When you run and jump, your legs absorb a force approximately three times your body weight. That force travels through the knee, which is the body’s largest joint—and one of the most easily injured through overuse. Here’s what you need to know about four knee injuries that are common to dancers.

Patellofemoral Syndrome (Moviegoer’s Knee)

  • Definition: A condition that involves pain in the area of the patella and the edges of the bottom of the femur.

  • Symptoms: Pain is primarily felt in the front of the knee during movements when the knee is bent and the quadriceps are working strongly, such as landing from a jump or walking down stairs. Long periods of sitting may exacerbate this condition, which is why it’s also known as moviegoer’s knee. Symptoms develop gradually and, in early stages, may lessen as you warm up leg muscles. As this overuse syndrome progresses, pain may become more constant with activity, and increase with kneeling and during movements such as grand pliés.

  • Causes: Poor alignment of the legs in turnout is a major contributing factor. While the patella should move in a vertical up and down direction or tilt slightly, unequal pull from the quadriceps can add a lateral side-to-side motion. Most often in dancers, the patella is pulled toward the outside of the knee due to excessive external rotation of the knee joint, which wears down the cartilage on the underside of the patella.

  • Rehabilitation:  Initially, reduce activity, and ice frequently. Strengthen quadriceps, along with stretching to lengthen the hamstring, calf and iliotibial band. Also, be sure that your knees are always aligned properly in turned out positions. Instead of forcing turnout, stand in parallel first position, rock back on heels, flex toes off the floor, open legs outward (rotating from the hip) as far as possible and then place toes back on floor. This is your natural turnout from which you should work.

Patellar Tendonitis (Jumper’s Knee)

  • Definition: Inflammation of the patellar tendon that connects the kneecap to the tibia.

  • Symptoms: Pain at the bottom of the kneecap that increases with repeated jumping and running. It starts as a dull ache during activity, but can progress into more severe and continuous pain.

  • Causes: Misalignment of the feet such as pronation (rolling in) will put strain on the muscles surrounding knees. Structural variations at the knee, including bowlegs and knock knees, can do the same. Having weakness in the quadriceps and/or excessive tightness in the hamstrings will put stress on the patellar tendon.

  • Rehabilitation: Improve quadriceps strength and hamstring flexibility, remembering that muscle balance around joints is essential. With any tendonitis, the first task is to reduce inflammation through rest, ice, compression and elevation (RICE). If you take action right away, the prognosis is good, but ignoring symptoms can lead to chronic tendonitis, increasing risk of tearing and degeneration of the tendon.

Osgood-Schlatter Disease

  • Definition: Swelling, pain and tenderness just below the knee, where a bump forms on the top of the tibia.

  • Symptoms: Pain at the top of the shin, which increases during running and jumping. Kneeling will be uncomfortable because of the developing bump on the tibia.

  • Causes: Bone grows faster than muscle, so when a dancer is in the midst of a growth spurt, the quadriceps muscle pulls at its tendon. This strain causes the tendon to pull away from the bone, causing pain and swelling. If left untreated a visible bump will appear, as new bone is formed.

  • Rehabilitation: When pain develops, apply ice to decrease swelling. Cease leaping and jumping in dance class, use kneepads during floorwork and focus on building quadriceps flexibility. Osgood-Schlatter usually goes away when growth spurts stop and muscle tightness releases; however, dancing in spite of the pain lengthens the time needed for rehabilitation and increases the risk of a permanent large boney bump beneath your knee.

Iliotibial Band Syndrome

  • Definition: Inflammation at the bottom of the iliotibial band where it crosses the outside of the knee.

  • Symptoms: Pain and tenderness on the outside of the knee, especially after dancing.

  • Causes: Weak lateral hip muscles make the iliotibial band overwork. Pre-existing iliotibial band tightness along with uneven leg length and pronation can contribute to this problem. A tendency to stand with feet wider than hips is often a clue that the iliotibial band is tight.

  • Rehabilitation: Reduce inflammation through icing. Then, stretch and release muscular tension of the iliotibial band, followed by strengthening lateral hip muscles. Try this stabilizing/strengthening exercise for the lateral hip muscles: Stand on right leg, with the knee neutral and the pelvis square. Left leg is in a low parallel passé and hands are on hips. Slowly turn your head from side to side four to six times as you maintain balance. Repeat on the other leg. To release tension in the lateral hip and iliotibial band, stand on a straight right leg with the left foot crossed in front for balance. Shift hips to the right as you lean left, feeling a stretch on the outside of the right hip. Repeat on the other side.

Neuromuscular specialist Deborah Vogel is the co-founder of the Performance Institute in NYC and author of Tune Up Your Turnout.