Tag: injury prevention

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RICE is at least 10 years out of date!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!

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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.

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Looking to get your isolations sharper, your figure eights and circles smoother, and your quality of movement crisper and cleaner? It’s all about practice! However, the way we practice can have an effect on what we get out of that practice. Mindful drilling trumps mindless drilling, so here are three tips to strengthen your belly dance isolations!

1. Know what you’re moving, and how you’re moving it

Hip locks. Well, we’re moving the hips right? Sure, but what’s the driving force behind that movement? We know we need to alternate straightening and bending the knees, so have you taken the time to notice if one leg is working more than the other?

First, start noticing what your default pattern is. Film yourself and watch it back, or ask your teacher or mentor to help you identify what’s driving your movement.

Then, it’s time to get a little nerdy. What muscles can you choose to activate a little more to emphasise the hip lift? (Side note: Muscles are always working – there’s no such thing as a skeletal movement, so here it’s more about what you’re actively choosing to contract a bit harder for emphasis!)

Are you feeling contractions in your glutes (butt muscles) or obliques (side abdominals)? You may be choosing to contract (or unconsciously using) one muscle group more than another. I cover some of the ways I use my obliques for hip movements in the free tutorial below on Bigger Hip Shimmies, and I also have an an exclusive video on improving Oblique Strength for Stronger Hipwork just for my newsletter subscribers.

It’s really helpful to learn what muscles could be driving the movement, and get an understanding of how privileging one muscle group over another could change the movement quality of that isolation.

I cover some of the ways I use my obliques for hip movements in this free tutorial on Bigger Hip Shimmies

2. Strengthen those muscles!

We’ve gotten nerdy, we’ve started to think about the muscles involved! Now what? Easy – strengthen those muscles. Interested in how you can get your obliques to play a part in increasing the size of your hip lifts and drops? Start strengthening them. Plus, there’s the added bonus of a decreased injury risk when our muscles are stronger.

(Don’t know where to start with strength training for raqs sharqi and fusion dancers? Siobhan offers the Dance Strong Challenge several times a year!).

3. Slooooooooow it down…

…. Then speed it up, but don’t cheat! Slowing down an isolation can help you to feel and see the “sticky” parts. When you take your hip circle, maya, or hip lock at a slower speed, you’ll be more able to see differences in size and symmetry. If you’re more aware of these differences, you’ll be more able to work on them. When we’re learning or perfecting a skill our brain has to be involved in doing the work. So slow it down, notice what you want to change, give your brain time to process, and keep at it. When you’re ready, increase the speed. Find where you’re comfortable, then get to that “sweet spot” that’s just out of reach – when you’re not flailing and getting too frustrated, but where you’ve gotta work and reach to get and keep that technique strong and even! Playing with speed is not only a good way to identify how we can improve our quality of movement, but also great for challenging our current level of technique.

Interested in putting some strength and technique work into practice? Register for the Greenstone Belly Dance semi-regular newsletter. You’ll be rewarded right away, with an exclusive video on improving Oblique Strength for Stronger Hipwork, and a mini lower body strengthening workout designed for belly dancers!

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One of the biggest mistakes I see dancers make when it comes to training is ignoring the concept of progressive overload.

What the heck is progressive overload!?

Progressive overload refers to gradually (the key word here!) increasing the amount and/or difficulty of your training over time. In both the rehabilitation and athletic performance spheres, we use progressive overload to safely and effectively improve strength, mobility/flexibility, and conditioning status (cardiovascular fitness).

Learn more about progressive overload, and how to tell if you’re increasing your (dance) training load too quickly!

I see dancers make two big mistakes when it comes to progressive overload:

Not acknowledging (or perhaps understanding) where they currently are NOW.

I see so many dancers injure themselves (or just make themselves so sore that they NEVER want to train again!) because they set a goal that is too lofty for their current fitness levels. Lofty goals are fun, but you need to progress towards that goal over time. Just because someone else can run 5km right now, doesn’t mean you can right away, especially if you’ve never run before!

The next most common problem I see is:

Building up to a certain level…. And then never changing anything!

You don’t need to always aspire to stronger, faster, more flexible (although, I truly believe that stronger is better in lots of ways for our bodies – but that’s a discussion for another time). But our bodies are REALLY good at adapting to stressors. Exercise is a stressor. We need a certain amount of consistency for our body to adapt, but once the body is used to something, we need to change it up to keep ourselves seeing the same benefits of training. This can be as simple as changing the type of exercises you do every 4-6 weeks, or adding weight or resistance to the exercises you’re doing.

Progressive overload is not just important for our strength, conditioning and mobility work. It’s also important to consider when planning our dance practices.

Consider this common scenario:

You’re going to a belly dance festival for the first time in a long time (especially after the last 2.5 years of most things being online!). You’re usually dancing for 45 minutes, three times a week. But you’re so excited to dance again, and all the workshops look SO good (sound familiar?). So you’ve signed up for 8 hours of workshops this weekend!

Jumping from 2.25 hours of dance in a regular week to 8 hours (or 10.25 if you also did those standard regular classes) is a big jump in load for our bodies. This can be one of the reasons you might be more likely to sustain an injury at a dance festival – it’s a huge jump in loading that your body is not used to.

