Dancers often perform hundreds of jumps in a single dance class, so it’s no surprise that knee pain is a common problem. Many dancers assume pain and even injury are part of the job, but knee problems are neither inevitable nor untreatable. Here are five of the most frequently occurring knee injuries and how to prevent them.
PATELLOFEMORAL PAIN SYNDROME
Kneecap pain is common among dancers and dance students. Symptoms of patetellofemoral pain syndrome develop gradually, causing soreness around the edge or underneath the kneecap. Pain is aggravated by dancing or sitting for long periods of time. “The patella doesn’t track properly as the knee goes through a range of movement,” explains Dr. Coleen Sabatini, Director and Chief of Orthopaedic Surgery at UCSF Benioff Children’s Hospital Oakland (BCHO) and Director of the BCHO Dance Medicine Program. Often there is a popping or cracking sound under the patella when bending or straightening the knee.
Muscle imbalance, lacking exibility and improper technique are all factors that can lead to knee problems. “A lot of young dancers get injured because they tend to force turnout which puts abnormal stress across the joints, particularly the inner knee,” says Dr. Sabatini.
Turning out with control is essential. “The most important thing for any dancer, young or old, is to have strong core muscles, strong hip abductors, strong and balanced quadriceps and flexible hamstrings,” says Dr. Sabatini. When turning out, use your abdominals, lower back muscles, thighs and glutes. Avoid sinking into your hip, tucking under or gripping as you move from one position to the next, maintaining correct placement.
The meniscus serves as a shock absorber, protecting the knee joint from impact. Meniscal or cartilage tears are a common injury in dance, often occurring after landing a jump or a sudden twist of the knee. Wear and tear from loading the joint as well as twisting your lower leg to improve turnout can also damage knee cartilage. Performing new choreography with sudden or very deep plie?s may be another factor.
Symptoms of meniscal damage include pain and swelling, as well as a locking feeling which, is caused by a piece of cartilage coming loose and getting caught in the joint. Minor meniscal tears can be handled conservatively, but serious injuries may require surgery.
If you experience sudden knee pain during a class or rehearsal, stop immediately, says physical therapist Dr. Suzanne Martin, the founder of Pilates Therapeutics in Alameda and the lead physical therapist with Smuin Ballet. “Sometimes the knee is just twisted out of position,” she says. Her go-to method for fixing minor twists: “Sit on a high enough surface and swing your legs. It’s like rebooting the knee.”
PATELLAR TENDONITIS/ JUMPER’S KNEE
Jumper’s knee is another name for patellar tendonitis, or inflammation of the patellar tendon. Pain is usually felt at the bottom of the kneecap and worsens when running or jumping.
Misalignment of the feet is a main cause, especially excessive pronation (rolling in), which increases the strain on the muscles around the knee. Dancers with certain anatomical variations, such as knock-knees or bowlegs, are also more vulnerable. Weak quadriceps and hip muscles can contribute to tendonitis issues.
Instead of forcing your feet, rotate your legs outward from the hip. In a ballet class, avoid sacrificing placement for a perfect first position. Use muscle control to maintain your natural rotation during the barre and in the center, making sure that the knee is aligned over the foot as you go through demi-plie?.
Initially, it can be difficult to know the severity of any knee injury. Dr. Martin recommends starting with the standard treatment for acute injuries: RICE (rest, ice, elevation and compression). “Ice from the back and the front,” says Dr. Martin, “and use a gel pack from the refrigerator instead of the freezer.”
Young dancers can develop Osgood-Schlatter disease, which may cause a painful bump to form below the knee on the front of the tibia (shinbone). Symptoms begin with increasing pain during activity. Later a visible bump develops on the tibia which may become permanent if untreated. Kneeling is also uncomfortable because of the swelling on the shin.
The condition is caused by overuse of the quadriceps, which straightens the knee, putting strain on the patellar tendon where it attaches to the growing tibia. It typically affects growing dancers because the bone is not yet strong enough to withstand the force of the quadriceps pulling on it.
Osgood-Schlatter disease usually heals after growth has stopped. However, dancers should avoid pushing through the pain, as it can worsen the irritation and prolong rehabilitation.
ANTERIOR CRUCIATE LIGAMENT TEARS
Anterior cruciate ligament (ACL) injuries are uncommon in dancers, but the consequences are serious. The ACL is one of four ligaments that are crucial in stabilizing the knee. A partial tear does not necessarily require surgical repair, but may result in many months of rehabilitation.
Awkward landings are a main cause of ACL injuries. Fatigue may be a factor and many injuries happen at the end of the day or after a long performance season.
Both doctors emphasize the importance of strength training for beating knee injuries. “You have to do conditioning if you want to stay in the game,” says Dr. Martin. She adds that dancers can do strengthening exercises without bulking.
Safeguard Your Potential
Dancers are used to dancing in spite of pain, but pushing through can lead to more problems down the road. If a physical evaluation has ruled out a serious injury, try reducing activity, along with icing and physiotherapy. If your knee pain continues or is recurrent, your physician may order an MRI to ensure a correct diagnosis.
While knee injury rates are high among dancers, there are things you can do to keep knee problems from worsening. Getting a proper diagnosis, adjusting your training during growth spurts and allowing your body to fully recover after an injury diagnosis can help. “You have to get smart about how you take care of yourself,” says Dr. Martin. “Talent is not enough. You have to protect your talent.”
Better knee health
If you are not injured, Dr. Martin recommends this exercise to stretch the quadriceps and psoas for more flexible hip flexors:
- Kneel near a wall and place a cushion or pillow under your left knee.
- Face away from the wall and lunge forward on your right leg until your working knee forms a 90-degree angle.
- With your legs parallel and your hips level, place your left shinbone against the wall.
- Keep your back upright, pelvis square and glutes tight. Hold this position until you feel a gentle stretch on the front of your left hip and thigh.
- Repeat on the other side.