Instep Dance Magazine Articles
Reprints of monthly column as first appearing in Instep Dance Magazine.
Knee Injuries - Part 3
By Rick Allen, DC
"Better health leads to better dancing."
Let's wrap up traumatic knee injuries with a discussion of injury and repair of the anterior cruciate ligament (ACL). I've also got another real-life story to tell. In fact, it's in progress right now.
The ACL is a tough band of tissue about the diameter of your finger that lies deep inside the knee, joining the bones of the leg (the femur and tibia). Injury to the ACL is caused either by a sudden twist or extension of the knee, or by a direct blow. For example, changing direction suddenly while running or dancing can cause enough of an overloading torque to partially or completely tear the ACL.
A "clipping" injury in football that applies a direct force on the outside of the knee (a valgus force) may cause the additional damage of an "unhappy triad": tearing of the medial meniscus, medial collateral ligament and ACL. You may feel a sudden tearing sensation or hear an audible pop. Tearing of blood vessels can lead to internal bleeding and rapid swelling of the joint. The pain forces you to limp and, most likely, you will be unable to move the knee without increasing the pain. This is a serious injury. You will need to be carried off the playing field or dance floor. You will need to be examined and may require surgical repair.
Sometimes the ACL and associated structures are only partially torn. You may have only mild swelling and think you are OK. This can be a false sense of security. If you injure your knee such that it swells or locks up or gives way, have it examined post haste.
Rotatory instability occurs when the ACL is lost, making it difficult for an athlete to change direction without the knee giving way, buckling, swelling or causing pain. Again, this is a serious injury requiring immediate medical attention.
Following ACL surgical reconstruction, expect to have several months of intense rehabilitation. Under the guidance of your doctor or physical therapist, you will start with "closed chain" exercises, keeping your foot on the floor or on a machine. Examples of these exercises are partial squats and leg presses. Do them slowly and gently. I suggest standing in a pool where the buoyancy will lighten the load on your knee. Balance and quick responses can be improved by exercises on a balance board and, later, a trampoline. The best aerobic activities are low impact exercises, such as cycling, step aerobics, swimming and stair stepping. I suggest staying off the dance floor for a month or two, until you have regained strength and coordination. You may require an external brace to avoid re-injuring the knee. Even then, start simple and slow - waltzes and foxtrots without any fancy moves.
Now let's look at the on-going saga of a local dancer, Janet Hummel. On 3/10/98, she believes she partially dislocated her left patella when her heel slid out from under her while simultaneously backing and turning doing the tango. She felt as if her patella shifted and then came back into proper position. Nevertheless, her knee felt unstable, as if it might give way when hit from behind. She went to four medical doctors through the maze of managed care without getting any care. She gave up seeking treatment until, on 4/3/98, she twisted her knee again while squeezing into her car in a tight parking space. She collapsed with a sharp pain in her left knee. She went back to her last orthopedist only to be told it would take three weeks for a magnetic resonance image (MRI) of her knee through managed care. She fought and was able to reduce the waiting time to one week. As I write this on 4/10/98, she has had the MRI today and will see her orthopedist for a follow up visit on 4/20/98. She is unsure of the diagnosis. There may be additional injury from the second fall. She says something hurts now deep inside. Stay tuned and pray for a good outcome.
Janet analyzed the factors that made the injury more likely. First, she hadn't been dancing in heels for about a year. Second, she was out of shape from working 50 to 60 hours per week for over two years as a computer consultant with very little physical exercise. Third, her shoes were slippery. Three strikes and she was unfortunately out!
Remember that prevention is best:
- Keep in good physical shape through regular exercise.
- Be careful about your shoes and the dance floor.
- Keep well hydrated by drinking water before you even feel the need for it.
Keep on dancing!
Next article: Let's take a more in depth look at chronic osteoarthritis of the knee and other weight-bearing joints. There are steps you can take to stay healthy and pain-free naturally.
Future article: I still want to do an article on foot supports, technically called "orthotics". I've interviewed one dancer who has gone through three sets or orthotics. I would like to speak with a couple more folks before writing an article. If you have had experience with orthotics (good, bad or indifferent), I would appreciate hearing from you.Error processing SSI file
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