But don’t just take my word for it – let’s use a simple method to assess this jump in dance volume:

The acute-to-chronic training/workload ratio (ACWR)

Sounds complicated already, I know! But I promise it’s not, and for this simple method, you can even find a calculator online. I use a slightly more involved version of this method, but this basic method is a great way to get a snapshot of whether you’re increasing your dance and/or training volume too much.

The acute-to-chronic training/workload ratio (ACWR) compares your mileage (for activities like running, cycling, and swimming) or duration (for activities like dance) from the last week to your average weekly mileage/duration for the last four weeks. Week 4 is last week, Week 3 is the week before it, and so on.

When you do an ACWR calculation, you’ll end up with a number at the end. Here’s what the numbers signify:

<0.8 = danger zone; undertraining which can lead to injury risk (yes, we also don’t want to DROP our training amounts too much from week to week if we want to avoid injury!)

0.8-1.2/1.3 = sweet spot; optimal workload and lowest relative injury risk

1.3-1.5 = increased injury risk

>1.5 = danger zone; significantly increased injury risk, highest relative injury risk

So let’s revisit our dance festival example:

ACWR Example: Dance Festival

Week 1 = 135 mins (3 weeks before the festival: your standard 3 x 45 minute dance sessions)

Week 2 = 135 mins

Week 3 = 135 mins

Week 4 = 615 mins (The week of the festival: Your standard 3 x 45 minute dance sessions, plus your 8 hours of workshops at the festival!)

To calculate your ACWR, add up the minutes from each week:

(615 + 135 + 135 + 135) = 1020 mins 

Then, divide that number by the number of weeks (this is standardly measured in 4 week blocks):

1020 / 4 = 255

Then, take the amount of load (in our example, in minutes) from the most recent week, and divide it by the average of the last four weeks (the number we just calculated above):

ACWR = 615 / 255 = 2.4

In this example, your ACWR would be 2.4 → You’re currently in the “danger zone,” the highest risk category for injury because of how fast, and how unevenly, the load has been ramped up.

This is just one of the reasons why we want to progressively overload all of our training – dance, strength, conditioning, mobility or otherwise. We want to progressively build up overtime to reduce our chances of injury.

Have you got any questions about progressive overload for me? Leave me a comment below!

Want to create the strength, mobility, and metabolic conditioning you need to be the dancer you dream of? Siobhan Camille writes personalised strength and conditioning programs for dancers, and regularly hosts online and in-person dance-specific workshops. Find out more about what Siobhan has to offer here, and sign up for semi-regular newsletter here to get all the knowledge delivered right to your inbox!

In addition to being the founder and director of Greenstone Belly Dance, Siobhan Camille is a Rehabilitative Exercise Specialist and Strength & Conditioning Coach. Siobhan Camille has an extensive background in exercise science with postgraduate level degrees in Exercise Prescription and Rehabilitation Science. She takes a particular interest in the safety, strength, and performance of dancers, and has conducted formal research on injury incidence in belly dancers. She draws on this background to emphasise safe dance technique and teaches her students how to find and activate muscles to create clear movement.⁠

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Want to learn more about Warm Ups for belly dance? Join Siobhan Camille for her online workshop in July 2022: What’s in a Warm Up?

Find out more about “What’s In a warm up?” Online Workshop

I think by now, most of us are thoroughly convinced of the benefits of warming up for dance – or at least, we like doing it! When we surveyed 109 belly dancers in New Zealand, we found that 84% of them warm up prior to their dance practice[1] (bravo!).

When I first started out in the world of exercise science, the evidence for warming up was a bit patchy and contentious. Nowadays, there’s a lot more evidence out there that a good warm up can improve your performance[2][3], and can decrease your risk of injury.[4][5]

However, it’s important to know that not all warm ups are created equal!

How to structure your warm ups for belly dance: The RAMP protocol.

To be fair, I have not seen too many awful warm ups in my time. The one that stands out was when a dancer started with extreme (and I mean: extreme) backbends and hair tosses within 30 seconds of the warm up song commencing. This was one of the few times I was generally worried about injuries (but to be honest, I was stifling laughter because it was so unbelievable). Aside from that, I do see a few warm ups that don’t really fulfil the goal of getting warm, and could have some potential for injury.

One of the common mistakes I see includes beginning with stretching. Dynamic stretching (moving joints through the range of motion you’ll use in your session, but doing so by actively using muscles) is a common part of a warm up routine, but it’s not usually the first thing we do, and it isn’t a passive, held (or static) stretch.

We don’t generally recommend static stretching before exercise sessions (an exception is made at times for hypertonic muscles), as it’s been found to be linked with an increased injury risk due to decreasing the muscles’ ability to produce power (and therefore meet the demands of our dance). Most of this research is on long, static stretches of 60 seconds or more, which a lot of exercise professionals brush off, saying “no one does this in their warm ups anyway!” However, a specific sub-group sometimes does engage in this practice of long, static stretching: dancers!

So how do we warm up properly?

