First Aid for Dancers

by the International Association for Dance Medicine and Science 
www.DanceMedicine.org 

Introduction Avoiding Further HARM

Over the past few decades, dance science has In the first few days after an injury, remember to
produced a vast range of conditioning and injury avoid HARM.
prevention techniques, enabling dancers’ bodies to be
• HEAT: Any kind of heat will speed up the
stronger and more capable than ever before.
circulation, resulting in more swelling and a
However, the expectations of choreographers and
longer recovery.
audiences have increased at the same rate, so dancers
still face the possibility of injury at some time during • ALCOHOL: Alcohol can increase swelling, causing
their careers. How well they are informed about a longer recovery.
injury care can play a large part in their successful • RUNNING OR OTHER EXCESSIVE EXERCISE:
rehabilitation and return to dancing. This resource Exercising too early can cause further damage to
paper suggests short and long term strategies for the injured part. Exercise also increases the
dealing with dance injuries when they occur. blood-flow, resulting in more swelling.
First Aid Immediately After an Acute Injury • MASSAGE: Massage increases swelling and
bleeding into the tissue, prolonging recovery
All dancers need to remember the acronym time.
PRICED – an invaluable first aid guide to the
immediate treatment of injuries. Using PRICED in To understand how PRICED and HARM work,
the first minutes and hours after an injury occurs can dancers need to learn more about the way the body
help in controlling the severity of inflammation reacts to injury.
and/or pain and in assisting a safe return to dancing. What Happens When a Dancer is Injured?
PRICED describes a simple procedure to follow
immediately after injury occurs. When a dancer has an injury such as an ankle sprain
or muscle strain, the cells within the injured tissue are
• PROTECTION: Remove additional danger or risk damaged. To limit the damage, the body releases a
from injured area. number of chemicals that create an inflammatory
• REST: Stop dancing and stop moving the injured response, generating swelling, redness, heat, pain and
area. loss of function. The inflammation brings white
blood cells to the injured tissue to defend the body
• ICE: Apply ice to the injured area for 20 minutes against harmful substances, to dispose of the
every two hours. damaged tissue, and to promote new cell growth. It
• COMPRESSION: Apply an elastic compression is important to understand that inflammation is the
bandage to the injured area. body’s natural response to injury and is a necessary
• ELEVATION: Raise the injured area above the phase of healing. Following an acute injury, the goal
heart. should be to control – not eliminate – inflammation
to assist with decreasing pain and increasing function
• DIAGNOSIS: Acute injuries should be evaluated by
of the injured area. The following diagram (page 2)
a health-care professional.
depicts the body’s response to injury that leads to
these signs and symptoms.
 Tissue cells are
injured

Chemicals are
released into the
blood stream

Widening of Increased Increased Migration of

blood vessels permeability of sensitivity of pain white blood cells
blood vessels fibers to injured tissue

Fluids leak into

the injured tissue

Redness and Damaged cells New cell growth

Swelling Pain
heat are eliminated occurs

part is not involved. The health-care professional

How Does PRICED Help Recovery?
will be able to advise how much rest is appropriate
Using PRICED as a first aid method immediately and how to modify dance and other activities while
after an injury helps limit the inflammation and the maintaining fitness, taking into account the particular
pain and can also guide continuing care and injury. It is important to note that the dancer should
rehabilitation. stop exercising the injured body part and seek
Protection immediate care if there is severe or unusual pain,
The injured dancer should stop dancing and limit serious traumatic onset, immediate or excessive
movement of the injured part to avoid any further swelling or discoloration, or if they are unable to bear
damage. If necessary, the dancer should be moved to weight.
a safe place. Support, such as an elastic compression Ice
bandage, air cast, fiberglass cast, tape or a splint can Cryotherapy, or cold therapy, narrows the blood
decrease the risk of further injury and stabilize the vessels, reducing blood flow to the area1,2 and
injured area to allow for optimal healing. If the decreasing tissue temperature.3 This helps to prevent
dancer is unable to bear weight on an injured leg due swelling and abnormal accumulation of fluid beneath
to pain or loss of function, seek medical attention. the skin and also helps prevent further tissue
Rest damage.4,5,6 Cryotherapy also decreases pain by
If the injured area is not rested, continual stress is slowing down the speed of nerve signals that tell our
placed on the injured tissue. Although many dancers brain that we have pain.7
tend to push through their pain and continue to dance, Although there is conflicting research regarding
this could be detrimental to their healing. how long a dancer should apply ice, a sound
Insufficient rest can cause increased inflammation, guideline is to apply ice for 20 minutes every two
pain, or further trauma to the injury, which will delay hours.4,5,6 It is simple to remember to apply ice at,
the healing process. Depending on the severity of the say, 2 pm, 4 pm, 6 pm and 8 pm. For the initial 48 to
injury, resting a dance injury may not mean complete 72 hours following an acute injury, ice should be
inactivity. In some situations, rest may include used exclusively and heat should be avoided. Ice
moving the joint through pain-free motion or should be above 0° C (32° F) if it is to be applied to
performing other activities where the injured body the skin.4,5,6 Crushed ice or frozen vegetables are

