Knees – simple, but yet one of the most complex joints of our body. The ultimate connecting piece from our feet to the rest of the body structure. Dancers use knees … A LOT, thus shall know what to if body send a signal that there is something is wrong with the knees.
1. “I have pain on the front of my knee. It gets worse with stairs, and after sitting for a long time.”
Patella-Femoral Syndrome (PFS) – is a general term used to describe pain affecting the joint surface between the patella and the femur underneath. Behind the patella is a cartilage lining that provides a smooth gliding surface between the two structures. PFS is a softening or wearing away of this cartilage under the patella, resulting in pain and inflammation.
Typically, pain with PFS will present over a period of time. You will notice pain during class, especially with jumps and/or squatting. The knee may begin to swell at the kneecap and may start to become painful with stairs and sometimes after sitting for a long time. Overuse during training and technique or mechanical faults by the dancer can aggravate PFS.
Ice and anti-inflammatory medications can be helpful in reducing acute inflammation and pain. You should modify your training activities when possible to reduce stress from jumping and excessive knee flexion. A chiropractor or physical therapist consult is essential to determine which structures in the knee exhibit excessive tightness or weakness. An examination of the foot, ankle, and hip should also take place as those joints transfer stresses to the knee.
2. “I have pain in my knee and it ‘locks up’ on me.”
Meniscus Tear – Inside the knee joint, the meniscus are two “C” shaped pieces of cartilage that protect the joint surfaces of the femur and tibia from grinding against each other.
Injuries to the meniscus usually occur as a result of some type of trauma (landing a jump, twisting a knee, etc). Minor tears may not become painful for you until some time has passed after the injury. Severe tears will be immediately painful and swollen. You will notice impairments with knee range of motion, walking, and may even complain of the joint ‘locking up’.
If you have a minor meniscal tear, you may be able to return to activity with only conservative treatment, including ice, anti-inflammatory medications, and physical therapy to help strengthen the knee. More significant tears usually require arthroscopic surgery to prevent further damage to the whole joint and its stability.
3. ” I landed a jump badly and felt pain on the inside of my knee.”
Medial Collateral Ligament (MCL) Tear – The MCL is a key stabilizing ligament of the knee that prevents movement of the joint from side to side by attaching the femur to the tibia on the inside, or medial, portion of the leg. An MCL injury is one of the most common ligamentous injuries occurring around the knee.
Commonly, dancers sustain an MCL injury as a result of some trauma to the knee, such as repeated jumping or sudden twisting, turning, or stopping movements. You will notice immediate pain on the inside of the knee. The pain will generally last for few hours or more. You may also notice a lack of full range of motion in the knee, and often a feeling of ‘instability’. MCL tears can be painful to touch on the inside part of the joint surface.
There are varying severities of MCL tears, ranging from stretching of the tissue to a complete rupture of the ligament. Most MCL tears can be treated conservatively, including rest from activity, ice, and anti-inflammatory medications. Treatment by a chiropractor or physical therapist is indicated to strengthen the knee and prepare the dancer for return to class and rehearsals. On rare occasion a complete rupture of the MCL may require surgery to repair the ligament or reattaching the ligament to the bone.
4. “I landed a jump and heard a pop in my knee.”
Anterior Cruciate Ligament (ACL) Tears –The anterior cruciate ligament (ACL) is a deep ligament primarily responsible for maintaining the stability and integrity of the knee, connecting the femur to the tibia within the joint, behind the kneecap (patella). Injuries to the ACL can vary in severity – minor sprains to complete ruptures. The ACL unravels like a braided rope when it’s torn and does not heal on its own. All types of athletes and dancers can experience ACL injuries. As a dancer, injuries typically occur when you land a jump or perform a sudden movement where the knee is forced side-to-side or unnaturally twisted. With complete ACL tears, you will usually hear an audible “pop” sound and notice immediate instability and pain. You may not be able to bear weight on the injured leg.
