How to avoid knee pain while dancing

5 ways to prevent common knee and hip injuries for dancers

Beautiful lines. Extreme flexibility. These are some phrases we associate with dancers, along with extraordinary hand-eye coordination. It’s not uncommon to see pictures of dancers stretching in the most nonhuman way possible.

You might think that one way to be a better dancer is to stretch more often. So unsurprisingly, when the Australian Ballet shared that they would stop stretching and focus on strengthening to prevent dance injuries, it caused quite a sensation in the dance world. Yet, the ANB is not wrong in refocusing their techniques to focus on strengthening and cross-training for Ballet. Cross-training is one way of preventing knee and hip pain.

You might be wondering, how else do I lessen my chance of being injured so I can enjoy full mobility and dance?

We have shared some common knee and hip injuries in our previous post and what you should do if you are experiencing pain.

This article will highlight five ways you can prevent knee and hip injuries.

Why do dance injuries happen?

Dancing is physically demanding, and dancers perform repetitive movements for several hours a day. Studies have shown that dancers tend to injure their lower bodies more often. Additionally, as an art form and a sport, dancers do not just dance, they also attend techniques and choreography classes, leaving no ‘offseason’ in between.

Dancers also like to ‘dance through their pain’, further aggravating the injury. Restrictive diets and improper training can also lead to dance injuries.

5 ways to prevent dance injuries

1. Cross-train to build strength and endurance in all parts of your body
2. Warming up properly
3. Always wear proper shoes
4. Practise with proper technique
5. Eat well and hydrate regularly

1. Cross-train to build strength and endurance in all parts of your body.

As mentioned earlier, cross-training to strengthen your leg muscles is a good way to prevent injuries.

Cross-training for dancing involves varying your fitness program by combining different types of exercise activities such as cardiovascular exercise, strength training, and flexibility exercises like yoga or Pilates.

When you cross-train, you strengthen your leg muscles. These exercises will help stabilize your knee joint to protect it from injury.  Strengthening your muscles can help to prevent meniscus tears. The meniscus is a cartilage that protects the knee joint from impact by absorbing shocks. Meniscal tears, are common injuries in dance. It often occurs after landing a jump or a sudden twist of the knee. Wear and tear from loading the joint and twisting your lower leg to improve turnout can also damage knee cartilage.

Symptoms that have damaged your meniscus include pain and swelling. You might also experience a locking feeling caused by a piece of meniscus coming loose and getting caught in the joint. You may recover from minor meniscal tears when you rest, but serious injuries require surgery.

If you experience sudden knee pain during a class or rehearsal, you should stop immediately.

Another way is to wear protective knee gear during sports to support your knee during activities that may increase your risk of injury. If you are on the floor a lot for floorwork, it is a good idea to invest in a knee guard to protect your knee from the hard impact of the floor.

Apart from cross-training, you can try specific exercises to strengthen your lower leg muscles so your meniscus does not absorb the full impact of your landing.

2. Warming up properly

Before any physical activity, you must adequately warm up your muscles. Dancers often neglect this step as they want to literally jump straight into action.

This is the first step to prevent injuries. Many hip flexor injuries usually occur from a lack of warm-up before a dance class. Since we use our hips in nearly all movements, you should spend time on a proper warm up which will help to reduce hip flexor irritation.

Hip injuries in dancers can happen suddenly or result from gradual overuse. Constant excess rotation on the hip and repetitive extension of the legs put extra stress on the joint.

If you often feel pain in your hips, you might have overused your hip joint and surrounding muscles, resulting in hip flexor tendonitis. This can cause bouts of frustrating pain while dancing or sitting for extended periods. Apart from that, a lousy landing or fall can cause a hip flexor injury that, if not tended to, can develop into a lifelong struggle.

As a dancer, you might yearn for extreme flexibility and stretch your muscles further to reach your flexibility goals. But it is important to remember that stretching and warming up are not the same. Static stretching involves holding a position for a length of time to elongate the muscle, while a dynamic warmup involves stretching through a range of motion.

Dynamic warm up stretches that involve active movements to stretch the muscles to their full range of movements, such as side-to-side lunges and walking lunges, will help you warm up your hip flexors. Warming up helps to prevent hip injury and it is extremely important.

For dancers with hip flexor injuries consult a doctor or physiotherapist. They may recommend specific hip flexor exercises for you to warm up the joint and prevent further injury.

3. Always wear proper shoes

Your knees and hips are the largest joints in your body and support your weight. The type of shoes you wear impacts the position and movement of your feet, and your knees. When you wear shoes that properly support your feet, you can move naturally, maintain regular leg and knee alignment, and reduce damaging stress on your knees.

Different dance styles may have other shoes required for that style. Always check with your dance teacher what is needed and buy the proper footwear. Below, we have a few tips on shoe choice based on dance styles to prevent knee injury.

Many dancers like to train barefoot, especially in contemporary dance. Without shoes to cushion the impact of a bad landing, it’s easy to injure yourself. Wearing flat ballet shoes to offer some level of protection can help to cushion your jumps.

Some cardio-intensive dances such as hip-hop or K-pop require fast and sharp movements. Wearing shoes that can cushion the impact of a sudden turn and keep your knees aligned will prevent the occurrence of knee injuries.

