising

-joint pain such as in knee / ankle

-significant pain

-loss of function / inability to bear weight

-neurological symptoms / change of mental status

-obvious deformity

-uncontrolled bleeding

-no obvious improvement after 48 to 72 hours of doing the PRICE therapy

Other guidelines for when to seek medical help are:

-swelling that comes and goes with activity, even if there is no pain

-sharp pain that comes and goes with specific activity

-any injury that is being properly cared for (PRICED) and is not improving after a weeks’ time, or is getting worse.

4. Ok, so you know you need to see a medical professional – your next question is an important one:  Who do I go to ???  Here are some recommendations:

-your first choice should be someone who works with dancers /  is familiar with dance, whether this is an MD, PT, DC, or another healthcare practitioner.  An MD who is a Physiatrist (listed as Physical Medicine and Rehabilitation in phone directories) is often a good choice – these are non-surgical musculoskeletal specialists.

Most major US cities now have dance medicine practitioners; some examples:

-Harkness Center for Dance Injuries (New York City)

-Westside Dance Physical Therapy (New York City)

-Cedars Sinai / USC Dance Medicine Center (Los Angeles)

-Denver Dance Medicine Associates (Denver / Boulder, CO)

These are just a few examples; there are many individual practitioners as well, in addition to groups such as those listed above.  Many dancers and teachers are members of IADMS, which has been mentioned before in this column – the International Association for Dance Medicine and Science.  Becoming a member enables you to access the on-line membership list, where hundreds of dance medicine medical specialists are listed.  Other benefits of membership include access to discussion forums, and a subscription to the Journal of Dance Medicine and Science, as well as discounted conference fees.

-If you are unable to find a dance medicine specialist in your area, your next best choice would be a sports medicine practitioner, who would be familiar with athletes (and dancers are high level athletes!)

And in conclusion:

An important piece to remember about being injured / seeking help:

Resting the injured body part is clearly crucial to a fast recovery and return to full-out dancing. That DOESN’T mean that you automatically rest the whole body and do nothing for six weeks, while your sprained ankle is getting better.  Keep everything else in good shape!  Otherwise you are setting yourself up to injure something else, when you return to dance. You can do so much during the healing period, such as:

-limited class work, depending on the injury / what is recommended medically

-floor barre (a GREAT way to stay in shape while non-bearing weight)

-Pilates (also terrific for injured dancers — and non injured!)

There are of course more ways to keep in shape than just those listed above, but whatever you choose – DO IT !

So – now you hopefully have more information on “Help! What do I do now?” than you did at the start of this article.  Till next month — keep dancing (safely!)!!

PS: IADMS has an excellent Resource Paper on First Aid for Dancers, available on line at www.iadms.org

BIO: Jan Dunn is a dance medicine / Pilates / Franklin Method specialist  based in Denver / Boulder, CO, and Los Angeles, CA.  She is Co-Director of Denver Dance Medicine Associates, and Adjunct Professor, University of Colorado – Boulder, Dept. of Theatre and Dance.  She has been active in Dance Medicine since 1984. Previously she was Coordinator of The Dance Wellness Lab, Dept. of Theater & Dance, Loyola Marymount University, Los Angeles, CA , and has held dance faculty positions at Connecticut College, Florida State University, Hartford Ballet, Washington Ballet, and Colorado Ballet.  She has been active with the International Association of Dance Medicine and Science (IADMS) for 22 years, serving as Board member, President, and Executive Director. Jan was Associate Dean / Workshop Coordinator at the American Dance Festival 1983 – 1991,  originated The Dance Medicine/Science Resource Guide; and was co-founder of the Journal of Dance Medicine & Science.  She has taught dance medicine, Pilates, and Franklin workshops worldwide, has published numerous articles, and presented at many US / international conferences.