coping with dance injuries

The web and social media can be wonderful places to get information – facts and news are able to be shared shared quickly and easily. Unfortunately, the same things that make these areas great for spreading information can also have a drawback. Too often something can get passed along without context, which can change the entire meaning…or information can be widely shared that may not have a solid foundation underneath it.

In the coming months our Dance Wellness team will be putting together some solid guidelines for readers on how to go about evaluating dance medicine and dance wellness information on the Internet. They will share specifics on what to look for when searching for, and reading dance wellness info on the web.

We’ll also be compiling and sharing a list of reputable sites that you can go to for information in this field.

In the meantime, our Dance Wellness editor, Jan Dunn, wanted to address some recent information that has been circulating around on social media about the use of ice for dance injuries to make sure that dancers know that indeed, the ice pack is still a useful tool!

by Jan Dunn, MS

This post is in response to discussions I recently became aware of online (primarily on Facebook) regarding the use of ice in treating injuries. Respected dance educators were advocating throwing away the ice pack, despite the many years where RICE (Rest / Ice / Compression / Elevation) has been advised, or more recently PRICE (Protection / Rest / Ice / Compression / Elevation).

I was not aware of any discussions, presentations, or articles on this topic in the dance wellness field – and so was cautious / skeptical, since some of what is seen or posted online is not necessarily true – or is not in line with current scientific / medical protocols. I started doing some research, and checking with various experts in dance medicine – including members of the 4dancers.org Dance Wellness Panel: James Garrick, MD; Moira McCormack, PT; Selina Shah, MD; Matt Wyon, PhD; Janice Plastino, PhD; Robin Kish, MA; Gigi Berardi, PhD; Emma Redding, PhD; Erin Sanchez, MS; and Nancy Wozny.

And what I learned is — well, please don’t jump on this particular bandwagon and throw away your ice packs!

Some basics

Ice can clearly be overused, and when it is, it’s not good. It can damage the tissue it’s meant to be helping if it’s kept on too long. It is usually advised the first 48-72 hours after an acute injury (like an ankle sprain). Some of the sites online are advising not using ice at all are saying that because inflammation is the body’s way of healing, and they imply that to use ice is to stop inflammation. But ice treats the symptoms of inflammation, it doesn’t get rid of it. Ice and compression (more on that in a moment) can reduce the amount of initial swelling –which speeds the healing process– and this is the whole point of post-injury care.

Why Ice Can Be Helpful

Ice is also very useful for helping decrease pain levels –another major symptom of inflammation. So another good reason not to throw away that ice pack.

There is also the issue of “secondary hypoxic injury” – this refers to tissue not damaged by the primary injury (such as the ligaments directly affected by an ankle sprain), but nearby, which can become damaged as a direct consequence of the physiologic response to the primary injury. Ice can slow down these metabolic processes and therefore save some tissue.

How to Use Ice

When you do use ice, go for at least 10 – 15 min. on a new injury (or until the area is numb, which vary slightly depending on how muscular or bony the area is), allowing at least 20 min. before re-applying. Try to go for at least 5 min. minimum on not-so-new areas, if you can’t do the full 10-15.* You have to also always be sure you have something between you and the ice itself – most icepacks come with a fabric covering, and that works fine. You just don’t want to put ice directly on the skin, without something to protect it (think “freezer burn”!). Never use heat on a new injury.

Compression

Now, let’s briefly go over Compression. Most people interpret this as (for example) wrapping an Ace bandage around a sprained ankle. Yes, all well and good – but, as Dr. James Garrick, MD (one of the founders of both the sports medicine and dance medicine fields) points out:

“The ‘hollowed out’ areas posterior (behind) the malleoli (ankle bones, on both inside and outside of the joint) and anterior (in front of) will have NO compression at all (with an Ace bandage), and those structures (the ligaments that were actually injured) will actually be encouraged to swell more.”

What is needed instead is focal compression (directly on those “hollowed out” areas)—which moves the bleeding away from the areas injured. Dr. Garrick gave the example of a dancer whose sprained ankle was treated with this protocol, and “the ankle actually looks like an ankle, not the polish sausage one sees if just an elastic wrap is used.” He noted that this dancer was able to walk with nearly full ankle motion 24 hours after the injury.

