When Your Dancer is Having Pain: Should I Ice or Heat?

For a dance educator or parent guiding dancers through pain, deciding between ice and heat depends on the type of pain and when the injury occurred. It’s important to understand that while both can help with pain relief, their effects on the actual healing process differ

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When to Consider Ice (and how long)

• Primary Benefit: Pain Relief. Ice is very effective at dulling pain and can help reduce initial swelling immediately after an acute injury, like a fresh sprain or muscle pull.

• How long: If you choose to use ice for immediate pain relief, short applications of around 10 to 20 minutes are generally recommended. Applying ice for 20 minutes specifically has been shown to reduce pain and increase joint mobility in soft tissue ankle injuries, with longer durations (30 minutes) potentially causing discomfort.
  
• Benefits: While generally cautioned against for promoting healing, ice does offer benefits primarily for temporary pain relief for acute injuries. It is effective at dulling pain momentarily and can provide a transient decrease in discomfort
  
• Important Cautions:
  • Ice can actually delay the body’s natural healing process. The inflammatory process, which ice reduces, is a vital and essential part of how the body repairs damaged tissue. By suppressing this, ice can hinder overall recovery.
  • It can decrease blood flow which impedes the delivery of necessary healing components to the injury site.
  • Dr. Gabe Mirkin, who popularized the “RICE” (Rest, Ice, Compression, Elevation) acronym, has since stated that ice may delay recovery rather than help it.
  • Prolonged application of ice can lead to tissue damage like frostbite.
  • There is limited high-quality evidence supporting ice for improving long-term healing outcomes for soft tissue injuries.
    

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When to Consider Heat (and how long)

• Primary Benefit: Pain Relief and Promoting Healing. After the initial acute injury phase, once the immediate swelling and sharp pain have subsided, heat can promote healing. This typically means waiting at least 48 hours after the injury for general musculoskeletal issues.

• How long: Heat treatments like hot packs have shown benefits with longer applications. Application of 20-30 minutes would suffice for the desired effect and body response.

• Benefits: Heat increases blood flow to the affected area, which brings essential nutrients and oxygen for repair and helps clear out metabolic waste products, thereby alleviating pain and promoting healing. It also helps relax muscles and can reduce nerve sensitivity.
  
• Important Cautions: Ensure the heat source is not too intense to avoid burns or scalds. Heat packs only penetrate 1-2 cm deep, so their direct effects might be somewhat temporary.

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Key Takeaways for Dance Educators

1. Inflammation is a Natural and Necessary Part of Healing: Your dancers’ bodies are designed to initiate an inflammatory response to injury, and this process is crucial for optimal tissue repair. Trying to completely stop inflammation with routine icing or anti-inflammatory medications (NSAIDs) can actually negatively impact long-term healing, particularly for bone. The “PEACE” acronym for immediate injury care recommends to Avoid Anti-inflammatory Modalities.

2. Movement is Medicine, Not Prolonged Rest: While initial protection for 1-3 days to minimize bleeding is wise, prolonged rest can actually compromise tissue strength and quality. Gentle, pain-free movement (also known as “optimal loading”) promotes repair, remodeling, and helps the body’s lymphatic system clear waste products from the injured area. This active approach is emphasized in the “LOVE” acronym for subsequent injury management.

3. Address the “Dancer Mentality”: Dancers often deny pain, accept it as an inevitable part of their career, or hide injuries for fear of affecting their roles or career. Encourage an environment where dancers feel safe to openly communicate about pain. Hiding pain can lead to chronic issues, including a type of pain called “nociplastic pain,” where the brain’s processing of pain signals becomes disturbed, causing intense pain even without significant physical threat.

4. Educate and Empower: Educate your dancers on the benefits of an active approach to recovery and set realistic expectations for healing times. Encourage optimism about recovery, as psychological factors like fear can hinder it. Promote vascularisation through pain-free aerobic exercise to boost blood flow, and emphasize structured exercise to restore mobility, strength, and balance.

5.  When in Doubt, Seek Professional Medical Advice: For any persistent, severe, or ambiguous pain, it is always best to consult a healthcare professional. A physical therapist, especially one familiar with dancers, can accurately classify the pain and recommend the most evidence-informed treatment strategies tailored to the individual.
   

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In summary, for dancers experiencing pain:

• Use ice sparingly, primarily for immediate, short-term pain relief, if desired, for about 10-20 minutes. Be aware it may delay healing.
  
• Consider heat for muscle soreness (DOMS) or for injuries after the initial acute phase has passed, applying for longer durations (e.g., 30 minutes) as comfortable. Heat generally aids the healing process by increasing blood flow.
  
• Prioritize gentle, pain-free movement and open communication about pain with your dancer centered health ecosystem. 

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1. Pountos, I., Panteli, M., Walters, G., & Giannoudis, P. V. (2021). NSAIDs inhibit bone healing through the downregulation of TGF-β3 expression during endochondral ossification. Injury, 52(5), 1294–1299.
2. Horschig, A., Sonthana, K., Williams, B., Horgan, M., & Starrett, K. (2024). The efficacy of icing for injuries and recovery – A clinical commentary. Journal of Contemporary Chiropractic, 7, 96–101.
3. Dubois, B., & Esculier, J.-F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine, 54(2), 72–73.
4. Wang, Y., Lu, H., Li, S., Zhang, Y., Yan, F., Huang, Y., Chen, X., Yang, A., Han, L., & Ma, Y. (2022). Effect of cold and heat therapies on pain relief in patients with delayed onset muscle soreness: A network meta-analysis. Journal of Rehabilitation Medicine, 54, jrm00258.
5. Aliberti, A., Milidonis, M. K., & Long, K. L. (n.d.). Performing with Pain- Tools to Guide Rehabilitation and Injury Prevention for Professional Ballet Dancers. Cleveland State University, Doctor of Physical Therapy Program.
6. Proulx, J., & Canales, A. (2024). The Benefits of Heat Application and Range of Motion vs. Ice Therapy. MaineHealth Knowledge Connection. https://knowledgeconnection.mainehealth.org/nurseresidency/66