Knee Pain in Dancers
Knee injuries are some of the most common injuries a dance-physio will treat in their clinic. Why do they happen - and what can we do about it?
Knee injuries are prevalent among dancers and pose significant challenges for physiotherapists specializing in dance-related injuries. This article delves into the biomechanics of the knee, emphasizing the intricate relationship between the knee and foot. Additionally, we'll explore the impact of hypermobility on the knee joint and discuss evidence-based strategies for injury prevention.
‘The knee is the slave to the hip and the foot ‘
Dancers subject their lower extremities to considerable stress during class, training and performances, with the knee acting as a primary pivot point and ‘middle man’ between the actions of the feet and hips. The knee joint moves primarily into flexion and extension (sagittal plane). There is also a degree of rotation that needs to happen along with this motion (transverse plane). The knee therefore is heavily influenced by the joints directly above and below…the foot and the hips/pelvis.
Biomechanical Dynamics: Knee and Foot Alignment
The alignment and stability of the knee are closely tied to the biomechanics of the foot, particularly its ability to pronate and supinate. Non optimal foot alignment and motion can lead to deviations in knee mechanics, predisposing dancers to injuries such as ligament strains, meniscal tears and patellofemoral pain.
Scientifically-backed interventions include targeted exercises to enhance foot arch control, awareness and proprioception, and timing in motion. These measures aim to optimize foot function, reducing the likelihood of malalignment and subsequent stress on the knee joint.
NOTE; healthy pronation is necessary for good knee flexion mechanics.
Biomechanical Dynamics: Knee and Hip Alignment
The intricate interplay between the knee and hip joints is also a critical aspect of biomechanics in dancers, and imbalances in this relationship can also contribute to lower limb injuries. The hip serves as a proximal anchor for the lower extremity, influencing the alignment, control of motion and stability of the knee. Poor timing or incorrect hip musculature recruitment can lead to compensatory mechanisms in the knee joint during dynamic movements, such as jumps and turns. This compensation often manifests as increased stress on the knee ligaments and cartilage, heightening the risk once again of overuse injuries and conditions like patellofemoral pain syndrome. Addressing hip-knee coordination through targeted strength training for the hip abductors, external rotators, and flexors is crucial for maintaining proper biomechanics and distributing forces effectively throughout the lower limb. The muscles of the lower limb are all designed to decelerate pronation of the leg and need to work well together as a team to do so in an optimal manner. Rehab and strengthening needs to be specific, as open chain leg exercises such as a seated knee extension does not improve the single leg squat!
NOTE; knee flexion needs to work with flexion of the hips and an anterior tilt of the pelvis to effectively load the stability and control muscles of the hips /pelvis.
Hypermobility's Influence on Knee Stability
Hypermobility, characterized by an excessive range of joint motion into extension, presents a unique challenge for dancers. While this attribute allows for impressive alignment, it can compromise the structural integrity of the knee. Hypermobile joints are more susceptible to instability and ligamentous laxity, increasing the risk of injuries such as patellar dislocations and ligament sprains.
Understanding the role of hypermobility in knee injuries is crucial for developing tailored prevention strategies. When the knee moves past extension and into hyper extension, it actually changes direction. We see an internal rotation of the thigh, shin and foot. This is the opposite of what we should see with an extending leg. This can then lead to further injuries related to both the feet and hips as pressure is altered from centre in motion.
Evidence-based approaches may include targeted strength training to enhance muscle stability around the knee joint and proprioceptive exercises to improve joint awareness, reducing the risk of hyperextension during dynamic movements.
Preventing Knee Injuries: Evidence-Based Strategies
Preventive measures play a pivotal role in minimizing the occurrence of knee injuries in dancers. Scientifically-supported strategies include:
Proprioceptive Training: Incorporating exercises that enhance proprioception, or joint position sense, can improve the dancer's ability to control movements and reduce the risk of joint misalignment.
Strength Conditioning: Targeted strength training, focusing on muscles that control the lower limb, is instrumental in providing stability. This can involve exercises for feet, core and hip muscles to maintain optimal biomechanics. It will always need to have a 3d component.
Biomechanical Analysis: assessing and viewing the body as a whole and understanding the connection from the foot to the head with regards to joint interplay, cause and effect. We need to achieve proper foot motion with good hip and pelvis connection.
By implementing targeted interventions, dancers can optimize their physical preparation, mitigate injury risks, and sustain a career marked by biomechanical efficiency and joint health. Collaboration with physiotherapists well-versed in dance-specific biomechanics ensures a data-driven approach to injury prevention, allowing dancers to perform with confidence and longevity.
Say goodbye to hypermobile knees!
We are thrilled to announce the launch of Brace-IT - the latest product from the Band-ITS & Strength4Dance team. This supportive but flexible knee brace is designed to enhance the natural ergonomics of knee extension, to give the correct feedback for knee alignment in both the weight-bearing and elevated leg.
Knee taping will be a thing of the past, you will be able to quickly attach this brace over your tights or against skin and get the feedback you need to prevent the injuries associated with a knee that moves too far into extension!
We will be officially launching in February 2024 but you can pre order already and read more about this amazing product through the site and the link below …
