Patellofemoral Issues
Dancing Smart Newsletter
October 7, 2005
Announcements
I had an absolutely wonderful time working with the dance department at TCU last week. What a good start their dancers are getting with their college training by looking at the common myths of technique and learning to analyze their own movement patterns. I know there are many studio owners who are teaching their young students about anatomy who may want to take advantage of a sale that Anatomy.com is having with a discount 33-inch skeleton now on sale for $40. You can check it out at http://anatomical.com/product.asp?pn=WCP%2D1 (It's also perfect with Halloween coming up – you can have the skeleton greeting dancers in the waiting room and giving them time to peruse the bony markers of their body!)
Question of the Week
First of all, I would like to thank you for these great newsletters. They're simply wonderful, with excellent advice!
I'm a 19-year-old dancer, just beginning my BA in Dance Theatre (focus on modern dance, but with a lot of ballet training.) I've been having some trouble with my knees for a while now. I went to a sports PT, who said that I have patello-femoral syndrome, and also that I was pronating my feet. She gave me some exercises to help me strengthen the right muscles (mostly plies with the feet a bit turned in, so I couldn't pronate), and I also started to wear orthotics in my regular shoes. It helped, but I can still "feel" the patello-femoral syndrome every now and then. My PT said that it was all right to dance as much as I wanted to, as long as I'm not in severe pain. Well, it never really hurts, I just feel it, but it still worries me a bit (dancers and their bodies!). Recently, I've discovered another thing. I'm a bit hyperextended, but I've never had any trouble with it until now. When I push my right knee into hyperextension (non-weight bearing, of course), it feels as if there is something in the way and I can't hyperextend full out, like a tendon or something is hindering it. The knee starts to feel a bit sore, not really hurting, but still. My left knee feels perfectly fine. What's causing this, and what can I do to fix it? And about the patello-femoral syndrome, is there anything I can do about besides working right in class? Will it be OK to dance professionally with it, or can it hurt my knees in some way? I hope that you have some advice for me, it would be really appreciated!
Warm regards, Christina
Deb's Answer
Patellofemoral pain syndrome is normally felt as pain around the kneecap that worsens when during activities such as going up or down stairs. The underlying causes to Patellofemoral pain syndrome include overuse or overloading of the quads (often caused by an imbalance between the use of the quadriceps and the hamstrings in dancers), and biomechanical problems such as pronating feet, or tightness from tight lateral hip muscles (iliotibial band).
Wearing the orthotics in your regular shoes is helping, which is great. It may be useful to also have a more flexible orthotics to put into your jazz shoes. Some dancers will tape their arches up to remind themselves not to pronate while they are working to change these habits in class. You didn't mention whether the Patellofemoral discomfort has always been equal between the two knees. It has been my experience that typically one knee feels it more because of our tendency to have pelvic/torso shifts, and inequities in the turnout between the two hips.
See if you can do a little bit of detective work looking at the other joints of the right leg to make sure you don't have a twist happening at the knee. You might have the PT check if you have any external tibial torsion on the right leg. Feeling that you can't go into your hyperextension as much on the right may be due to some low level swelling still occurring in the joint, or even some subtle differences in the cartilage underneath the kneecap. I don't think you should stress that it means something is wrong, but instead continue to ice your right knee after class to see if that makes a difference and continue to listen to it's message not to fully lock into your hyperextension.
I'm glad you are paying attention to the differences between the two sides of the body. The time after being diagnosed or coming off of a pain syndrome is tricky. Sometimes it is three steps forward and one step back as you come back into dancing fully. Having been diagnosed with Patellofemoral syndrome will not keep you from having a professional career if that is what you so desire. In fact, the discovery that pronation was a cause of the pain, and your correcting this subtle and detrimental habit, should enhance your ability to have a long and healthy dance career.
On with the dance!
Deborah