Presented by: Liane Simmel 

IADMS Simmel from Steven Karageanes on Vimeo
This presentation gives an insight into the functional anatomy of the dancer’s knee, its biomechanical prerequisites and its economic use as base for a high resilience to dance injuries.

Over the last decade as more and more acrobatic movements invaded the various dance styles, the strain on the dancer’s knees has largely increased. Training on hard, inappropriate floors or dancing choreographies in high heels can add even more problems. Pirouettes on the knees, knee drops, and even a plié in fourth position require particular leg stability and optimal mobility in the knee. But dancers often pay little attention to their knees. They are seldom specifically warmed up, directly trained or used consciously in everyday life. Nonetheless, their functionality is a top priority if dancers’ knees are to be kept fit and healthy.

Being the largest joint of the body, the knee works as an important coordination centre to the leg. Located between the hip joint above and the foot below, it reacts to all movements and positions of these, its two functional partners. With its high number of daily repetitions, even seemingly small dance technical pitfalls like rolling onto the inner side of the foot in the turned out position or losing the alignment of the leg in demi plié can lead to overuse problems and even acute injuries in the knee area.

As dancers are accustomed to work precisely on their coordination and alignment they do have a big supply of tools for improving leg alignment, be it in the dance class or in everyday life. They just have to be made aware of this potential...

When analyzing leg alignment and knee load in a dancer, there is more to consider than just screening the bony and functional anatomy of the lower extremity itself. When it comes to assessing the stress and load on the dancer’s knee, the form and mobility of the foot, the bony and muscular situation of the hip joint, the position and mobility of the pelvis as well as the torsion of the tibia play an important role. Thus, to get an impression about the dancer’s anatomical prerequisites, screening should start by analysing the anatomy of the whole functional chain: the foot, the torsion of the tibia, the antetorsion angle in the hip joint and the position and mobility of the pelvic girdle. To detect the keystones by which the dancer can influence, change and improve his or her individual biomechanics the next step in line is to assess the flexibility, function and muscular strength of all functional partners – foot, hip joint, pelvis and last but not least the knee itself.

Being the most common challenges in many of the different dance styles, turnout, plié and hyperextended legs have been chosen to explain the approach of biomechanical awareness training in dance. Dancers spend a great deal of their days in the studio, but there is still a life outside the ballet room, and movements and biomechanics outside the studio seem to have potential for improvement in many dancers. Therefore the habits in the dancer’s everyday life movement should thoroughly be analysed and searched for negative influence on body functionality by imprinting unhealthy movement patterns in the dancer’s neurological motor program. If not detected and changed these often unconscious habits will be trained on a regular daily basis, imprinting into the dancers motion cortex. To break them up, specific exercises should be performed, with the focus on (1) mobilization (to allow new movement possibilities), (2) awareness (to make unhealthy movement patterns conscious and consider possible changes), (3) strengthening (to enable the muscles and the neurological system to perform unfamiliar movements) and (4) relaxation (to reduce unnecessary muscles tension and soft tissue restrictions). With “one second exercises” performed numerous times per day, the reset of the neurological motor program gets started.

Finally, what seems for the majority of the dancers the most challenging step, the new movement potential have to be transferred back from everyday life to the studio, to the individual dance technique. Easily understandable anatomical and biomechanical images and movement cues can support this tricky step. And last but not least: patience.

Liane Simmel, MD, DO, tamed, Tanzmedizin Deutschland e.V., Fit for Dance, Munich, Germany