RICE is at least 10 years out of date!

The RICE (or RICED; rest, ice, compression, elevation, diagnosis) method for injury management has been advised against in the research & academic settings since at least 2010. In early 2019 I wrote an article about a more up to date method, “do no H.A.R.M” (no heat, no alcohol, no reinjury, no massage). But there’s been even newer suggestions on how to remember to manage injuries!

What’s wrong with RICE?

RICE ignores that there are different phases of healing, and implies that passive modalities (rest, ice, compression, and elevation) are of utmost importance to healing. While we need rest in the very early phases of any injury, we know from decades of research that getting back to movement as early as possible is key to better recovery. And re-loading an injured area is what ultimately makes it stronger and restores it capacity – not resting it!

There has also been some research suggesting that icing could delay tissue repair because it could decrease inflammation.Inflammation is CRUCIAL in the early stages of tissue healing – this is what brings in all the white blood cells to clean things up! It is especially important to avoid taking anti-inflammatories in the first 48-72 hours after injury.Professional performers may also consider avoiding ice. Even if this blunts inflammation only slightly in comparison to anti-inflammatory drugs, professional dancers often need to return to work quickly. Anything that could speed recovery could therefore be worth considering.

A new alternative: PEACE and LOVE

A paper that came out in 2019 (Dubois & Esculier) suggested PEACE & LOVE as an alternative to optimise recovery.

P is for Protect

E is for Elevate

A is for Avoid Anti-inflammatory Modalities

C is for Compress

E is for Educate

L is for Load

O is for Optimism

V is for Vascularisation

E is for Exercise

Let’s learn what these mean!

P if for Protect

In the first 1-3 days, minimise movement that could further cause injury, BUT rest should be minimised

E is for Elevate

Elevate the limb higher than the heart. There is weak evidence that this helps, but it won’t cause harm

A is for Avoid Anti-inflammatory Modalities

Definitely avoid anti-inflammatory drugs in the first few days. The use of ice is questioned and cautioned because it could also disrupt inflammation – which is crucial to healing!

C is for Compress

There is conflicting evidence, but taping or bandaging does seem to offer some benefits to our ability to function

E is for Educate

Health care providers should let you know that an active approach (actual rehab, not just things that feel good) is what you need to recover, and help you have realistic expectations for recovery

L is for Load

Putting weight on the injured part or doing strength exercises should be introduced early, as soon as symptoms allow. This promotes repair & remodeling of damaged tissue, and builds capacity – so you can do the things you used to!

O is for Optimism

Patients who are optimistic have better outcomes. From pain science we know that distress and negative feelings (or anything that makes us feel in danger) can increase pain. I know it can be hard, but trust that your body is adaptable!

V is for Vascularisation

Aerobic exercise (“cardio”) should be started a few days after injury to increase blood flow to injured areas. Early mobilisation and aerobic exercise improve function and reduces the need for painkillers.

E is for Exercise

Exercise is strongly supported for reducing the prevalence of recurrent injuries, and can help restore mobility, strength and proprioception after injury.

While some research papers can be hard to read and/or interpret if you don’t have a background in science, this paper is really readable. Click here or click the article title below to find it!

Did you learn something new about injury management?

My name is Siobhan Camille. I’m an exercise scientist and a professional dancer. I love helping dancers get better, stronger, and more resilient. If this was helpful for you, please feel free to share this article, or sign up to my newsletter to get posts like this in your inbox!

Want to dance stronger?

Siobhan Camille offers the Dance Strong 6 Week Online Fitness for Belly Dancers 4-5 times a year, and writes personalised strength and conditioning and/or rehabilitative programs for dancers year-round. Find out more about the Dance Strong Challenge here and find out more about personalised programming here.

In case you missed it: An article by Greenstone Belly Dance founder, Siobhan Camille, was featured in the January 2020 edition of Zameena magazine! Read on below for a sneak peek, and check out the full article here.

The New Year is upon us!

And for 2020, I’d like to propose a different sort of New Year’s Resolution.
One that doesn’t focus on the size of our bodies, or on avoiding certain foods. One that doesn’t focus on how our bodies look in a bikini, but rather, one that focuses on how our bodies function and feel during dance and life.

Dance allows us an outlet to express ourselves whilst keeping active at the same time. However, too often as dancers we spend all our time loving the dance, and neglecting to maintain the condition and strength of our bodies to keep up with our graceful, strong, and at times athletic movements.

I’ve met many young dancers who are secretly nursing niggly injuries that they try to ignore, and older professional belly dancers who tell me they wish they had taken better care of their bodies when they were younger. Whether you’re a professional dancer, or just dancing for fun, you can help reduce your injury risk (and improve your dance stamina and technique) if you put some time into looking after your body.

As part of my work, I conducted the first ever scientific study examining injury incidence in belly dancers. From the results of this, and combined with almost a decade of experience working in injury rehabilitation and athletic performance, I have some ideas on what we, as dancers, can do to look after our bodies.

To ensure you’re dancing strongly into 2020 and beyond, here are my 4 quick tips for happier, healthier bodies!

  1. Be active outside of belly dance

In our study of 118 female belly dancers, participation in non-dance-related exercise was associated with a significant decrease in injury rate.[1]

This may come as no surprise to some of you, as it’s well known that training in other types of exercise has been found to reduce injury in professional dancers of other styles.[2]

Working on your strength (think bodyweight exercises like squats and push ups, or using weights or resistance bands), and aerobic fitness (with activities like swimming, cycling or jogging), can be beneficial as it can help make your body more resilient, and better able to deal with the demands of dance.[3],[4]

My personal motto is that I always want to be stronger and fitter than my performance or teaching schedule actually requires, so I’m less likely to experience injury.

Be easy on yourself if this is your first time incorporating non-dance exercise into your schedule. If you’re not exercising at all during the week apart from belly dance, jumping into 5 days of training will be both unrealistic for your motivation, and perhaps even lead to an injury from such a sudden change in your training load!

Start low, progress slow: Aim to add in just one 20 minute strength session per week, or start getting off the bus or train a stop earlier to work and take a brisk walk the rest of the way. Look for places to sneak in just 10 minutes of continuous exercise into your day, then build from there.

Want to read the other 3 tips? Check out the full article here in Zameena magazine!

References:

  1. Milner SC, Gray A, Bussey M. A Retrospective Study Investigating Injury Incidence and Factors Associated with Injury Among Belly Dancers. J. Dance Med. Sci. 2019 Mar 15;23(1):26-33.
  2. Bronner S, Ojofeitimi S, Rose D. Injuries in a modern dance company: effect of comprehensive management on injury incidence and time loss. Am J Sports Med. 2003 May-Jun;31(3):365-73.
  3. Koutedakis Y, Pacy P, Sharp NCC, Dick F. Is fitness necessary for dancers? Dance Res. 1996 Oct;14(2):105-18.
  4. Koutedakis Y, Jamurtas A. The dancer as a performing athlete: physiological considerations. Sports Med. 2004 Aug;34(10):651-61.

In case you missed it: The recording of my podcast with Belly Dance Geek is now live! I chat about my research into injury in belly dancers, my top tips for injury prevention, and moooooore. 

In the podcast, you’ll learn:

  • What we know about injury in (belly) dance according to current scientific research
  • 4 top tips for injury prevention in your own practice
  • How to structure warm-ups and, cool-downs and general classes for optimal performance and injury prevention

Head over to the Belly Dance Geek Clubhouse website now to download the podcast!