Four Common Knee Problems for Dancers

Dancers train for the perfect splits, amazing turnout, powerful jumps, high kicks, and quick turns making knee pain common for dancers. Some knee injuries can be very serious and require medical intervention. Other knee problems can be managed or avoided with proper technique and training.

1) Hyperextension

Knee hyperextension occurs when the knees pass straight and begin to bend the other direction. This is common practice for dancers because it can make for longer, cleaner lines, however, it can cause strain and injury. Dancers should first focus on proper technique without gripping the quadriceps muscles. Think of lengthening instead of locking the knees. Remember that each body is different and it is important to find your healthy neutral.

2) Over Turn-out

Forcing turn-out will apply pressure on your inner knees. Focus on hip flexibility. Make sure you are not rolling in on your feet and that your knees are over your toes when you plie or land a jump. When you are not dancing, do not walk around with your legs turned out

Knee pain from improper turn-out

Preventing injury with proper technique

The turn-out position where the dancer stands with the feet in first position with the feet at 180 degrees will not be achieved by every dancer. Proper turn-out must be obtained gradually through focusing on hip rotation instead of foot placement. A dancer who forces his or her feet to turn out without the appropriate hip flexibility will put extra strain on the inside of the knee causing pain and possible injury.

All dancers train to improve their dance skills in order to look great for the main stage. While is it nearly impossible to fake a higher jump, it is, however, very common that dancers force their turn-out in hopes to improve their technique faster.

The shape of a dancer’s hip joint that they are born with cannot be altered by stretching or exercise. These limitations are made up by the depth of the acetabulum (place where your hip joint meets the pelvis) and the angle of head and neck of the femur (the top of the thigh bone). There are also ligaments in place to stabilize the hip, which can be hard to stretch for most people, causing another structural limitation for turn-out.

The muscles used to turn out the hip are the interaction between the external rotators and the internal rotators. The rule is to strengthen the external rotators like are the piriformis, the group of adductors, the sartorius, and the lower fibers of the gluteus maximus while stretching the internal rotators like the tensor fascia latae, the gluteus medius, and the gluteus minimus.

There is no active turn-out possible below the hips. The friction of the foot on the floor allows for some passive turn-out, which if overly used will have damaging results to the knee. To prevent knee pain, the dancer should only turn out the feet if the thigh, knee cap, and foot can stay in proper alignment.

How to make sure you are not forcing your turn-out:

Start with your feet together in parallel. Lift up your toes at the same time and use your rotators to turn out your legs and put your toes back down. That is your natural turn-out.

With proper technique, every dancer can maximize his or her turnout without pain or injury

How walking turned out can lead to pain and injury

We’ve all seen the dancer duck walk. Somewhere between ballet barre and petite allegro, our legs get permanently stuck in turnout. We decide that if we walk with our feet turned out we will be constantly working on bettering our technique. While we have good intentions, the problem is we are setting ourselves up for injury.

The way people walk, also known as their gait pattern, plays an important part in how their lower body functions. There are several phases to walking including striking the ground with the heel, swinging the other leg through and pushing off with the back toes. The arch of the foot tenses during walking to act as a shock absorber. This ideal way of walking naturally protects the feet, ankles, knees, hips and back. When dancers walk in a turned out position, everything changes. Instead of the mid heel striking the ground, the outside of the back of the foot does it. The arch then overpronates, or collapses onto the ground. The knees and hips are left twisting against the turned out position, and the pelvis tilts which turns off core muscles and puts strain on the low back. Sound fun? Not exactly.

Places you might experience pain from walking in turn out:

• Arch of the foot, known as Plantar Fasciitis
• Achilles or calves
• Knee joint
• Hip or IT Band pain
• Low back pain

What can you do to help?

Walk normally

While you feel like it is helping, duck walking is actually weakening your arch and putting you at risk of injury. It turns off the strong core muscles you worked so hard to develop. The muscles used for turn out get tired from staying that way all day and as a result, they tire out more quickly when you need them in dance class.

Stretch out your calves

Stretching your calves more will help your feet get used to using a natural heel strike while walking. Begin in a lunge stance with the front knee bent and back leg straight. Push hips forward to feel a stretch and move the back foot between parallel, turned out and slightly turned in to get the best stretch.

Work internal rotation of the hip

Dancers work so hard on turn out tend to forget about the other actions of the hip. Stretching and strengthening internal rotation will balance the muscles and help prevent injury. To do this, lay flat on your stomach. Loop an elastic band around your ankles and bend your knees to a 90 degree angle. Press against the band with both feet going outward for 3 sets of 10. This will help strengthen internal rotation. The same motion without the band stretches internal rotation.

Focus on your glutes

Your hip rotators are located in your gluteal muscles. Don’t forget to roll out or stretch your glutes after class to loosen up the muscles that work on turn out.

You can walk turned out in the studio all you want, but it is important to walk with feet parallel outside of dance. If you think you may have an injury from duck walking, you should see your doctor to make sure it is nothing serious and that it is safe for you to take class.

3) Falls

This pain will be immediate. Any serious fall should be iced immediately and examined by a professional for proper diagnosis to rule out meniscus and ligament tears that may require surgery, especially if there was twisting, overextension, or a popping sound.
To avoid falls, train at your level and takes breaks when needed to avoid exhaustion. If choreography requires falling onto knees, wear knee pads if possible.

Will Taking Time Off Fix Me?

Well, maybe. It all depends on your injury. If you are sore from training very hard, time off will make you feel like new. If you had a minor incident, time off with some ice will also do you some good. You may have “tweaked” your back when you twisted just right, lifted your partner in a weird way, or rolled your ankle a little when you landed, ice and rest will help. However, if you have an overuse injury, it is likely from long term poor movement. Even if you take the time off to allow your body to heal, that movement pattern has not been fixed and will cause the same problem when you return to the studio.

Take Home Tips

Time off is a good start for injuries
Ice all new injuries
Utilize the mirror and your teachers to coach proper movement
If it has not fixed itself or continues to return after rest, time to see a specialist

4) Imbalanced Muscles

Muscle imbalance can cause knee pain anywhere around the knee, but is most likely to cause patellofemoral pain just below the knee cap. This pain will occur overtime and worsen with exercise and is caused by over developed quads and overstretched hamstrings . Be sure to stretch quads and hip flexors in a parallel stance daily.