Dancing is a form of exercise that is increasingly popular now. With technology, entry barriers to master slick dance moves are also lower. From the young active student to their retired grandparents, everyone can hop onto Youtube and dance to an energising dance video.
But as a sport, dancing requires a lot of manoeuvres with your hips and knees. For amateur dancers, injuries can happen if the person’s form is wrong. If you are a professional dancer or a serious hobbyist, you are probably familiar with the muscle soreness that follows after a rigorous dance session. However, repetitive movements can also cause pain beyond the soreness you feel. Understanding Dance Injuries is crucial for maintaining health and performance.
1. Snapping Hip Syndrome
What is it?
Do your hips often have an audible ‘popping’ sound when you move them? You may have Snapping Hip Syndrome (SHS). People with this condition feel a snapping sensation in their hips. Additionally, they may hear a “snap” or “click” as they move their hips.
What does it feel like?
There are different types of SHS. The most common SHS for sports-related injuries is external and internal SHS. For those with external SHS, they might hear a snap when they flex or extend their hip. They might also have a painful sensation of their hip dislocating, especially at the side. Riding a bicycle or running might trigger these sensations. You may experience snapping when you run or climb stairs. You might also experience some pain or tenderness on the outside of the hip.
Another type of SHS known as internal SHS is experienced within the front side of the hip or further at the groin area. You might feel like your hip is popping, and there is a pain sensation coming from deep within the front groin area when you turn your knee and foot inwards or outwards. For these people, the pain gets worse when they run, jump or cycle. Internal hip snapping can lead to a tear in the cartilage rim around the hip socket.
What are the causes and risk factors?
In most cases, snapping arises because the muscle or tendon glides over a bony structure in the hip.
External SHS
External SHS occurs when the iliotibial band, a strong, thick band of tissue that runs down the outside of your thigh, slides over the top of your thigh bone. This phenomenon is the most common type of SHS and is usually caused by repetitive movements that lead to muscle and tendon overuse.
Internal SHS
Internal SHS occurs when your hip muscle or tendons slide over the front of your hip joint. Another cause is when your quadriceps muscle slides over the ball part of your hip’s ball-and-socket joint. People with this problem might feel pain near the groin and hear a pop when they run. This pain gets worse gradually over time.
In a study of dancers, it was found that those typically affected by snapping hip syndrome partake in sports that include repetitive extreme hip motions. These sports include competitive and recreational ballet dancers, weight lifters, soccer players, and runners. Of the competitive ballet dancers, almost 90% reported snapping hip syndrome symptoms, and 80% had bilateral involvement.
Risk factors for external SHS are similar to internal SHS. Repetitive action is usually the most common cause. Unlike internal and external SHS, intra-articular SHS is not caused by a muscle or tendon. Instead, a hip joint injury or issue from trauma or injury can trigger this condition. Intra-articular SHS can occur suddenly if a dancer lands awkwardly from a jump and injures their hip from the force of the jump.
When should you see a doctor?
If the pain you feel gets worse with each ‘click’ of your hips, it’s time to see a doctor and get professional help.
2. Hip Impingement
What is it?
Since dancers use their hips a lot, you might experience hip impingement. Hip impingement is when the ball of the hip pinches up against the cup of the hip. Your hip is the joint where your thigh bone meets your pelvis. The top of your thigh bone shaped like a ball fits into the cup-like area of your pelvis, similar to a baseball that fits into a glove. Typically, the ball of the thigh bone glides smoothly within the socket, but if the ball or socket rim is hurt, this smooth motion is affected.
Repetitive hip flexion can cause damages to the cartilage of the socket, leading to hip impingement. The technical name is femoral acetabular impingement (FAI). When you experience hip impingement, damage to the labrum (cartilage surrounding the acetabulum) can occur, causing hip stiffness and pain. In the long term, hip impingement may lead to arthritis.
What does it feel like?
Most patients with hip impingement experience pain or stiffness in the groin or front of the thigh. They might also feel a pinching sensation when they bend their hip or at the waist. Other activities such as riding a bike, tying shoes or sitting for long periods can also aggravate hip impingement.