Some of the dance medicine medical and scientific colleagues (and non-dance as well) whom I contacted on this Ice / No Ice question, gave some pertinent thoughts that are worth passing on:

“There is no research that counters the practice of using ice to reduce swelling. On the contrary, there are studies that do show the benefits of ice as well as NSAIDS. Not using ice is not standard of care in sports medicine, and I don’t know of any research in dance medicine.” (orthopedic MD who specializes in sports and dance medicine).

“The articles being referenced (in some online sites advocating no ice) need to be referenced to determine their quality – most research in this area is pretty poor. I am also a great believer in using our years of clinical experience (on the beneficial aspects of using ice)”. ( PhD researcher in Sports Physiotherapy).

“Until I see some really solid physiological studies, over time, that ice is detrimental and actually damages the tissues, I will continue to use it as part of my treatment protocols.” (long-time sports medicine physical therapist).

So in conclusion – I hope this article / advice from dance (and sports) medicine experts (who keep up with the latest research) will help clarify this for you, and as I said at beginning – please don’t throw away your ice packs!

Happy Nutcracker and Holiday Season! – Jan Dunn, MS, Dance Wellness Editor

*Please note that this time has been adjusted from the recommendation of 5 minutes, along with a clarification to make it more applicable to a variety of injuries

Editor Jan Dunn is a dance medicine specialist currently based on the island of Kauai, Hawaii, where she is owner of Pilates Plus Kauai Wellness Center and co-founder of Kauai Dance Medicine. She is also a Pilates rehabilitation specialist and Franklin Educator. A lifelong dancer / choreographer, she spent many years as university dance faculty, most recently as Adjunct Faculty, University of Colorado Dept. of Theatre and Dance. Her 28 year background in dance medicine includes 23 years with the International Association of Dance Medicine and Science (IADMS) – as Board member / President / Executive Director – founding Denver Dance Medicine Associates, and establishing two university Dance Wellness Programs

Jan served as organizer and Co-Chair, International Dance Medicine Conference, Taiwan 2004, and was founding chair of the National Dance Association’s (USA) Committee on Dance Science and Medicine, 1989-1993. She 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 for medical / dance and academic institutions in the USA / Europe / Middle East / and Asia, authored numerous articles in the field, and presented at many national and international conferences.

Ms. Dunn writes about dance wellness for 4dancers and also brings in voices from the dance wellness/dance medicine field to share their expertise with readers.

by Emily Kate Long

Last month’s “Finding Balance” explored the relationships among dancer identity, passion for dance, injury, and age. A month after writing that column, I can’t get away from the topic—it utterly fascinates and confounds me. I was directed by a friend to a widely cited study by Linda Hamilton (American Journal of Sports Medicine, March 1989) titled “Personality, Stress, and Injuries in Professional Ballet Dancers.” In it, Hamilton states:

“[The] dancer must possess extraordinary dedication, a limitless capacity for hard work, and the ability to persevere through more or less continual pain, in addition to having a specific body type and talent….[The] personality traits that are programmed into success in this profession may ultimately prove detrimental to those dancers who have not learned to work within the natural limitations of their bodies.”

The italicization of that last phrase is my own—is that the key to balance between doing our best and doing too much? How can we push ourselves hard enough that we achieve highly without letting those “success traits” run so rampant as to destroy us? How do we learn what our natural limitations are? How can we expand them?

Hamilton’s statement compelled me to seek out dancers I admire and view as highly self-driven, and ask them to weigh in on the subject of coping with and learning from injuries. Of those I contacted, three dancers were able to contribute to this article. My utmost thanks go out to them for taking the time to answer my questions candidly and thoughtfully.

Jeanette Hanley was a Leading Artist with Milwaukee Ballet when I was in the second company there. Her dancing and her spirit and her enthusiasm made a great impression on me—I never saw her get injured or upset, and her energy and motivation seemed endless. She was like superwoman, or the energizer bunny. She has since retired from dancing, but I still think of her as a role model. I decided to get in touch with her for this article to discover what strategies kept her going throughout her 21-year dancing career, and how she felt about retirement. She shared with me that her love of yoga and going to the gym made it easy to stay in good physical shape during layoffs, and that she never had trouble with injuries while she was dancing. With the birth of her daughter, healthy diet and exercise got her going again. Now that she’s retired, it has been helpful to have a new line of work that she loves. Always learning, Jeanette also takes karate with her daughter, and they will both be receiving black belts in the fall.

