Understanding Knee Trauma

A knee injury may seem like the end of your career, but with time and proper care, many dancers return—often in better shape than before: Proper rehab corrects the muscle imbalances that may have contributed to the injury. We’ve put together tips to beat a few knee injuries common to dancers. Always see a physician at the first painful twinge in order to prevent further damage. In the meantime, follow RICE (rest, ice, compress, elevate).

Sprained and Torn Medial Collateral Ligament
Two vertical ligaments act as side supports to the knee:  The lateral collateral ligament, or LCL, which connects the femur to the fibula, and the medial collateral ligament, or MCL, which connects the femur (thigh bone) to the tibia (shin bone), and is injured more often.

Causes: Most often, a blow or force to the outside of the knee, such as a collision with your fellow dancer.

Symptoms: You may hear or feel a pop, after which the knee buckles inward. Swelling will occur immediately.

Recovery: 2-3 weeks for a mild sprain; 6 weeks or more for a tear. Generally, surgery isn’t required.

Prevention: This injury is difficult to prevent, because it usually happens unintentionally, whether by slipping or by colliding with someone or something. Using proper technique and strengthening legs can speed up recovery time and lower the severity of such an injury.

Sprained and Torn Anterior Cruciate Ligament
Two ligaments run through the middle of the knee: the anterior cruciate ligament, or ACL, and the posterior cruciate ligament, or PCL. “Cruciate” means “cross,” and that is what these two ligaments do as they pass through the joint. They also keep the femur from sliding off the tibia. When torn, surgery is sometimes needed.

Causes: Typically, the ACL, which is injured more often than the PCL, is torn as the result of a sudden twisting or hyperextension of the knee, such as landing improperly in consecutive tour jetés.

Symptoms: Usually, a pop will be heard and felt at the knee before it gives way. The knee will swell immediately and you won’t be able to continue moving. Ligament injuries are graded from first-degree sprain, where there may be some tearing of the fibers and mild pain without joint instability, to a fourth-degree sprain—a complete rupture of the ligament and the joint is totally unstable.

Recovery: 6-9 months after surgery.

Prevention: Align knees over your toes, and watch out for planting your right foot, and then sharply turning your body without rotating the right leg; or landing from a jump and pressing the leg into hyperextension.

Tendon Ruptures
Causes: The quadriceps tendon that encases the kneecap may rupture from a trauma such as a fall, but often from long-term tendonitis, which weakens the tendon and makes it vulnerable to tears. A rupture is rare.

Symptoms: A ruptured tendon will cause considerable pain and you won’t be able to straighten your knee. Immediate medical attention is imperative.

Recovery: About one year to heal after surgery.

Prevention: Don’t allow tendonitis to go untreated—and watch where you’re going!

Meniscus Injuries
The menisci are crescent-shaped pieces of cartilage on top of the tibia that create a bowl shape for the rounded end of the femur to sit in. They absorb shock when you run or land jumps.

Causes: A weight-bearing abrupt rotation of the knee, such as turning your body to shift directions but leaving your foot planted.

Symptoms: If the meniscal injury is mild, you may have some pain and a feeling of a catch inside the joint. When a larger piece of the meniscus tears away, the knee may lock painfully. You may or may not have visible swelling.

Recovery: Minor tears of the meniscus can be treated with RICE. More significant tears require surgery. If surgery is necessary, recovery may take 1-6 months.

Prevention: Like the other knee injuries, the best prevention is to train knees always to align. Be especially aware when dancing fast combinations.

Dislocated Kneecap
Causes: An abrupt change in direction while running or dancing and/or from a direct blow. Dancers with knock-knees will be more susceptible.

Symptoms: You’ll be able to see that the patella is out of place; it will be painful to bend or straighten your knee.

Recovery: A few weeks to a few months, to allow the tissues that were strained by the dislocation to heal and for swelling to reduce. It’s possible that the patella will spontaneously pop back into place by itself, but you should still see a doctor to figure out why the dislocation occurred and what you can do to prevent it from happening again.

Prevention: Practicing proper alignment is key—and not just when jumping. When landing in fourth position from a pirouette, for instance, the front knee should be equally turned out as the foot.

Bony Fractures
Causes: Usually falling on the kneecap.

Symptoms: Pain, inability to move the knee, bone abnormalities, swelling and bruising.

Recovery: 6-8 weeks; surgery may be required.

Prevention: Take precautions when learning choreography that involves a lot of landing or sliding on your knees. Use kneepads until you learn how to fall correctly.

Neuromuscular specialist Deborah Vogel directs the Institute for Performance Studies in Ohio and is the author of Tune Up Your Turnout.

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