What are the causes and risk factors?
When hip impingement causes symptoms, you may feel groin pain, especially when walking or flexing the hip. Sufferers will also feel a decreased range of motion in the hip.
As the condition progresses, you may feel pain even when sitting too long or walking up a hill. You might also feel pain even when you walk on flat ground, which suggests that the cartilage cushioning the ball and socket is starting to wear out.
When this happens, you might be experiencing a condition known as osteoarthritis. In those under age 40, hip impingement is a significant cause of early osteoarthritis of the hip.
There is a problem with both the ball and the socket in some cases. For many people, the abnormal shape is thought to have been present since birth. It is also possible to develop this irregular shape over time and is seen more frequently in young dancers who twist their hips a lot or when they squat.
When should you see a doctor?
If the pain gets worse, you should rest the affected hip area and see a doctor. Your doctor might also recommend that you modify your activities to avoid moving the joint in a way that causes pain. They might also recommend choosing exercises to strengthen the muscles that support the hip. If needed, you might also be prescribed anti-inflammatory and pain medications.
If these treatments do not relieve pain, your doctor may recommend hip impingement surgery. The surgery will depend on the problem causing hip impingement and how much cartilage damage has occurred.
3. Patellofemoral Pain Syndrome / Runner’s Knee
What is it?
You know you have runner’s knee, or its more technical term, patellofemoral (puh-tel-o-FEM-uh-rul) pain syndrome, when you feel a dull ache around the front of your knee, known as the patella. Although it is known as ‘runner’s knee’, it affects participants in all sports that require running and jumping.
Runner’s pain can affect a dancer’s mobility as it’s challenging to do jumps or even move.
What does it feel like?
You will feel dull, aching pain at the front of your knee, around your kneecap (patella). Some patients feel a grinding sensation on the kneecap, when they bend or strain.
The pain often gets worse when you run, walk up or downstairs. Even sitting with bent knees for long periods or squats can aggravate the pain.
What are the causes and risk factors?
Patellofemoral pain syndrome is often associated with overuse of your knee due to running or jumping sports, which puts repetitive stress on your knee joint, causing irritation under the kneecap.
It can also result from muscle imbalances or weaknesses when the muscles around your hip and knee do not keep your kneecap correctly aligned. Most people feel this aching pain when they do a squat.
In other cases, trauma to the kneecap, such as dislocation or fracture, can also cause patellofemoral pain syndrome. Knee surgery can also increase the risk of patellofemoral pain.
Patellofemoral pain syndrome usually affects teenagers and young adults. Knee problems in older populations are more commonly linked to arthritis.
It is theorised that because a woman’s wider pelvis increases the angle at which the bones in the knee joint meet, women are twice as likely as men to develop patellofemoral pain.
When to see your doctor
While muscle soreness is quite normal immediately after a workout, dancers should not ignore knee pain.
Knee pain can mean any number of issues related to your knee and leg. Importantly, knee pain over the front of the knee can be caused by cartilage injuries or even cartilage ulcers. So if you have knee pain that is not going away or is worsening, see your doctor to get a diagnosis. The sooner your knee problem is diagnosed, the sooner you can start treatment and return to your regular activities.
4. Hip Bursitis
What is it?
We all have small, fluid-like sacs called bursae (bur-SEE) — that cushion the bones, tendons and muscles near your joints.
Hip bursitis (bur-SY-tis) is a painful condition when bursae become inflamed.
Bursitis is usually felt near joints that perform frequent repetitive motion.
What does it feel like?
If you have bursitis, your joints might feel achy or stiff. When you press on the joint or move it, the pain gets worse. It might also look swollen and red.
What are the causes and risk factors?
The most common causes are repetitive movements that pressure the bursae around a joint. For dancers who constantly sway their hips repetitively, the joint can become inflamed and hurt.
Certain factors can increase your risk of hip bursitis. The older you get, the higher your chances of getting hip bursitis.
If your work or hobby requires repetitive motion or pressure on your joints, you also have a higher risk of developing bursitis.