Katie Rideout and I attended Milwaukee Ballet School’s summer intensive in 2007 and spent two years together in Milwaukee Ballet II, 2007-2009. Katie has struggled with lower leg injuries as long as I’ve known her. In November 2011, after dealing with intense pain in her tibia for almost two years, she made the choice to take a break from dancing and finish her Bachelor’s degree from Point Park University. She later found out she had been dancing on two stress fractures. During her recovery period she struggled most with making decisions independently of a career-oriented framework. Addressing the reality of her injury –its severity was a direct result of overuse and denial—forced Katie to begin freeing herself from obsessive passion for dance in order to return to dancing and avoid re-injury. This, in turn, allowed her to establish new training habits: integration of Pilates work and a focus on technical efficiency rather than an exclusively aesthetic aim. Finishing her undergraduate degree also gave her another aspect of her person to cultivate: an understanding and exercise of her intellect, measured separately from dance achievements.

My good friend Jason Wang tore his Achilles’ tendon on August 30, 2011 and underwent surgery to repair it three days later. Naturally a planner, he, like Katie, found one of the greatest challenges in his recovery to be the uncertain timeframe and absence of a familiar “roadmap” in his decision-making process. The stillness that was necessary while waiting for doctors’ orders quickly degraded to depression; Jason felt he had been “stripped from [his] lifestyle without [his] own consent.” Also significant for Jason was the difference in coping with this long-term injury versus the short-term ones he had previously sustained: “…sitting and watching dancers do what I loved for weeks on end made me extremely stressed and depressed….[If] you’re not clear and sound in your mind then your physical side will become its collateral.” He felt it was important to step back and take time to clear his mind before deciding how to approach re-entry into the dance world.

I consider Jason, Katie, and Jeanette all to be high achievers. Pushing themselves to the limit and beyond just seems like a natural thing for them. However, in Katie’s case, pushing led to chronic injury. In Jason’s case, his inability to work led to feelings of uncertainty, depression, and isolation. Jeanette, however, was able to push herself through a two-decade career without major setbacks caused by injury. What’s her secret?

Could it be than Jeanette is simply older and wiser?

I recall another of Milwaukee Ballet’s leading artists telling me once that the time she spent in Boston Ballet II was the hardest of her life. Perhaps the more time we spend with ourselves, and the more adversity we face, the more we can come to understand that one of the “natural limitations of [our] bodies” is our very own psyche.

Readers, what dance-related experiences have forced you to face your inner demons and come out on top?

Contributor Emily Kate Long began her dance education in South Bend, Indiana, with Kimmary Williams and Jacob Rice and graduated in 2007 from Pittsburgh Ballet Theatre School’s Schenley Program. Ms Long attended Milwaukee Ballet School’s Summer Intensive on scholarship before being invited to join Milwaukee Ballet II in 2007. She also has spent summers studying at Saratoga Summer Dance Intensive, Miami City Ballet, Pittsburgh Ballet Theatre School, Pittsburgh Youth Ballet, and Ballet Chicago.

Ms Long has been a member of Ballet Quad Cities since 2009. She has danced featured roles in Deanna Carter’s Ash to Glass and Dracula, participated in the company’s 2010 tour to New York City, and most recently performed the title role in Courtney Lyon’s Cinderella and the role of Clara in The Nutcracker. Prior to joining Ballet Quad Cities Ms Long performed with Milwaukee Ballet and MBII in Michael Pink’s The Nutcracker and Candide Overture, Petipa’s The Sleeping Beauty and La Bayadére, Balanchine’s Who Cares?, Bournonville’s Flower Festival in Genzano and Napoli, and original contemporary and neoclassical works by Tom Teague, Denis Malinkine, Rolando Yanes, and Petr Zaharadnicek.

Dance Injuries – About That Ice Pack…

Some basics

Why Ice Can Be Helpful

How to Use Ice

Compression

Finding Balance: Dancers On Coping With Injury

Some basics

Why Ice Can Be Helpful

How to Use Ice

Compression

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