One common method that is supported by science is the RAMP protocol. This consists of three phases:

  1. Raise
  2. Activate and Mobilise
  3. Potentiate

Let’s take a quick look at how we can use each of these phases to build effective warm ups!

Raise

The first aspect of the RAMP protocol relates to raising the heart rate, breathing rate, blood flow, and core body and muscle temperature, but also the level of skill of the dancer or athlete.

Raising a lot of these physiological aspects like heart rate and blood flow is particularly important for some dancers with pre-existing conditions like exercise-induced asthma, but it also helps all of us by increasing muscle temperature and getting our body ready for the challenges our practice or performance will present us.

Raising the level of skill is also not to be ignored. Here, you can think of including key movement and skill capacities for dancers. If you’re teaching a beginners class, it could involve introducing some basic foot patterns as part of this phase. For all levels, it could be including certain movements that use the same muscles you’ll be using in the rest of the class or session.

The general rule for this phase is that movements are bigger and less isolated, they make dancers feel warmer and breathe a bit heavier, and there is no kind of stretching present yet.

Activate and Mobilise

The “Activate and Mobilise” phase of the RAMP warm up protocol involves moving from more general movement in the “Raise” phase, to key movement patterns required for belly dance performance.

This is where things start to become a little more isolated and more closely resemble belly dance technique. This is also the phase where we start to focus on stability and flexibility, and use active range of motion exercises, such as lunges, big hip circles; things that start to move the joints through their required range of motion for the upcoming practice session. This will likely look different for a drills class compared to when preparing for an advanced choreography run-through!

This phase also has benefits for learning, as if you introduce similar movement patterns to those you’ll be using later in the class, it gives students a chance to repeat them and learn them better.

Potentiate

This is where the warm up starts to bleed into the class or practice session itself! The “potentiation” phase is all about increasing the intensity of the warm up until it is truly “sport-specific” (or dance-specific, in our case!). This phase is where you start moving and performing movements at the same intensity as you will for the rest of the class. The more intense you intend your practice session or performance to be, the more important this phase is. So if you’re about to get on stage and do a drum solo, you certainly want to be moving quickly, feeling really warm, and have worked up to fast, strong isolations by the end of your backstage warm up!

Warm ups should be individualised to what is coming in the class or performance ahead. The literature suggests that this full warm up (phases 1-3) should last about 10-20 minutes, which can sound scary when we only teach 50 or 60 minute classes!

However, as mentioned, the third phase (“Potentiate”) really starts to become inseparable from the class itself. I tend to spend around 8 minutes on the first two phases, and then I move in to specific drills that increase in intensity. That way, we’re all warm and ready to go, but we’re also learning and improving during this time!

As long as you make your warm up specific, that 5-10 minutes at the beginning won’t feel like a waste. Consider what dance concepts you can remind students of as you get them warming up so they’re not only prepared physically, but also mentally for the class ahead.

Have fun getting warm!

Want to learn more about Warm Ups for belly dance? Join Siobhan Camille for her online workshop in July 2022: What’s in a Warm Up?

Find out More about “What’s In A Warm up?” Online workshop

Want to create the strength, mobility, and metabolic conditioning you need to be the dancer you dream of? Siobhan Camille writes personalised strength and conditioning programs for dancers, and regularly hosts online and in-person dance-specific workshops. Find out more about what Siobhan has to offer here, and sign up for semi-regular newsletter here to get all the knowledge delivered right to your inbox!

In addition to being the founder and director of Greenstone Belly Dance, Siobhan Camille is a Rehabilitative Exercise Specialist and Strength & Conditioning Coach. This blog post was originally written by Siobhan for her Safe Dance Column in the Middle Eastern Dance Association of New Zealand (MEDANZ) December 2020 Newsletter. You can join MEDANZ to access their newsletters and find out more about MEDANZ here.  Photo by Veronika Hegedus-Gaspar.

[1] Milner et al., 2019. A Retrospective Study Investigating Injury Incidence and Factors Associated with Injury Among Belly Dancers.

[2] Jeffreys, 2007. Warm-up revisited: The ramp method of optimizing warm-ups.

[3] DeRenne, 2010. Effects of Postactivation Potentiation Warm-up in Male and Female Sport Performances: A Brief Review

[4] Malliou et al., 2007., Reducing risk of injury due to warm up and cool down in dance aerobic instructors.

[5] Barengo et al., (2014). The Impact of the FIFA 11+ Training Program on Injury Prevention in Football Players: A Systematic Review.

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Happy holidays, dancers!

If you’re looking for something to help you unwind (are you like me? An active relaxer?), take a listen to the latest podcast episode to feature Siobhan Camille of Greenstone Belly Dance!

As many of you know, Siobhan is also an exercise scientist and a Certified Strength & Conditioning Specialist. She works with dancers and athletes across the globe to help them get the most out of their bodies and optimise their performance! Read more about Siobhan’s work for dancers here.

Siobhan spent some time chatting to Zana on the Advance Your Bellydance Podcast about strength training for belly dancers. Listen to a little preview below, or click here to listen to the full episode!

Enjoy, and Happy New Year!