Knee Pain... Should we approach Dancers differently in the Gym and the Clinic?
Don't worry... this is still an article for everyone.
Parents... you're going to be thinking about keeping your offspring fit and healthy whilst they pursue their dream...
Dancers... maybe thoughts are consistently centred around an old injury or a persistent niggle that will not disappear...
Health Pros... there are plenty of reasons for an against treating Dancers with the same consideration as other athletes but there are also certain conditions we must also consider.
I am sure some will relate the main topic of this article. Patellofemoral Pain (PFP) and Patella Tendonitis or "Knee pain", which tends to be the most common description for both these scenarios, are extremely common in Dancers of any age. These issues are also particularly prominent in female Dancers. Therefore, for the benefit of the readers out there, we are simply going to discuss the processes and considerations that we should be aware of when approaching potential bio-mechanical discrepancies/deficits in Dancers... and then rectifying and progressing the situation.
Firstly... we are not diagnosing injuries here and all Dancers should be receiving treatment that is individualised and specific to their own situation. At the onset of pain, we should be encouraging Dancers to seek the relevant professional advice.
However, if we take Patella Tendinopathies first... symptoms that are regular with the is issue will often arise as the result of an unwanted increase in loading of the tendon via an increase in workload demand such as: a dramatic increase in the volume of high impact jumping tasks which in turn may create pain as the tendon not cope with the cumulative force requirements of jumping and landing. Due to the jump intensive nature of Dance and the impact involved it is important that Dancers receive specific training that addresses coping with the high demands of repetitive jump:land activities.
In the case of treatment of tendon injury we should be aiming to treat the issue to create acute pain relief so that the tendon tissue or area of concern can then be loaded optimally for the correct positive adaptation to occur. In the case of tendinopathies, this is isometric or eccentric loading to increase the loading capabilities of the tissues.
PFP as a general term, can encompass a large amount of factors that could contribute to pain however there are some significant factors that contribute to instances of PFP in Dancers. Rather than dive into the depths of PFP I will simply refer to the Dance specific factors of potential contribution.
Are you working with true turn out...? This is also a consideration for Physical Therapists who may end up working with Dancers...
If an individual presents PFP. There is a possibility that this could be due to a movement pattern dysfunction and/or altered biomechanics that, when under high Dance training loads, creates discomfort and pain.
If we examine this individual then we must consider their desire to work and perform movement in a position that is permanently externally rotated "from the hip".
Ideally we would achieve as much "turn out" from the hip as possible. However, there could an illusion of external rotation created as a result of rotation at the ankle and knee instead of optimising turn out from the hip. This would be noticeable in a simple Plié, where the knees will track forwards instead of over the toes.
Within vocational Dance settings it can particularly present as a result of continuously landing on one leg and the knee subsequently dropping inwards into valgus. Young Dancers with PFP often present an inconsistent pattern on landing whereby there is a different knee position from rep to the next.
However, we are not in a position where we can state that a single definitive movement pattern alteration or mechanic can lead directly to knee pain. Yet, research has demonstrated that knee valgus (caving in) during landing tasks places an individual at twice as much risk of developing PFP. This research is also of interest as it was conducted on adolescent females.
As with all injuries we should look at the athlete or dancer as an individual and progress with respect to the findings. However as a health practitioners we must consider some key factors when looking at knee pain in Dancers:
Volume of Dance being undertaken
Strength Training Status
Despite Dancers generally being strong in a task specific setting. As a population, and by athletic standards, Dancers rarely present good strength relative to body mass. Therefore it may be advantageous to mitigate some risk of PFP by performing strength exercises which have been shown to significantly reduce the occurrence of overuse and acute injuries.
Therapists, Coaches and Parents... we can do all the corrective exercises in the world yet we will see no change in pain or mechanics if this strength and isolated movement is not transferred to open movement and in this case DANCE!
If knee pain and PFP is something yourself or your Dancers are suffering with then addressing the issue with a Professional is a must. As such, practitioners must play attention to Dance specific setting that this may have occurred in and Dance teachers should also address any potential changes in Dance mechanics.
The aim of this article was not to diagnose knee pain but rather to draw attention to the factors that could influence knee mechanics and potential pain in Dancers. As we know... there will always be people that have less than optimal technique yet present no pain. However, we should always aim to eradicate the risk by undertaking quality Strength and Performance Training.
There are a number of extra factors that lend themselves to the onset of PFP, however in Dancers, ensuring turn out is available at the hips will allow for better knee tracking and optimal function when Dancing in external rotation.
Dancers, seek advice so issues do not become chronic.
Therapists and Coaches, consider the confines and parameters of Dance as a discipline. Lets load tissues and improve both conventional and Dance specific movement patterns.