Patellofemoral Syndrome
Dancing Smart Newsletter
July 22, 2005
Announcements
Greetings!
Countdown to DT Conference in NY! My classes have been set. I will be teaching a ballwork session on Sunday morning, and a session on assessment tests on Monday afternoon. I'm especially excited about showing dancers how to test for hip flexor tightness, hamstring flexibility, and range of turnout.
Let's start today's newsletter with a response to last week's newsletter.
I have been a dance teacher for many years and raised three lovely daughters inside my studio at the same time. One daughter is now a Doctor of Chiropractics. Her childhood and young adulthood background in dance, tumbling, basketball, tennis and softball opened a whole new view to her Chiropractics. She loves working with young active patients because she understands their injuries. What I think that sets her apart from other Chiropractors is her extra training she has done on rehab of injuries and strengthening the body, and at the same time understands her limits and is not afraid to refer someone to an orthopedic if needed. I believe that she, and other doctors like her, will change the world of Chiropractics and open new doors for especially dancers.
I would encourage the parent that wrote in about "dancers knee" to seek out such a person for a second opinion. I have sent several of our dancers to Dr. Sarah after they have seen their other doctors without success and each so far have been very satisfied and were able to rehab and improve their physical ailments. And by the way, if you have never had your feet adjusted before.....well! I guess I thought feet were always suppose to hurt because of my career choice.
Dancers work very hard and deserve to have options in health care, especially preventative care that keeps us dancing and moving freely! Love your newsletter and I share it with "Dr. Sarah" as well! She says you are very well informed and encouraged me to read and archive them for reference.
Thank you, Ms. Mary
Dear Mary,
I enjoyed your note and especially appreciated your comment about having your feet adjusted. It always feels so good! Point well taken that if you aren't standing correctly on your feet then the weight isn't going to go through the joints efficiently. It is the relationships between body parts that are so important. Our bodies are amazing. When we hurt ourselves, even when it is the smallest of tweaks, our body immediately and automatically compensates. We don't even notice that we have subtly shifted over to the other side, or take the slightly shorter stride after straining a hip flexor muscle, for example. It is always wonderful to find medical practitioners who understand movement and the musculoskeletal patterns of the body. Yea for your daughter, for taking her love of sports and dance into the medical field where she can help so many!
Question of the Week
Another knee question from Heather
I have been dancing since I was very young, and I am now 34 years old. My dance instruction was not the best, and my practice was far from perfect. I started teaching various styles of dance in my teenage years and have continued on and off through the years. As I got older and began taking dance from different instructors, I began to realize how much I didn't know. I am now also a certified group fitness instructor, have completed many hours of yoga teacher training in several Hatha styles, and I have become accredited through the upper levels of teacher training through the National Teacher's Association for Country Western Dance.
So, to get to the point; the older I get, the more I want to learn, and the more I want to learn it correctly. It seems the more that I try to improve my dancing abilities, the worse my turnout gets and the worse my knees feel. I have been diagnosed with Patella Femoral Syndrome. I've had PT on several occasions, but nothing really makes a difference. My knees hurt while going up or down stairs. They hurt as I sit down. They hurt if I sit too long. They hurt when doing almost anything when my knees are flexed and bearing weight. In dancing, they hurt when doing anything in demi plił (that's about everything in Ballet). In addition to my knee problems, I teach an 18 year old girl who is new to dance but very fit, and she is having similar knee pains. I check her alignment, and all looks good to me; however, her knees bother her - just as mine do me. I noticed in your most recent article, you wrote that "...dancers...believe that a certain amount of pain goes along with being a dancer. Rubbish I say to that myth!" That made me think I'm still doing something wrong, and I hope I'm not teaching my students wrong. It has been my belief that ballet and jazz dancing is not necessarily good for our knees and may contribute to knee problems. ANY SUGGESTIONS???
Thank you for your time and opinion.
Heather
Deb's Answer:
You have described patellofemoral syndrome and it's classic symptoms, Heather. Pain going up and down inclines and pain when sitting for a long period of time (called movie-goers knee, cute, eh?) Physicians and therapists have no problem diagnosing this problem, but there is not a standard protocol for treating it. This syndrome is thought to have many facets to it. It is considered an overuse syndrome as well as often having structural components such as an increased angle between the hips and the knee. In other words, having wider hips as females are apt to have.
When someone comes into my practice with patellofemoral syndrome the first place I look is to the iliopsoas muscle and evaluating its flexibility. I often find a tight iliopsoas tipping the pelvis and loading the knees, making the quads both over work and tight. Try focusing on stretching the iliopsoas muscle, not once a day, but 4-5 times a day, especially with a quick sitting stretch. I stretch my iliopsoas when I am sitting at the computer and need a quick break. (Pictures of iliopsoas stretching can be found on page 68 -69 in Tune Up Your Turnout
I also suggest that you do frequent ball work to release as much tension around the hip joint, working the front, back and sides of the legs. Make sure you include working the anterior tibialis muscle, which is the muscle on the front of the shin. Releasing the pull of the fascia and muscles below the knee, since they are connected in a fascial band to above the knee can't hurt. This is the area that anyone who has a tendency towards shin splints needs to be releasing frequently.
How much tension do you carry in your feet? Do you ground your weight while doing demi plies? Your toes should be resting as you do your demi plies, and often dancers grip the floor with their toes. Flip flops and sandals without straps around the heel require you to grip with your toes to hold them on. This will increase muscular tension up the front of the leg.
Pay attention to the changes in intensity of the discomfort. How do your knees feel after doing yoga? I'm delighted that you have broadened your knowledge base and movement studies into complementary areas. Focus on breathing into stretching is something that dancers often forget to do.
I stand by my statement that the human body is designed to move – easily and gracefully when in efficient anatomical alignment with good muscle balance. I know how frustrating it is to have one area talking so loudly that it demands all of your attention. I hope a few of these suggestions might help you notice changes, however small, that will guide you into a more comfortable movement.
Wishing everyone a wonderful week!
Deborah