Knee pain in a hyperpronating dancer

Knee pain in a hyperpronating dancer (Full Version)

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pvanwell -> Knee pain in a hyperpronating dancer (July 14, 2000 8:41:00 AM)
I am currently treating an 18 y.o. female dancer with medial knee pain and bilateral hyperpronating feet. MMT and ROM WNL. While dancing she either wears specific dance shoes. I do not see a large population of dancers and until now was quite unaware of the specialization in shoewear that exists for them. She predominantly c/o knee pain when or after dancing or when walking large distances. Specifically jumps and leaps and negatiating stairs are bothersome to her. There is no specific single traumatic event. So far I've given her temporary orthotics, aside from some specific home instruction geared toward strengthening the lower kinetic chain and applying ice. She now can walk long distances and has no to minimal pain after a weekend in Chicago. Unfortunately dancing still aggravates her symptoms. Control over specific muscle (strengthwise)does not appear to be an issue. Does anyone have any advice? Is any of you experienced in the treatment of the above complaint pattern in dancers? What, if any, corrective possiblities are there for shoewear that "professional" dancers use? Feel free to address me directly at my email address, or for the benefit of all use this forum. Thanks for your help. Peter van Well, PT Henry Ford Health System Southfield, MI PS: I left out many specifics of my eval, if you need more info let me know.

mcap -> Re: Knee pain in a hyperpronating dancer (July 14, 2000 8:54:00 AM)
Dear Group Member: Dancers are definitely a tough crowd to work with. There is overuse everywhere but they can't really stop dancing. I can suggest looking at two things. One....the hamstring quad ratio. In female athletes it is usually out of balance in favor of the quads. Second is her turnout. Modern dance requires at least 60 degrees of turnout at the hips. Dancers who cannot acheive this will compensate at the knees and the feet. This might be happening. You may try it by assing hip lateral rotation. The best way is to use functional footprints or a similar device designed to measure turnout at the hips only. Also remember that if you are unable to help her, there might be performace med. PT's in your area. Try the international association of Dance Medicine and Science (IADMs). [URL=http://www.iadms.com]www.iadms.com[/URL] Hope that helps....... mcap

pvanwell -> Re: Knee pain in a hyperpronating dancer (July 14, 2000 8:50:00 PM)
mcap Didn't think about the quad/hamstring ratio. Hip ROM for turn out is sufficient and performance of turn out seems normal. She does actually have a patellar tendonitis for which I am treating her and some crepitation was noted in the PF joint. She is still a HS student and does more modern dance than classical ballet. She does have and wear pointe shoes, but apparently most of the time she wears a special dance shoe. It has a heel and toe or forefoot sole , but the midfoot sole is completely missing. She has a rather "flaccid" foot type and severely over pronates. Her primary dance shoe gives no support to the foot whatsoever. I'm still in my mode of looking for a cause of her pain and that way possibly arriving at a solution. Are you aware of any evidence that any form of exercise will help improve a hyperpronating foot? I haven't seen any nor have I recently done any major search for this either. Just thought I'ld give you some more info. SJ As I stated earlier elsewhere, thanks for the referrences. And no, I didn't get any free ice today. Peter.

Dana D -> Re: Knee pain in a hyperpronating dancer (July 15, 2000 4:55:00 AM)
When she does wear her toe-shoes for pointe, does she experience pain? (besides the "normal pain" experienced with your toes cramped in the box of the shoe) (I did pointe for 3 years....) Because, I know that when you are up in your toe shoes, you have extreme plantarflexion and the development of a nice medial arch. Just an idea, but it may be a way to help build the structures/muscles which support her arch, if she is so pronated. What about taping? I have used a taping technique to help correct pronation... I just don't know how durable the taping and all would be while dancing... but maybe it's worth a try... Also, would any type of neoprene wrap or support be able to be applied to her foot, underneath her "nonsupportive dance shoes"... ? Maybe this would help and could be worn during practice rather than shows, as it would probably be able to be seen. Just some ideas! Good Luck and keep us posted [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG] [This message has been edited by Dana D (edited July 15, 2000).]

nicaragua -> Re: Knee pain in a hyperpronating dancer (July 16, 2000 12:01:00 AM)
[QUOTE]Originally posted by Dana D: When she does wear her toe-shoes for pointe, does she experience pain? (besides the "normal pain" experienced with your toes cramped in the box of the shoe) (I did pointe for 3 years....) Because, I know that when you are up in your toe shoes, you have extreme plantarflexion and the development of a nice medial arch. Just an idea, but it may be a way to help build the structures/muscles which support her arch, if she is so pronated. Dear colleague You can use orthotics the soft type. There are two types for low shoes and high heels. You need to use the high heel. Not necesary the problem is anterior pain. It could be anterior coronary ligament, patella tendinitis, neuroma in medial retinaculm. It sound more like just the patellar tendinitis or maybe infrapatellar bursitis. Does she when dancing hyperextends her knees? For patellar tendinitis there is little evidence that I am aware. You could use eccentric loading to the tendon. Sandra Curwin Phd Husson college advocates this treatment. Unfortunetely, she supports her treatment from the evidence of one study of 200 patients. non RCT. But the clinical evidence is good. The program is: warm up stretch tendon specifc exercise repeat stretch * ice to affected area Day 1-2 x's slow controlled eccentric movement 30 rep. day 3-5 rapid controlled eccentric loading to tendon day 5-7 drop and stop or drop and reverse. Very important the person should feel discomfort only after 20-30 rep. Good luck What about taping? I have used a taping technique to help correct pronation... I just don't know how durable the taping and all would be while dancing... but maybe it's worth a try... Also, would any type of neoprene wrap or support be able to be applied to her foot, underneath her "nonsupportive dance shoes"... ? Maybe this would help and could be worn during practice rather than shows, as it would probably be able to be seen. Just some ideas! Good Luck and keep us posted [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG] [This message has been edited by Dana D (edited July 15, 2000).][/QUOTE]

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