Certain systemic diseases and conditions — e.g. rheumatoid arthritis, gout and diabetes —can also increase your risk of developing bursitis.
When should you see a doctor?
If you feel that your joints cannot move, or there is a sharp or shooting pain, especially when you exercise, you should see a doctor. Other signs include excessive swelling, redness, bruising or a rash in the affected area. You might also experience fever.
In most cases, bursitis pain can go away within a few weeks with proper treatment, but recurrent flare-ups of bursitis are common. It’s better to consult a doctor if you experience the above symptoms.
5. Knee Hyperextension
What is it?
Knee hyperextension is a highly debated topic in the dance world. In the ballet world, dancers with knee hyperextension supposedly look more elegant, with long, precise lines indicating training and strength. But it is very dangerous when the dancer does not train properly.
What is hyperextension?
Hyperextension of the knee develops when the knee joint bends backwords in extension.
Our joints have a predetermined range of motion available. Muscle length, bone size, cartilage and ligaments determine this range. However, some people are born with naturally hyperextended joints (like ‘double-jointed’ elbows). Others train their bodies to work within a greater degree of movement.
When a person has hyperextended knees, this usually means that they have hypermobile joints and their ligaments are lax. This puts more stress on a smaller area of joint contact points. In addition, their centre of gravity is different and often smaller. With hyperextension, your weight is shifted forward, and your alignment is out, meaning you have to adjust the rest of your body to balance out. In contrast, those with straight legs have their centre of gravity in line with their hips. Hyperextension can progressively stretch out the ligament and capsules, and the degree of backward bending can increase with time.
What does hypertension pain feel like?
When the knees are bent back too far, past the normal range of motion, this movement can cause severe pain and also swelling in the surrounding joints and ligaments.
They might feel a mild aching pain in the knee joint, sharp pain in the back of the knee or a pinching sensation in front of the knee joint.
Dancers may also notice instability in the knee joint. Many people report feeling that their leg is “giving out” while they walk or might be unable to bend or straighten their leg.
What are the causes and risk factors?
Dance movements such as locking their knees when dancers turn out in the fifth position or performing actions like sous-sous can cause a hyperextension injury.
Dancers who have not trained their hyperextension and do not have good alignment are more prone to injury as their posture puts pressure on ligaments in the knee such as the Anterior Cruciate Ligament (ACL), the Medial Collateral Ligament (MCL) and the Posterior Cruciate Ligament (PCL). These are the ligaments responsible for maintaining the stability of the knee.
The ACL is the ligament in the centre of the knee, the MCL is the ligament on the inner side of the knee, whereas the PCL is the long ligament that runs behind your knee. A sudden hyperextension force can cause an injury to one or a combination of these ligaments. Structures such as meniscus (shock absorber of the knee) can also be injured during these movements.
This movement adds pressure on the knee and can cause tears in muscles and ligaments. When the knee joint bends the wrong way, it results in swelling, pain and tissue damage.
Risk factors increase when the person might have a genetic predisposition or they have hypermobility sndrome where they have ‘loose’ ligaments surrounding the knee joint.
When should you see a doctor?
If you suspect you have a hyperextension injury, you may notice immediate or delayed swelling and even bruising of the knee and surrounding area.
Although less common, knee hyperextension can also result in a ligament tear or rupture. These injuries may require surgical repair or reconstruction.
If you notice your knee bending backward, and you experience pain, recurrent swelling or a feeling of instability, you should also seek help.
Conclusion
Many dancers love the workout, the community, and the performative aspects of dance. They might be willing to stretch their bodies to the limits so that they can do the same moves as their favorite dancer. However, dancers need to know that prevention is better than cure. It is especially important to note that when you experience pain around your hip and knees, you should seek a doctor’s advice before you continue dancing.
At Hip and Knee Orthopaedics, we believe that every patient deserves to receive comprehensive and efficient care for their musculoskeletal conditions so that they can gain back their independence in mobility and enjoy quality time with their loved ones.
With a passion for treating hip and knee conditions, orthopedic surgeon Singapore
aims to provide you with quality care by thoroughly assessing your condition and personalizing your treatments to meet your needs and goals.