Without the proper diagnosis and treatment, an ACL injury can place the entire knee joint in danger. Book a consult with a chiropractor or physical therapist to properly diagnose. Fitting for a custom-made knee brace may be necessary. A torn ACL often requires surgical reconstruction.
5. ” I have been dancing all my life and now have a constant knee pain.”
Osteoarthritis – involves inflammation and degenerative breakdown of the cartilage lining the ends of the bones within a joint. Healthy cartilage normally protects the joint, allowing for smooth movement and shock absorption. Without the usual amount of cartilage, the bones rub together, causing pain, swelling and stiffness.
The most common causes of osteoarthritis are previous injuries, joint overuse, and aging. It is also suspected that there is a genetic component to the disease. You may have little or no complaints of knee pain until the disease has progressed significantly. With significant arthritis, you will start to notice pain with many activities, including walking, ascending stairs, and even at rest.
Confirm diagnosis of osteoarthritis with an X-ray. Osteoarthritis is a degenerative condition and there is presently no cure. You should maintain existing flexibility in the knee joint to help prevent injuries caused by friction. A physician may recommend anti-inflammatory medication to assist with pain relief. A consult with a chiropractor is also helpful to determine if strength deficits or imbalances exist and help to correct them. Severe conditions may require total knee replacement surgery once pain becomes no longer tolerable.
6. “My kneecap came out of joint.”
Patellar Malalignment/Dislocation – A displaced patella occurs when the kneecap (patella) slips out of it’s groove on the thigh bone (femur). Often the kneecap will slip out of its groove momentarily, and then relocate. This is known as a patellar subluxation and can happen repeatedly. A patellar dislocation is when the kneecap slips out of its groove and will not relocate. This is a very painful condition and usually requires a physician to assist with relocation.
Injuries commonly occur during running, jumping or sudden changes of direction. A sharp blow to the knee may also dislocate the patella. With a subluxation, you will notice momentary pain, followed by a feeling of unsteadiness or the tendency for the knee to “give out”. With a dislocation, the pain is significant and disabling and a visible deformity can be seen. Both conditions result in immediate swelling of the knee. In severe cases, there may be numbness or partial paralysis below the dislocation as a result of pressure pinching or cutting blood vessels and nerves.
Both patellar subluxations and dislocations require a physician consult. With a dislocation, the physician can usually reposition the joint with a physical manipulation. X-rays may be required to rule out any fracture to the boney surfaces. Following relocation or with repeated subluxations, the knee may need to be immobilized or placed in a brace for several weeks. Rehabilitation with a chiropractor is essential to restore strength and range of motion of the knee and to help prevent reoccurrence. Severe conditions may require surgery to stabilize the kneecap.
7. “The front of my knee hurts when I jump.”
Patellar Tendonitis (“Jumper’s Knee”) – At the base of the kneecap (patella) is a thick patellar tendon, connecting the patella to the tibia bone below.
Patellar tendonitis arises when the tendon and the tissues that surround it, become inflamed and irritated. Usually caused by overuse, especially from jumping activities and is often called “jumper’s knee.” Patellar tendonitis usually causes pain directly over the base of the kneecap. A clinician may be able to recreate your symptoms by placing pressure directly on the tendon. The tendon will often be visibly swollen.
Avoid activities that aggravate the problem such as stair climbing and jumping. Restrict class and rehearsals until symptoms improve. Ice and anti-inflammatory medications may be helpful for pain relief. Stretching of the quadriceps, hamstring, and calf muscles prior to activity is needed to relieve stress on the patella tendon. Consult with a chiropractor to evaluate strength, flexibility, or technique deficits.
Exclusively for Dance Comp Review
Dr. Glenn Paul Uy | Ossington Chiropractic and Rehabilitation : www.ossingtonchiro.ca and www.dancefeet.ca.
Source: Harkness Centre for Dance Injuries – Hospital for Joint Diseases — http://hjd.med.nyu.edu