Why do dancers get KNEE PAIN?

After writing a blog about ankle and foot pain in dancers, I thought, let’s move up the leg and write about knees! Knee pain can be common in dancers, but there are quite a few reasons your knees could be in pain! Below is some of the anatomy that may be contributing to your pain!

MENISCUS

Medial Meniscus

Your meniscus is a cup shaped cartilage that sits on top of your tibial plateau (the top of your shin bone). You have two in each knee, one on the inside (medial) and one on the outside (lateral). Each meniscus fits congruently with one of the condyles of the end of the femur (thigh bone). If we twist our knee during a sport or fall injury, we can damage or irritate our meniscus. Some injuries can require surgery, but often treatment (rehab, manual therapy, and modalities) is great for knee injuries. Your meniscus is one part of your knee that relies heavily on proper technique. If you plié with poor alignment you could be damaging your knee every single jump landing, or pirouette preparation. 

ILIOTIBIAL BAND

Iliotibial Band

Your IT band as it is more commonly known is a length of very strong connective tissue (thickened fascia) that connects the side of your pelvis to the side of your knee. Your IT band is tensed via the muscle Tensor Fascia Latae and is considered a lateral hip stabilizer. If the muscles that feed into your IT band are overworked, this ends up pulling on the attachment of the IT band. This attachment is into the periosteum of the fibula. We know that our periosteum, or the skin on the outside of every one is highly innervated with free nerve endings. You can see how tugging on this from the IT band could be painful. If your pain is on the outside of your knee, consider investigating your IT band and the muscles that may be pulling on it!

PATELLA

Our patella or kneecap sits in a groove created by the femur. Our patella is also pulled by our quadriceps, vastus lateralis, vastus medialis obliquus, vastus intermedius, and rectus femoris. If one of these muscles is pulling more or less than another you can see how that may shift how perfectly your patella is sitting in that groove. This condition is known as patellofemoral pain syndrome. Our patella can also become degenerated on the backside causing pain where this damaged cartilage is rubbing constantly or being compressed by active quads. This is called chondromalacia patella. If kneeling or a plié hurts your knees, consider investigating your patella!

PATELLAR TENDON

Our patellar tendon connects our patella to our tibia. Think of this as an extension of your quadriceps tendon as it wraps itself around the patella, attaching distally. This tendon can get irritated and damaged, especially in dance and acrobatics due to the amount of jumping and direct contact the patellar tendon has with the floor. Jumper’s Knee, as it’s also referred to, is essentially a tendinopathy which responds well to manual therapy. If you are doing a lot of grand allegro and experiencing knee pain, you may want to consider getting your patellar tendon checked.

TIBIAL TUBEROSITY

Your tibia is your shin bone, and on the front, where your patellar tendon attaches is a bony prominence called your tibial tuberosity. Before this is fused, if you pull on that growth plate (epiphysis) enough, you can essentially fracture it (a Salter-Harris type fracture). When this happens at the growth plate at the knee (tibial tuberosity), we refer to it as Osgood Schlatter. Having a dance doctor in your corner when experiencing Osgood Schlatter can be beneficial. PBT is a great option for those feeling the pains of Osgood Schlatter.

LIGAMENTS

We have quite a few strong ligaments that keep our knee congruent and aligned. On the inside of our knee joint we have ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament). Your ACL prevents anterior translation of your tibia (shin bone) and PCL prevents posterior translation of the same bone. On the inside of your leg at your knee you have your MCL (medial collateral ligament) and on the outside of your leg at your knee you have your LCL (lateral collateral ligament). Although these ligaments are harder to injure as dancers, if your mechanism of injury (how you were injured) involves a lot of speed, force, or change in direction, consider having your ligaments checked out!

POPLITEUS

Popliteus is a muscle that due to its size and location, can be forgotten! Popliteus is behind your knee and is involved in the screw mechanism of the knee joint at full extension (straightening). If you are dancing and your pain is behind the knee you may want to have popliteus investigated!

MUSCLES

A lot of muscles are close enough to the knee to cause pain or refer knee pain. We have several muscles that adduct the thigh, our quads, glutes, gastrocnemius (calf), and of course your hamstrings. A few muscles I want to highlight are semimembranosus, semitendinosus, gracilis, and gastrocnemius. The first three muscles cross your knee joint and attach on the inside of the tibia (pes anserine bursa). These are important to the knee because they cross the knee joint, and the hip joint. Gastroc also crosses the knee joint but from the calf. This muscle is another one that should be included when looking further into knee pain.

PROXIMAL TIB/FIB JOINT

Did you know that you have a joint where your tibia and fibula meet near the knee joint? This joint truly demonstrates how the knee is connected to the ankle. Some ankle restriction or dysfunction can lead to knee pain!

FEMORAL CONDYLES

As mentioned previously, at the knee joint, our femur separates into two condyles which sit on each meniscus on top of the tibia. Sometimes we can have idiopathic degeneration from lack of blood supply. Repetitive trauma at the condyles can be a risk factor for developing Osteochondritis Dissecans. This is yet another part of our anatomy to consider when developing knee pain, especially deep rooted, slow onset pain with a history of multiple traumas.

If you are experiencing knee pain, please consult a licensed healthcare practitioner with diagnosis in their scope of practice. For more information or questions, please email hello@madetomove.ca or if you are a dancer in Toronto experiencing an injury, book a visit in-person!