Ballroom dances require high heels and increase pressure on the front part of your foot. When you put constant pressure on the front part of your foot, the shin muscles and the foot are strained, possibly leading to knee pain. The height of the heels can also cause your calf muscles to shorten, leading to foot and knee pain. If you constantly wear heels, do:

• Vary your footwear if you wear heels often in and out of dance class.
• Choose shoes with firm midsoles and good soles to keep your foot forward and prevent knee pain.
• Look out for wear and tear and change shoes when you need them.

Knee strain can affect the tendons, which contributes to many knee conditions. Any shoe that forces your foot into an unusual position can cause tendon strain.

If your knee hurts, consider your shoes first, especially if you lead an active lifestyle or work for long hours on your feet.

4. Practise with proper technique

Dancers often perform hundreds of jumps in a class, which puts a lot of impact on the knee pain. Many dancers assume pain and injury are part of the job but knee problems are neither inevitable nor untreatable.

Symptoms of patellofemoral pain syndrome (runner’s knee) can develop gradually. You might first feel soreness around the edge or underneath the kneecap, which gets worse when you dance or sit for long periods.

What happens is that the patella does not track properly as the knee goes through a range of movement. You might also hear popping or cracking sounds under the patella when bending or straightening the knee.

Incorrect technique, muscle imbalance, and a lack of flexibility are all factors that contribute to knee pain.

These are also the reasons why so many young dancers get injured is because they tend to force their turnout, which puts abnormal stress on their joints, particularly the inner knee.

The meaning of turnout in ballet is to rotate the leg at the hips. Then, turn the feet (and knees) outward, away from the body. A turnout is an essential part of classical ballet technique. A 180° turnout where both heels are touching, and your feet are in a straight line from the front is considered a “complete turnout” and is not possible without conditioning. Even with exercise, your body places some limitations on your turnout potential.

To prevent injuries, you have to turn out with technique and control. You need strong core muscles, strong hip abductors, quadriceps, and flexible hamstrings to turn out correctly.

5. Eat well, hydrate regularly

Water and electrolytes are essential to delivering nutrients that help cartilage repair itself when injured. When you stop drinking water, the wear and tear on your cartilage (especially your knees) outpace the body’s ability to generate new cells. Injuries like cartilage tears and meniscus tears can result.

Our joints have cartilage which is made up of 60% water. This cartilage acts like a cushion or a shock absorber that reduces the friction between the bones in the joint with the help of gel-like lubrication called synovial fluids.

When you do not drink enough water, cartilage loses its sponginess. Drinking more water may not heal joint pain directly, but it can keep your joints healthy. Proper hydration improves synovial fluid production, reduces inflammation, and maintains the shock-absorbing properties of cartilage.

A recommended intake of water for adults daily is 3.7 liters of fluids a day for men and 2.7 liters for women. Of course, if you perspire more and workout more often, you should increase your water intake.

Conclusion

While it is easy to think ‘mind over matter’, and try to grit your teeth through pain, minor aches can lead to major injuries. If you do experience pain around your hip and knees, you should seek a doctor’s advice before you continue dancing or any form of exercising.

At Hip and Knee Orthopaedics, we believe that every patient deserves to receive comprehensive and efficient care for their musculoskeletal conditions so that they can gain back their independence in mobility and enjoy quality time with their loved ones.

With a passion for treating hip and knee conditions, our doctors aim to provide you with quality care by thoroughly assessing your condition and personalising your treatments to meet your needs and goals.

The 3 Best Exercises to Help Dancers Prevent Knee Injuries

When it comes to injury-prone body parts, knees reign supreme for dancers. But a little strengthening can go a long way in preventing painful outcomes. We turned to Dirk Hartog, a physical therapist with Westside Dance Physical Therapy in NYC, for three exercises that’ll support and stabilize your knees.

Photography by Erin Baiano. Hair and makeup by Angela Huff for Mark Edward Inc. Modeled by Nellie Licul.

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Exercise #1: Knee Rotation Control

NOTE: This exercise encourages proper rotation and control of your lower
leg, which, if incorrectly turned out, can strain around and below your knee.

1. Put a sock on your right foot. Lie on your back with your hips and knees bent at about 90 degrees and your feet hip-width apart and planted firmly against a stable wall. The front of your tibia should be in line with the space between your second and third toes.

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Exercise #2: Body-Weight Squats

NOTE: This exercise helps strengthen your quads, so they can absorb the shock of jumps and floorwork, protecting the soft-tissue
structures of your knees.

1. Begin with your feet hip-width apart and your toes slightly turned out. Find your neutral lumbar spine position.

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Exercise #3: Turnout Stabilization

NOTE: This exercise promotes proper use of your glutes and external hip rotation to control turnout, which takes pressure off your knees.

1. Begin standing with feet hip-width apart. Soften the backs of your knees so your quads are relaxed and you’re not hyperextended. Find a neutral position for your lumbar spine by tucking your pelvis under, then arching your back—the midpoint between the two is where you should be. Place your left hand on your chest and your right hand over your belly button.

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A version of this story appeared in the April 2019 issue of
Dance Spirit with the title “The Bee’s Knees.”

causes and methods of dealing with them