Knee Assessment

Dancing Smart Newsletter
January 20, 2006

Announcements

The results from the survey told me that written material on anatomy and technique was clearly the first choice, followed by attending a workshop. The blog came in a weak third. So…I believe the first in depth article will be on port de bras. I appreciate all of you who took the time to respond and give suggestions!

Today's newsletter is going to be a long one. Claire, from Malaysia, sent me a question this summer and has recently sent photos of her legs, which she has kindly given permission to post. I'm going to start with the original question and my answer, and then post the pictures and we'll discuss her knees some more. I'm still on a learning curve with putting photos into the newsletter - so bear with me as I travel along my steep learning curve!

Question of the Week

Deb's Answer

My original response

Let me try and sort through some of your concerns. First, I want to put your mind at rest that you created the bowing of your legs from turning out incorrectly. You didn't. As children grow they can appear to be more or less bow legged during growth spurts, so the amount of bowing that you have now, you may not have had always. Bowlegs are a structural problem. You are genetically predisposed to having bowlegs. There are a few stray situations where it can develop in other ways, rickets, for one. But that disorder is very rare in this day and age.

What I read into your comment that your teacher has informed you that you are using the wrong muscle to turn out, I'm assuming that you were rotating the foot more than what the hip could tolerate. This may create some tibial torsion or outward rotation of the shin bone, and create some knee and ankle problems, but won't create bowlegs.

If you do have the bowing of the shin bone (called the tibia), then when you point your feet and follow the line of the bone, it will appear that your foot is sickled. So the answer to whether bowlegs and sickled feet can go hand in hand is yes. I would encourage your to strengthen all the muscles around the ankle to better control the tendency to sickle. Try putting your foot in a theraband and doing large ankle circles, slowly and then more quickly. Rotate your foot in both directions. It won't take very many of the ankle circles to feel some fatigue around your ankle joint. Don't over do, but slowly increase the amount of circles you are doing. Start with ten in each direction, and then work up to twenty.

To work towards pointe, you can do slow relevés standing on the bottom step of a stairs. Monitor carefully that when you are rising onto the demi pointe that the weight is placed between the second and third toes, which is the middle of the foot. When you are sickling the weight would be towards the little toe side of the foot, and when you are pronating it would be primarily over the big toe. You want to be right in the center of the foot,

You didn't mention whether you have hyperextended knees. If you do, and are allowing yourself to drop back into your hyperextension, then your legs will look bowed. If that is the reason for your bow legs, then the correction would be to stop going into hyperextension, at least when you are standing on your feet. In the air, you can hyperextend the knees without being concerned.

Hope that helped, Claire, and good luck with your advanced exam!

Pictures and further discussion

Let’s begin by looking at Claire’s first position. From this perspective her knees don't look hyperextended.. Her heels are lightly touching with her knees in line with no visible bowing from this angle. It does appear that her right knee more than her left is facing a bit more forward than her feet, a possible cue that she is turning her feet out more than her hips, or it might be that she does have some tibial torsion. The way to check this is to have her sitting on a surface high enough so her feet won't touch the ground. Look at where the knee is facing and where the feet are. If the lower leg is externally rotated into tibial torsion their feet and knees won't line up. Don't overcorrect this situation by gripping your toes and lifting your arches up, tibial torsion is a structural - not a muscular problem. Check the weight on your feet to make sure you are standing with even weight on the three points of the feet (pads of the big toe, little toe, and heel). The way to check this is to have her sitting on a surface high enough so her feet won't touch the ground. Look at where the knee is facing and where the feet are. If the lower leg is externally rotated into tibial torsion their feet and knees won't line up. Don't overcorrect this situation by gripping your toes and lifting your arches up, tibial torsion is a structural - not a muscular problem. Check the weight on your feet to make sure you are standing with even weight on the three points of the feet (pads of the big toe, little toe, and heel).

From the side we see a few other things. It appears that her knees are slightly hyperextended in this position. I would guess that if we dropped a plumb line from the middle of her hip it would drop in front of the ankle bone.The knees look locked in this picture, but we can't be sure without knowing where the middle of the hip is in relationshiop to her knees.

 

I want to now go back to one of Claire's original question and that is about the shape of her calf. Sometimes if you begin to develop your quadriceps more than your hamstrings, the line from the quadriceps to the calf muscles can have more curve to it, making it look like it is hyperextended, but it is only visual. If you sit on the floor with your legs stretched in front of you, a hyperextended dancer will straighten her legs and flex her feet and have her heels come way off the ground. Everybody's heels lift slightly - we are talking 2-5 inches for the hyperextended dancer. I don't think that Claire is very hyperextended, more likely her knees are locked

In the parallel position we can see confirmation of the tibial torsion. Look how her right knee is turned inward while her feet are in parallel. This angle is the first to show a small amount of tibial bowing which is different from having bowlegs. The right leg again has more bowing than the left. This is what causes the tendency to sickle the foot in a tendu, and Claire will have to work against that tendency as I described in my first response.

In fifth position Claire's right knee isn't facing the same direction as her foot. This refers again to the tibial torsion we saw in earlier pictures. I would have her check the weight on her feet as she is standing. Is it even? If it isn't, most likely she is pronating with more weight to the big toe side of the foot. I'm happy to see that she hasn't over-crossed her 5th. I know many teachers ask for the heel to be lined up with the end of the big toe, but that is very challenging for any dancer who has hips. The farther across a dancer has to reach with the foot in front the harder it is to maintain turnout.

Thank you, Claire, for sharing your photos! I want to assure you that everyone has assymetries and their own unique structure to work with and there are many dancers with both tibial torsion and tibial bowing who are wonderful dancers, so not to get discouraged, and keep focused on the muscles around the hip to create and maintain your turnout.

On with the dance!

Deborah

"Education is the key to injury prevention"

Copyright ©2003-2006 The Body Series. All Rights Reserved.

Deborah Vogel is a dancer, author, and master teacher who conducts workshops across the U.S. for both student and professional dancers. Her numerous articles on dance technique and injury prevention have appeared in Dance Spirit and Dance Teacher magazines. She is the Director of the Institute for Performance Studies and a faculty member at Oberlin College and the OC Conservatory of Music. During her years in NYC she co- founded the Center for Dance Medicine. Deborah makes her home in Oberlin, Ohio.