Hyperextended Knees

Dancing Smart Newsletter
April 21, 2006

Announcements

Greetings! A new template is in place which hopefully will take care of the spacing issues some readers were having. I'd like to make a request that if you are interested in the summer workshops to fill out the registration form, even if you aren't ready yet to place your deposit. Anneliese and I need to make some space decisions.

I'm delighted to have Anneliese back as our expert for this week as she answers a question on hyperextension.

Question of the Week

Anneliese's Answer

Great question. When I am teaching young dancers, one of my main points to focus is on is teaching them how to work with the body that they are living in and how to make the most of their personal potential. The 10 year old dancer is at a very crucial stage in their training as the demands made on his or her body are only going to increase and the habits and mechanics that they learn now will stay with them for many years to come.

First, it is very important to make sure that you are really dealing with hyperextension of the knee and not tibial torsion or any swaying of the lower leg. Testing for hyperextension has been discussed in a previous newsletter and can be found in the newsletter archives for 2005. It is also important to remember that the knee very rarely acts independently. Since it is the middle joint it affects and is affected by the hip and ankle joints. To work on correcting the hyperextension of the knee often will require changes at both other joints.

As the knee hyperextends, the ankle is brought into plantar flexion ( a more pointed then neutral position). This shift will move the body's weight back onto the heel. Quite often the foot will also go into some pronation here, which can loosely be described as rolling in. It is important to work the intrinsic muscles of the feet to allow them to hold a more stable position. Some wonderful exercises are described in Irene Dowd's book, "Taking Root to Fly". One of the exercises that I use with my pre-teen dancers is rocking. I have them roll from their heel to a relevé in a parallel position about sit bone width apart. The challenge is to maintain the straightest line possible in the movement.

Moving up to the knee itself, the vastus medialis obliques or VMO is generally not strong enough in comparison to the other muscles of the quadriceps group in someone who hyperextends. Part of what is allowing the joint to literally pass through straight into bending backwards is the lack of a muscle acting as a brake. A very effective exercise to strengthen the quadracep group in an even way is called a quad set. To do this have the student sit with one leg in a retire position and the other extended straight out in front of their hip. Take a bath towel and roll it up into a bolster about 4-5 inches high and place this under the knee (a neck roll pillow of firm foam will also work). Keeping the working leg as neutral as possible (this may not be 100% parallel, but the ankle, knee, and hip joints should all be in line) flex the ankle and think of extending the back of the leg as long as possible. At the same time the front of the thigh should be contracting, but not gripping to lengthen the leg. Hold this position for 5 seconds and then gently release – don't think of a sharp turn on and turn off. Repeat this exercise up to 20 times and up to 3 sets per day. Of utmost importance is that the leg remain as parallel as neutral can be maintained and that there is something under the knee to prevent hyperextension from occurring.

Continuing up the leg it is important that the young dancer realize that every time he or she hyperextends they are losing turnout and working the deep 6 rotators of the hip will be helpful to them. A great way to incorporate this into a dance class is to have the students lay on their right side, with the right arm bent and under the head and the knees bent and stacked so it looks like they are sitting in a chair. The waist should be lifted off the floor so that the pelvis is supported. Keep the feet together and lift the top knee like you are opening the cover of a book and then control the lowering. Repeat 10 times on each side.

The hip and pelvis area is also one to be addressed. Because of all of the shifts discussed below, it is hard to hyperextend the knees and keep the pelvis in a neutral alignment. Some people will tend to over tuck and create a backward displacement of the pelvis, while others will allow the pelvis to tip forward. Both directions are less then helpful in dance class. For students who tend to allow the pelvis to tip forward, have them place their pinkies on their hipbones and their thumbs on their bottom rib. Ask them to try to pull the pinky up to the thumb. The feeling of lift here is helpful in avoiding the over correction of tucking under. If the student tends to over tuck, ask them to stick their bottom out – like they are doing a jazz hip isolation to the back. From that position have them feel a heavy weight pulling their tailbone down towards the floor but not swinging forward.

If you are teaching a class with students with both habits try using some jazz hip isolations where they move the pelvis front, to the center, back, and to the center. Try to use the correction of dropping the tailbone rather then tucking under during class.

The importance of correcting hyperextension at a young age can not be stressed enough. Many girls can avoid knee problems in their teens by breaking this habit now. As the pre-teen's body continues to mature, the physical pelvic structure, including the opening of the hip joints and the resultant hip to knee angles will change. The better the alignment is going into that crucial development time, the lower the injury potential of the dancer will be,

Thank you Anneliese, for your very thorough response!

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.