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Preventing knee injury
- Veena Basavarajaiah, Bangalore

November 17, 2011

Most Bharatanatyam dancers at some point in their professional careers have experienced knee injuries. While some injuries like sprains have lasted for a few days, ligament tears have resulted in the end of many dancing careers. Is it the form itself or the mode of practice that makes the knee most susceptible to damage and causes excruciating physical pain and emotional trauma?

The technique of Bharatanatyam requires the dancer to stay in demi pliť / araimandi for long periods of time. While dancing in this posture, the lower back, gluteus, thighs and feet are at constant work. Extensive foot work, the full pliť / muzhumandis and lunges exert additional pressure on the knees. The 'araimandi,' an essential aesthetic of the form is not natural to the body. It takes years of training and building strength to attain a good 'araimandi' and many people with short Achilles tendon will not be able to achieve a deep pliť because of their body structure itself. Teachers must be aware of the limitations of each individual's body and not push every student to dance in a deep demi pliť.

The knee is a joint that is supported by the muscles of the upper leg (quadriceps) and lower leg (gastrocnemius/calf muscle). These muscles need to be warmed up effectively before dancing and compulsorily stretched after practice. Stiffness in gluteus muscles (the muscles in the buttock) sometimes can lead to serious knee injuries in many dancers. It is very important to understand that the pain, the cause of pain and the injury are inter-related but do not necessarily mean the same thing. For example, a knee injury could be caused due to a bad posture in the back. It could also be caused because of improper walking technique. Some dancers never develop knee injuries in their youth but suffer extensively as they grow older. It could be because of their genetic make or a weakness developed in the body due to illness, like Arthritis.

Knees have to be correctly aligned with the toes while standing, walking, running, jumping, ascending or descending stairs, lifting weight and dancing. The weight should be properly distributed through the feet and the core muscles must be engaged to reduce the impact on the knee. Warm-up and cool down has to be incorporated for safe practice. The body weight also plays an important role in injuries. Being obese means more weight and pressure on the knees and ankles. Extra care should be taken to keep the knees warm while dancing in cold environment. Adavus executed on a stone / concrete dance floor can damage the knees for life, so due care must be taken to practice and perform on sprung / wooden floors.

For prevention of injuries in the long run, regular massages, Pilates or core work, Yoga or cross training in a different physical activity that uses different set of muscles like swimming is essential. Asanas such as ardhamatsyendrasana, marichyasana, gomukhasana, ekapada rajakapotasana, janu sirsasana, virasana and balasana can be excellent postures for stretching those tired legs and knees. Simple treatment for injuries would be to protect, support, rest or ice it based on the intensity and the cause of pain. In case of severe injuries like ligament tears and fractures, medical help has to be sought and the knee has to be rehabilitated with physiotherapy.

Veena Basavarajaiah is a Bangalore based solo dancer and choreographer who is trained in Bharatanatyam, Kalaripayattu, Ballet and Contemporary dance. She has worked with Shobana Jeyasingh Dance Company, Angika Dance Company, Attakkalari, Kalari Academy, Gati Forum, Nritarutya, Natyantharanga & Yana Lewis Dance Co. She has performed on various platforms across India, UK and Europe. She is the recipient of Special Mention Young Achievers Award in 2007 and also a paneled artist of the Indian Council for Cultural Relations.

The knee has one degree of freedom - but unless the musculature is perfectly strong, the knee twists, and leads to injuries. Having enough strength to move the knee in the right direction is not the same as having the strength to keep it from twisting wrongly.

The back and knee are two things that are compromised for 95% of people including athletes and dancers and even so called martial artists.
Tendon strength and flexibility training is often ignored, since it takes long and shows no visible results.
To be in any physical art and survive intact, one needs to study various disciplines including anatomy.
- Vivek (Dec 7, 2011)

This is one of the areas where more studies are needed by persons who possess the knowledge of Bharatanatyam and a medicine degree. A full time dance college or an institution must include the human anatomy as basic subject to study these injuries. Have any conventions dealt with this subject? Is there any person who can we reach regarding this issue?
- Prasanna Kasthuri (Dec 22, 2011)

Knee injuries also have psychological implications in recovery. The feeling of helplessness and despair is one I'm sure many dancers have experienced. It's important to be positive and patient. No two rehabilitation stories can be the same. An online community for injured Bharatanatyam dancers would be helpful I'm sure.
- Monisha (Feb 16, 2012)

Anterior Cruciate Ligament (ACL) is a common type of knee injury in athletes. Its symptoms are joints that easily move beyond the normal range expected for a particular joint.
- Anjlena Julie (Sept 27, 2014)

This is very common with dancers especially with Bharatanatanatyam dancers that they face knee injuries. They should take care of the dancing etiquette so that they can keep them self safe from any kind of injuries. For any kind of little pains they can use Tiger Balm white ointment that is perfect for pain relief treatment.
- Elaine James (21 Jan 2015)

Knee arthroscopy is a surgical method that can detect and treat problems in the knee joint. Of course, there are other conservative approach wherein you will be just on medication for the knee injury.
- Dr. A.M. Rajani (March 2, 2017)

There are two very useful books to help prevent and treat knee pain; Fix Your Own Pain by Dr Jolie Bookspan and 'Trigger Point Therapy Workbook' by Clair Davies. Trigger points are small points of tension in the muscle that can be caused by many reasons, including overuse. Knees have no nerves so if there is pain, it's coming from tendons and muscles, most likely trigger points in the muscles.The book allows you to diagnose and self-treat with massage. If TP's aren't treated they can weaken muscle and result in injury. The book by Dr. Bookspan explains the posture defects that result in knee pain and how to fix them e.g. when ascending stairs, keep the weight on the heel so that muscles, not the knee, are doing the work. The posture in dancing where the knee is bent way over the foot is the one likely to cause injury. Surgery has been shown to be no more effective than doing nothing. Knees heal slowly and you need to keep pressure off them while doing so, but they also need a lot of motion to heal properly.
- Anon (April 30, 2017)

There was a good blend of medical info that went well with info from Bharatanatyam practices. The concision was also very good, and this serves as a nice primer to the full article. People who do this must be very skilled!
​- ​BostonInjuryMassachusetts ​​(Oct 4, 2017)​

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