First Aid for Dancers –2– www.iadms.org

ideal. Chemical ice bags and anything below 0° C may recommend protective measures or diagnostic
should be wrapped in a cloth to prevent ice burns.4,6 imaging such as an x-ray. An health-care
professional who is familiar with dancers’ particular
Compression
demands can tailor the advice accordingly.
Wrapping the injured body part in an elastic
compression bandage can help to reduce swelling. Long-Term Management Strategies for an
When wrapping an injury, apply the bandage snugly Injury
using a partial stretch of the bandage; you should be
Unless the health-care professional advises
able to slide at least two fingers under the secured
otherwise, the dancer should continue basic activities
bandage when done. It is important not to cut off the
to facilitate the rehabilitation process and wellness of
blood supply. If the elastic bandage is too tight
the entire body. Keep in mind that white blood cells
causing decreased circulation, the dancer will notice
accelerate healing, so good circulation is essential
symptoms such as ‘pins and needles,’ tingling,
throughout the dancer’s rehabilitation. When the
numbness, or change of skin color.
initial inflammation has carried out its purpose and
The best way to apply the compression bandage the injured area is no longer red or hot to touch, the
is to start away from the heart, wrapping towards the swelling should be reduced so it does not become
heart and wrapping slightly looser as you pass the chronic.
injured body part so swelling can move out of the
Reduce Swelling
injured site. Wrap an equal distance above and
below the injured area, overlapping by ½ the width of Although often used in the clinical setting, alternating
the bandage. Do not leave any skin showing (except ice and heat treatment (known as ‘contrast’) has not
tips of fingers and toes to check skin color); been shown to be effective at removing swelling
otherwise swelling will accumulate in the exposed unless combined with other strategies. It is now
skin area. Using ice and compression together is recommended that compression, gentle massage
shown to have a faster rate of decreasing the and/or moving the joint through pain-free range
temperature of the inflamed tissue than using ice should be combined with ice. This combined
alone.8 treatment, known as cryokinetics, causes the muscles
to contract and relax. The pumping action influences
Elevation
the pressure on the surrounding veins, causing the
Elevating the injured body part above the heart helps
blood to be pushed up towards the heart. Ice
to control swelling by increasing the return of blood
treatment is different during the recovery phase from
to the heart and removing waste products from the
immediately post-injury. The dancer should apply
injured area. A good time to elevate is while the
ice for 10 minutes, take it off and gently flex and
dancer is icing the injured area. To promote
extend the joints for 10 minutes, then apply ice for
circulation, the dancer can continue elevating after
another 10 minutes.9 This treatment will increase
the ice is removed. Gentle elevation can be
blood flow to the heart, gradually removing the
accomplished while the dancer is sleeping by
swelling and restoring range of movement. It is
elevating the foot of the bed or mattress 4 to 6 inches.
important to remember that ice application can
Diagnosis decrease muscle force production for up to 2 hours
Healthcare professionals play an important role in following application. Therefore, it is recommended
injury evaluation and rehabilitation. All acute to perform cryokinetics after physical activity, not
injuries should be evaluated professionally, before.
especially those involving significant pain,
Elevating the legs is a great idea after dancers
immediate swelling or bruising, loss of function or
finish class or rehearsal. While dancing,
the ability to bear weight, neurological symptoms,
gravitational forces increase swelling in the feet and
obvious deformity, uncontrolled bleeding, mental
legs. This phenomenon happens whether the dancer
status changes, or failure to progress in the first 48 to
is injured or not. It is evident when dancers notice
72 hours of PRICED therapy. After determining the
that their shoes fit more tightly after class than they
diagnosis, the health-care professional will advise on
did beforehand. Some clinicians recommend
the next steps towards recovery and, if necessary,

