This section of Damhsóir features articles written for us by Hullachan designer Craig Coussins on protecting your feet, toes, arches and heels.

Dance Injury & Prevention: The Knees
by Craig Coussins

Craig Coussins started training as a dancer in his mother’s school in the West of Scotland well over 50 years ago. He started fitting and designing shoes made by the UK’s oldest dance shoemakers 30 years ago and has designed many award winning sports and dance shoes. He retired in 1995 to develop shoes closer to his Celtic roots, including shoes for Irish and Highland dancers.

Starting at the lower part of the femur, the knee joint is one of the most difficult of joints to heal if damaged. Most of you will know that a sprained ankle can heal relatively quickly but a sprained knee can take up to three times as long and indeed may never recover fully. The knee is very delicate and is one of the most complicated joints in the body. I will need more than one article to cover all the things you need to know.

Many muscles, tendons and bones fit into this area and although they essentially make a straight up and down action, possible, slight rotation is possible when the knee is bent.

I need to explain a little technical information here though to understand the problems you can have with the knee. The Patella is not part of the knee joint although it is called the Kneecap. This is because the Patella is attached to the main lower leg bone below by ligament tissue and is attached at the top by the muscle on the front of the thigh. This muscle straightens the Knee Joint.

The complicated arrangement of Ligaments in the Knee holds the bones together in a horizontal and vertical fashion. Problems of the knee are as follows: Too much kneeling can cause inflammation of the main bursa. If a dancer comes down hard on the knee, a swollen bursa or one of the fluid pockets that sit in between the joints may start to leak causing extreme pain and stiffness. This can be serious.

Normal bending and stretching the knee will cause little or no problems for the average dancer, as the ligaments are tight, protecting the knee joint. However, in a partial bending or flexed position the ligaments are looser across the knee joint that in turn destabilizes the joint allowing more movement than the joint can safely take. What happens in a simple movement, such as a transfer of weight from one leg to the other can put a strain on the ligaments and while the muscles that surround the knee can take this strain, any sudden twist can cause too strong a pull. The ligament then stretches or drags the cartilage, or connective tissue, which in turn can dislocate or move. Movements that can cause this include any slight rotation of the performed with a relaxed knee and can start the problem that will move the cartilage eventually.

Any movement that increases rotation of the knee must finish each rotation by straightening the knee joint using strong extension as a counter active movement. Treatment is difficult and can leave the knee permanently weak and therefore liable to reoccurrence of trauma or injury.

Pulling Up

The knee locks when fully straight but just before it locks; a small muscle on the inside of the thigh locks the joint with a small rotation inward and unlocks with a small rotation outward. Your teacher may ask you to pull up through your thighs to lock your knee joint. The problem arises when the child is a little too enthusiastic and the Patella is pulled up.

This can cause either the ligament attaching the patella to the lower leg bone or the tendon of the muscles at the front and at the back of the knee, to stretch. This will result in pain above or below the knee. Rest and treatment is advised for two or three days and you must watch that the child does not jerk or pull the knee while at exercise.

Although I have explained that pulling up is in fact a locking action, this is different from a knee that actually locks by itself or indeed a knee that gives too easily. The causes are possibly a patella slipping or cartilage being pinched but the knee may recover temporarily. The dancer must get to the doctor or specialist to ensure that there is no inflammation under the patella or other condition that may re-occur. If inflammation is discovered it could lead to a complete stop to dancing. Overuse of a weak joint or a joint inclined to this condition could bring this about.

Dislocating the Patella

Let’s look at the dislocation of the Patella. This happens mainly to female dancers. The usual thing is that they feel is a partial dislocation as it goes out then clicks back in. If the kneecap actually goes right out of place, one should first look at whether the thigh, front muscle, is out of condition not strong enough or perhaps the dancer has poor leg alignment. It usually happens to girls because of the wider hip placement gives an increased angle of quadriceps pull on the tendon. It may be caused by another dancer accidentally kicking the dancer in question when the dancer is relaxed and this will make the patella slide over and lodge in the lateral aspect of the knee.

Not turning the knee out and over the foot the foot on the first step of a jumping action from one leg can force the Patella to be pulled latterly. The dancer is unable to move his or her leg in a semi flexed position. If it happens, then R.I.C.E. therapy, cast or rigid bandage should be used with a two or three week layoff.

Well-aligned knees tend to give little if any trouble. It is when the student has knock-knees and those with sway back legs. Also, look out for dancers with short hamstring muscles; identified by being unable to straighten their knee joint without some effort.

Knock Knees

Knock-knees are loose at the joint and makes dancers unstable and may affect the muscles, ligaments and structure on both sides of the knee. Some dancers unfortunately turn out from the knee instead of the hip and knock knees allows them to do this simply. The main lower leg bone is slightly turned out and allows the necessary movement to turn out from the knee. The results are strain on the foot and the knee with secondary strain on the upper outside thigh and eventually the hip and lower back. Knock-Knees are the result of an exaggerated slope inward from the width of the pelvis. Girls are more prone to the pelvic situation where they have wider hips than boys have and therefore have a greater slope inward.

A teacher should ask the pupil to stand facing away from them with their knees together and feet slightly turned out. If there is a gap at the heels greater than one and a half inches then the pupil may have some difficulty studying for advanced work as the shape of the knees can stop the dancer performing movements correctly. Subsequent forcing could then damage some ligaments. The resultant stance will invariably also show that the dancer rolls in, as this is normal in Knock-Knee condition. Although not a curable condition, there are specific anatomical examples that you should know about. This may help in slight improvement.

Very young children may grow out of this condition due to the flexibility of the skeleton and the unequal development of the two knee bones or condyles. The child can appear knock-knee at three or four then completely recover by five or six. As the child gets older and the bones get progressively harder, the condition becomes irreversible. Rolling in or out are conditions that can be helped if caught at a young enough age. Trying to change the line of the foot at a later age will put stress on other areas of the feet, legs, knees or hips.

The neat strong type of child can work through this condition with a degree of Knock-Knee up to two inches. In a thin or tall child, there may well be some looseness at the knee joint that will identify later trouble.

Speed will be affected, as will be good elevation and good elevation. The push up from the floor is not taken in a straight line from foot to hip as determined but through an angle at the knee joint that will of course put strain on feet and knees. Alternatively, dancers with a stiff knee as opposed to a loose knee will experience strains of the ligaments, cartilage problems and possible inflammations.

The articles on this website have been written by Craig Coussins and edited for the web by Damhsóir. Questions regarding article content should be directed to Mr. Coussins or visit or Hullachan Pro.com .

Advice given here is just that -- advice. If you are suffering from an Irish dance injury, please see your doctor for treatment.

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