Chronic Conditions of the Knee

         "There are three steps you have to complete to become a professional dancer: learn to dance, learn to perform, and learn how to cope with injuries." -D. Gere

      The knee is the largest joint in the body and is constantly supporting the body’s weight.  Dancers depend upon their knees to support their bodies while turning, jumping, and performing extensions.  Since the knee joint is found between sets of muscles that dancers use repeatedly, and dancers often have muscular imbalances in the leg that cause misalignments, it is not surprising that knee injuries account for 14-20% of complaints among dancers.

            This week’s post will discuss some chronic dance injuries that affect dancers.  These injuries develop over time and increase in severity until the cause is determined and eliminated.

            A condition that occurs in children and adolescents who are involved in activities like dance that involve quick turns or jumping is Osgood Schlatter’s Disease.  One in five adolescent athletes is diagnosed with this condition, and it occurs when quick movement demands are placed upon the body during the growth spurt.  During the growth spurt, bones grow quicker than muscles placing a strain on the body.  When this strain is exacerbated by activities that stress the body, this condition develops.  It manifests itself as a painful lump on the leg right below the kneecap.  Dancers may experience swelling, tenderness around the knee, tightness in the quadriceps and/or hamstrings, and/or pain with exercise.  It can involve inflammation of bone, cartilage, the patellar tendon, or any combination of the three.  It should be treated using the PRICE method (protection, rest, ice, compression, elevation) and anti-inflammatories.  It usually resolves itself in 12-24 months when the growth spurt is completed.  A physical therapist can help the dancer find ways to navigate through classes and rehearsals.  In extreme cases, a dancer may be forced to take a break from dance until the pain begins to subside.

            Patellar femoral syndrome occurs due to a misalignment in the leg.  Muscular imbalances or forcing the body into unnatural positions that are unhealthy for the body, like forcing turnout from the knee, can cause the 
patella, or kneecap, out of position.  Instead of sliding back and forth in the groove on the femur, or thighbone, the kneecap is “derailed”.

          As the back of the kneecap rubs against the femur, the cartilage under the kneecap wears away causing chondromalacia.  It is characterized by pain around the kneecap during jumps, during pliés, and after sitting for a long period of time.  The dancer may also experience some swelling around the knee and/or hear a “crunching” sound when moving it.  Rest and ice may help, and a physical therapist should be consulted to determine the underlying cause.  The dancer’s technique can be examined to determine what alignment issues may be present, and the dancer can be evaluated for muscular imbalances that may be the cause.  A physical therapist who works with dancers will be able to help correct technical problems and/or provide strengthening and stretching exercises to fix any imbalances that are present.

           Another knee problem that can be caused by alignment issues and/or muscular imbalances is patellar tendonitis.  In this condition, the patellar tendon, which connects the quadriceps to the kneecap, becomes inflamed.  When the tendon is pulled on excessively due to tight quadriceps muscles, it becomes swollen and painful.  Rest, ice, and anti-inflammatories will help alleviate swelling and pain, and a physical therapist can provide exercises to eliminate the tightness in the quadriceps.

            Prepatellar bursitis is a condition found mostly in modern and jazz dancers because of the knee work involved in these techniques.  Bursae are tiny fluid-filled sacs found in the joints of the body that act as cushioning.  When repeated friction occurs in a joint, the bursae become inflamed and painful.  When executing knee work, the constant friction between the knee and the floor becomes a source of irritation.  Rest, ice, anti-inflammatories, compression, and physical therapy can alleviate the swelling.  In more severe cases, cortisone shots or surgery may be necessary.

            My next post will cover acute knee injuries that are the direct result of trauma and tend to be more serious in nature.