Preventing Dance Injuries: Part 2: Avoiding Injury To The Knee | 
Author: Paul F. Clifford
Let's image you are late for class; you're rushing up a flight of stairs and you slip. Nothing dramatic! All that happened is that you felt your knee jar. You didn't experience any real pain, just the fleeting feeling of the knee absorbing the shock. Isn't that part of its function? So we think nothing of it and go into class.
The teacher has decided to spice things up a bit and introduces the class to a sleaze move - the "lay back". As it turns out it is really innocent and easy but it looks cool and gives the impression of a dirty dancing type move. It can be done in Salsa, Merengue, Mambo, Cha Cha and CeRoc. Basically, all you and your partner need to do is bend the knees, stick your bottom out and perform a diaphragm into shoulder wave of the body as you stand back up. It is a fluid motion but most beginners misinterpret it, squatting and simultaneously leaning straight back. This way of performing the move doesn't look very elegant and puts a lot of pressure on the hips and back muscles. Also, it puts the dancer out of balance so the body automatically compensates by putting a lot of pressure on the knees and ankles. The male suffers most, if he finds himself holding the girl up (the male and female are suppose to take their own weight).
Well, nobody in class is performing the move to the teacher's satisfaction so he/she gets the class to do it over and over again. That night you go home, your knee is aching a little. Next morning your knee is aching a lot! So, what happened?
The Knee
Normal bending and stretching of the Knee will cause little or no problems for the average dancer, as the ligaments are tight, protecting the knee joint. However, in a partial bending, such as you perform in moves like the "lay back" the ligaments are looser across the knee joint which in turn might allow more movement than the joint can safely take. The loosening of the ligaments is the body's normal reaction to bending the knee and you encounter it from just walking or walking up stairs. The body compensates for this as you take each step, straightening the leg and changing weight from one leg to the other.
In dance class an issue arises from keeping the knee bent for any length of time. This might happen as the teacher takes you through the various body movements of a move one by one. If you have an existing injury and the knee is weakened then you have an increased chance of aggravating it, when you maintain the bent knee position for too long. The same is true if you haven't danced for a while. The probability is your knees are weakened and not use to the stresses of dance, so you might be susceptible to an injury. If you feel any discomfort just stand up straight and lock the knee, then return to the bent knee position. Although it might not be immediately obvious, you might notice your teachers doing this themselves! If the discomfort continues, sit down and rest the knee or better still, go for a walk.
Remember, in our imaginary scenario you slipped on the stairs as you rushed to class. That jarring pain you felt might have camouflaged damage to the cartilage. When you rushed up the stairs you were bending your knee, so when you slipped your knee was destabilised and prone to damage.
Even in a simple movement, such as a transfer of weight from one leg to the other as you perform in the basic moves of Latin dance; you put a strain on the medial ligament. The muscles that surround the knee can take this strain but any sudden twist can cause too strong a pull. The ligament then stretches the cartilage, which in turn can dislocate or move. This is probably what happened when you slipped on the stairs. And continuing to dance might have caused more movement in the cartilage and that might be why you were in pain the next day. If this were a real experience, my advice would be to pack your knee in ice and see your doctor! So lets learn a bit about the knee!
The Anatomy of the Knee
Because you tend to be on your feet most of the time, with your knee taking most of your weight, the knee joint is one of the most difficult of joints to heal if damaged. A sprained ankle can heal relatively quickly but a sprained knee can take up to three times as long and might never recover entirely. The knee is very delicate and is one of the most complicated joints in the body. Comprised of two condyles at the front, they become a smooth surface that fits into the kneecap (patella). At the rear the condyles create a depression that is the back of the knee. This is called the intercondyloid fossa. On either side is a projection called the epicondyle. The knee joint is where the top area of the tibia fits into the femur. This connection allows the knee to articulate. Although this joint essentially makes a straight up and down action possible, slight rotation is also possible when the knee is bent. If there is a weakness in the surrounding muscles and ligaments, the possible rotation in the joint makes us all susceptible to knee injuries. Regular performance of strengthening exercises reduces the risk.
The kneecap is attached to the tibia by ligament tissue and is attached at the top by the quadrates femoris muscle on the front of the thigh. This quad muscle is used by the body to straighten the knee joint.
The knee locks when fully straight but just before it locks; a small muscle on the inside of the thigh locks the joint with a small rotation inward and unlocks with a small rotation outward.
A problem can arise when you are a little too enthusiastic about coming out of a knee bend and the kneecap is quickly pulled up by the quad muscle. This can cause, either the ligament attaching the kneecap to the tibia or the tendon of the muscles at the front and at the back of the knee, to stretch. This will result in pain above or below the knee. Rest and treatment is advised for two or three days and you must watch that you do not jerk or pull the knee. This problem can be avoided by making your dancing smooth and flowing, avoid jerky movements that put too much strain on your muscles and joints!
If you experience kneecap slippage or the cartilage is being pinched, you might suffer knee lock or a knee that gives away easily. This could be caused from overuse of a weak joint and all you might need to do is perform knee strengthening exercises The knee can recover temporarily but it is advisable that you see your doctor to ensure that there is no inflammation under the kneecap or that there isn't another condition that may cause on-going problems. If inflammation is discovered it could lead to an operation, and for a time, a complete stop to dancing.
Female dancers are susceptible to a dislocation of the kneecap. Often they feel a partial dislocation as it goes out then clicks back in. If the kneecap actually goes right out of place, this could indicate that the quadriceps muscle is out of condition or not strong enough or perhaps the dancer has poor leg alignment. Whatever the answer, it usually happens to girls because their wider hip placement gives an increased angle of quadricep pull on the tendon. Corrective exercises or change in dance technique will probably be required.
In both male and female dancers dislocation of the kneecap can be caused by banging the knee when you are relaxed. This could cause the kneecap to slide over and lodge in the lateral aspect of the knee. The major symptom is you will be unable to move your leg in a semi-flexed position. If it happens, then ice therapy, cast or rigid bandage should be used with a two or three week layoff. See your doctor!
Generally, the knees are strong enough to meet the demands of most situations but dance introduces strains that you don't encounter in every day life. If you are aware of the risks to knee damage, then you might be more inclined to do exercises that strengthen the muscles and stretch the ligaments that protect the knee.
If, as in our imaginary scenario, you happen to slip on a set of stairs, you should, (at least now) be aware of the warning signs that will protect you from long term or permanent damage which might prevent you from dancing!
Understanding your body's limitations will help you develop dance technique that compliments your physical abilities. There is no such thing as a correct or wrong way of performing a dance move; dance looks good when it appears effortless. Every "body" is different! Use yours to your advantage.
Remember! One of the stories relating Merengue's creation is about an army general dancing with a lame leg. All he could do was step side and drag close. He was a dancer to admire, for no other reason than he accepted his limitations and used them to his advantage. I hope you do the same!
Part 1: Introduction
Part 3: Avoiding Injury to the Foot and Ankle
Part 4: Anatomy of the Foot and Ankle
Copyright Paul F Clifford (2000)
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