First Aid for Dancers –3– www.iadms.org

elevating the legs for 10 to 15 minutes after dancing can work on their cardiovascular fitness by using an
to help increase the return of blood through the upper extremity bike or a modified swimming
circulatory system and decrease swelling. technique. For modified swimming, the dancer can
squeeze a swimming block between the ankles while
Restore Proprioception
swimming with the arms only.
An acute injury can change joint proprioception, or
the awareness of where the body part is in space. Nutrition Following an Injury
Decreased proprioception can lead to difficulty with Finally, an important component of the rehabilitation
motor planning, which is figuring out what each body process after an acute injury is nutrition. The proper
part needs to do in order to move a certain way or nutrition and varied energy sources, including the
complete a task. This can lead to difficulty with right balance of carbohydrate, fat, protein,
motor control or with executing planned movement, micronutrients, and fluid, are needed to facilitate
and to decreased postural stability and balance. The healing. For more information, see the IADMS
following simple exercises can help restore nutrition fact sheet.11
proprioception after a lower extremity injury:
Summary
1. Stand on one leg, with eyes closed, for as long
Immediately after an injury occurs, dancers can use
as possible, aiming for one minute. Repeat
the PRICED method to decrease the local
this balance exercise on each leg 4 to 5 times
inflammatory process and protect the injury prior to
a day.
seeking medical care. During recovery, it is crucial
2. Stand on one leg, with eyes open, on an that the dancer remembers to focus not just on the
uneven surface (folded yoga mat, couch injured body part, but to care for the entire body.
cushion or rocker board) for one minute on Cardiovascular fitness; restoring equal balance,
each leg. Once this is accomplished easily, proprioception, strength, and flexibility in bilateral
move the gesture leg in different directions limbs; and proper nutrition will facilitate the healing
(i.e., développé en croix or dégagé en croix) process while the dancer is rehabilitating the injury.
while balancing for one minute on each leg.
Repeat on each leg 4 to 5 times a day.
Regaining equal strength, flexibility, and Written by Nadia Sefcovic, D.P.T., C.O.M.T. and Brenda
proprioception in both the injured and non-injured Critchfield, M.S., A.T.C. under the auspices of the Education
parts of the body is essential to the rehabilitation Committee of IADMS.
process. For further information, see the IADMS Nadia Sefcovic is at Westside Dance Physical Therapy, New
resource paper on proprioception.10 York, New York, USA
Brenda Critchfield is at University of New Mexico,
Maintain Fitness Albuquerque, New Mexico, USA.
Cardiovascular health is also important for the
This paper may be reproduced in its entirety for educational
injured dancer. Maintaining strength and
purposes, provided acknowledgement is given to the
cardiovascular fitness can be a challenge when a “International Association for Dance Medicine and Science.”
dancer is immobilized in a boot or a cast. If a lower
limb is injured, riding a bike or swimming can be ©2010 IADMS, Nadia Sefcovic, D.P.T., C.O.M.T. and Brenda
alternative options for higher impact activities like Critchfield, M.S., A.T.C.
running. If the lower extremities are limited, dancers

Design: David S. Weiss 3 October 2010

First Aid for Dancers –4– www.iadms.org

 References:
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4. Knight K, Draper D. Therapeutic Modalities: The Art and Science. Baltimore: Lippincott Williams &
Wilkins, 2008, pp. 63-71, 310.
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2008. Available at www.iadms.org/associations/2991/files/info/proprioception.pdf.
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First Aid for Dancers –5– www.iadms.org