Chronic knee pain is among the most frustrating injuries a dancer can face, because it affects one of the most vital components of technique—the plié. One of the most common knee injuries, jumper’s knee, causes students to experience discomfort across the top of the shin, directly below the patella, with extra pain during grande plié and jumps. Learning how to catch and treat this syndrome will ultimately improve your students’ dance technique and lengthen their dancing careers.
Diagnosing Jumper’s Knee
Jumper’s knee affects the patellar tendon, the continuation of the quadriceps muscles that attaches to the tibial tuberosity just below the knee. An overuse syndrome, jumper’s knee occurs when the tendon is not able to withstand the strains that are placed on it during the course of a dancer’s training. The pain is felt most acutely in jumping because this is the activity that puts the most pressure on the tendon.
Many people believe jumper’s knee is a tendonitis, implying inflammation, but instead, the condition is known as a tendonopathy, which means that the tendon is no longer in its state of optimal tissue health and that there may also be actual degeneration of the tendon tissue. This information is especially alarming given that the condition is frequently diagnosed in adolescent dancers.
Finding Causes and Treatments
In order to decide upon an appropriate course of treatment for students diagnosed with jumper’s knee, you must look at individual dancers to discern the specific conditions that created the overuse strain in the patellar tendon. The three most common culprits are a growth spurt, lack of flexibility and muscular imbalances.
In a growth spurt, bones can elongate at a rate that exceeds the ability of the surrounding muscles to stretch, restricting motion at the joints they cross. To address this, dancers should implement a gradual stretching program for their quadriceps. Start with a very moderate stretch held for a short time, and work in very small increments to increase both factors. Attempting to gain too much flexibility too quickly will only result in more strain in the tendon.
Lack of flexibility can result from a growth spurt, as described above, but could also mean that your students are training toward a particular goal before their muscles are ready. For example, a dancer might focus on increasing the height of the gesture leg in attitude derrière, a goal that requires flexibility in the rectus femoris, one of the four muscles that make up the quadriceps. If the dancer persists in pushing the leg higher, even though the muscle lacks the needed flexibility, the strain created in the patellar tendon can actually compromise the structure of the tendon tissue. In this case, both a graded stretching program and a modest decrease in training would be helpful to lessen the stress on the tendon, while simultaneously addressing the muscle flexibility that is necessary to meet that goal.
A third possibility to consider when treating jumper’s knee is muscular imbalance. Generally, the contraction of the quadriceps pulls the patella straight upward, but a muscle imbalance can distort this patellar tracking. Two of the quadriceps muscles, the vastus lateralis (on the outside of the thigh) and the vastus medialis (on the inside of the thigh), approach the patella from opposing oblique angles. If one muscle pulls more strongly on the patella than the other, the patella will not track directly upward, but will instead droop in the direction of the weaker muscle.
For example, if the vastus medialis is working less, the top of the patella will droop toward the inner side of the thigh. You could use the “air chair” exercise in this instance to help strengthen the medial quadriceps. Students need to have a sense of what it feels like to engage these muscles equally, so that they can work with this muscle balance during dance class. In this way, you will begin to correct patellar tracking and decrease strain through the patellar tendon.
Jumper’s Knee and the Dance Teacher
Focusing on alignment of the hip, knee and foot is one crucial way to teach young dancers how to avoid putting excess strain on the patellar tendon. In every plié, the knee should track directly over the center of the foot. When dancers cheat their turnout by placing their feet in a more rotated position than their hip joints can match, their knees bear much of the strain. Not only are they rolling over on their arches (pronating), but their knees are tracking over or even beyond the big toe, creating tremendous torque at the knee. This can also contribute to the muscle imbalance seen with patellar tracking issues. Spending class time focusing on turning out from the hip joint gives young dance students a technical skill that has the added benefit of enhancing the health of their knees.
Teachers should also examine why dance students might be trying to cheat their turnout. They may lack strength in the six deep outward rotators, the muscles beneath the gluteus maximus that contract to turn out the hip joint, or they might have a fundamental misconception of how to produce rotation in their bodies. One common misconception is that turnout means making a particular angle between the feet. Dancers will often place their feet in the desired position without engaging the muscles of the hip joint that rotate the femur, the real source of turnout. It may be beneficial for you to spend time exploring turnout in non-weight-bearing positions, so that your students can translate this correct placement to their dancing.
As a teacher, you must be aware of how your students are treating their knees, because chronic knee pain shouldn’t be ignored. Always consult a physician or physical therapist if the student’s condition doesn’t improve with time and rest. Deal with a diagnosis of jumper’s knee immediately—often, the excessive force being transmitted through the patellar tendon can be lessened by simply changing the dancer’s habits in the classroom. Remember, correct technique is one of the best ways to ensure healthy knees and a long dance career. DT
Rebecca Dietzel is a dance teacher and choreographer, maintains a private practice teaching anatomy, physical re-education and nutrition, and teaches anatomy and kinesiology for the Ailey/Fordham BFA program in New York City.