Expert: Dr. Victor Dolan, DC, DACBSP - 7/12/2008

Question
Im 16 years old and i have recently started back to dancing after an injury about 2 and a half years ago. I was in middle of doing the spilts when i fell and heard a pop, then i looked and saw id dislocated my left knee, ever since this incident my knee has been very painful occasionally and feels weak. I started dancing again a few weeks back and i now do urban/street dancing but i would reali love to start ballet, however i am aware this type of dancing puts huge strain on your knees. So i was wondering is it a bad idea to start ballet with my injury or do you think it will make it stronger? Of course i will seek doctors advice before i start the dance class but i decided i would ask your advice first.
Thanx a million.
Amy.

Answer
Hello Amy,

First of all, at 16 years old I am not comfortable 'speaking' to you without a parent or guardian.  So I will comment on these issues, but these comments are in general and not specific for any 16 year old in particular.

Of course someone with a knee injury- ie kneecap (patellar)dislocation should see a sports injury (dance injury) doctor.  In the Medical Doctor world that would be an orthopedic MD (orthopedist) or perhaps a physiatrist.  In the Chiropractic arena, there are Doctors with additional credentials also, in sports injury (DACBSP  see www.acbsp.com) or orthopedics (DACBO see www.Accoweb.com).  This Staten Island Chiropractor is a DACBSP, treating many athletic/ sports type injuries every day.

If someone with a knee/ joint/ bone injury is young, one consideration is bone growth plate involvement.  Growth plate involvement is probably not involved given the description here, but when being evaluated by an appropriate health professional; an adolescent patient should be screened for any possible growth plate involvement.

In females there is something called the "Q- angle".  Q-angle has to do with a wider pelvis (for possible child bearing) creating a larger angle at the knee joint, creating a greater possibility of kneecap dislocation.  Certainly males can dislocate a kneecap, but it is much less common in males then in females.

Usually the FIRST time we dislocate a joint- ie the kneecap or a shoulder,,,, the first time it dislocates,  the joint usually re-locates itself (it 'pops' back into joint on its own).  If and when dislocation happens again, the re-location of the dislocation is less 'automatic' and starts to require skilled reduction of the problem by appropriate professionals.

Once it occurs, it is easier to happen again.

I know this sounds silly--- but the more often it happens, the easier it is for it to happen, and the more often it will happen when the joint is under stress.

If it happens , even just once, evaluation and treatment by appropriate health professionals should take place.  This could be the MD, the Doctor of Chiropractic, and or the physical therapist.

The kneecap can dislocate/ spontaneously reduce with no damage; or perhaps damage could have taken place- that is why professional evaluation is needed.

If it happens, even just once, after evaluation; appropriate exercises should be performed to lessen the likelihood of re-occurrence. Strengthening the quadriceps, particularly the vastus medialis should help the kneecap track properly see: http://weightlifting.cowebz.com/leg-training.htm . I would recommend doing lower leg extensions- even without any weight at all- tightening the quadriceps, with the toes pointed outward.  You can do this sitting in a chair as long as no one is close by to your chair.

Interesting website articles:
 http://www.chiroweb.com/archives/21/24/03.html  
       http://www.answers.com/topic/q-angle?cat=health  
  http://www.triadfitnessadvisors.com/article_qangle.htm  

In my Staten Island Chiropractic office , I see a lot of athletes- from young high schoolers to old weekend warriors. Appropriate treatment and exercise not only is good rehab but good prevention as well.

I hope this discussion helps inform you as to Kneecap dislocation (assumed to be lateral dislocation), knee injuries in female adolescents.  This is not specific recommendation.  Specific evaluation, DX, TX, PX can only be made in person by an appropriate health professional.

Wishing you good luck, dancing success, and good health naturally!

Dr. Victor Dolan, DC
http://drvictordolan.chiroweb.com  (email newsletter)
http://www.DocDolan.net
http://www.GoodHealthNaturally.info