How to get rid of knee pain in ballet dancers

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You're listening to the restoring human movement podcast where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales. Hey everyone. This is your host, Sebastian with the restoring human movement podcast. Thanks for joining the movement movement. This is your first time in the show. You've missed a lot of episodes before we started covering things like low back and hip and neck. And now we're on the knee today, but this is a, we're going into more specific populations. So we're going to cover knee pain in ballet dancers today.

And we have Allie Christensen from Align Fitness by Allie, who's also Insta-famous. I don't know the handle of the Insta-famous. What is it? Align Fitness by Allie. Okay. Yeah. So this is Alie. She's going to give us a little bit of insight into the dance world today because she works exclusively with dancers and she's noticed a lot of ballet dancers have knee pain. And so can you give us a little bit about what you think may be happening in common presentations? And I'll just ask you questions around me. Okay. Yeah. Thanks for having me on, uh, working with dancers. We have a very specific type of movement that's happening, particularly in ballet. There's also a little bit of a mindset that goes with that. That's a whole nother discussion. Um, but, uh, dancers tend to ballet dancers specifically tend to do a lot of squat motions.

They don't think they squat, but they do very high knee dominant movements and they don't use their hips very often. Ballet requires that they stay upright. Uh, so their knees are bending out, uh, straight underneath their midline and they're not allowed to let their hips move forward or backwards. They get a lot of knee issues and a lot of knee pain in my experience from not working or using their hips and other ways as, as well as, uh, their foot contact is not always very good because they are shoving their feet into their pointe shoes, which are essentially little brick coffins that don't let their feet move or spread.

I, and they don't have the ability to spread their feet and find contact on the floor. So when we, when I work with them just by getting them to use their feet a little bit differently and, uh, bringing in some hip hinge, I tend to see that their knee stuff dissipates. So the title of this episode is, is how to get rid of knee pain, um, with ballet dancers. Obviously we can't cover all the intricacies of it. Uh, we're just going to give a couple of tips here and there. And by the way, feel free to volley. I know I might be more interrogative style today, but, um, if you want to volley the question, we can certainly make it conversational too.

Um, uh, if you guys do have knee pain and you want something examined, examining and figuring out what is going on specifically for your problem, your body and your knee, that's the most effective route to take. But we're going to cover some very simple things that tend to work very well. Um, based upon what we've seen so far, we've worked with both work with ballet dancers. Allie's worked a lot more, uh, with ballet dancers than I have, but let's just see if some of the simple things, uh, may work for you guys, but always get examined. Yeah. I always tell my dancers, uh, they come to me and they have little discomforts and sometimes they need somebody to, to know where to go to. And I ended up referring them to someone like you or other places.

Uh, but if, if you're having little bit of knee pain, then having somebody who can tell you where to go and what your plan should be, that's the best case scenario. And then most of the time they send you back to someone like me, uh, specialized fitness trainer, movement specialist, and then we get to deal with, uh, what's going on in your knee. But yeah, I guess to give everyone a little bit of a notion too, that typically, especially, um, let's say, uh, children ballet, uh, are, um, adolescent and probably into young adult. Like generally speaking, there's not enough history to have long standing knee pain.

Uh, meaning that if you're dealing with knee pain and you've tried X, Y, and Z and you've tried resting it and so on, it should generally be better, feeling better, not even talking about dance movements, but feeling better day to day, walking, squatting down and so on probably within under a month period of time, well under a month period of time to get back into dance and doing specific movements. Generally speaking, two months, three months to create adaptation around the body. But again, that's not talking about pain. So if you are, have had long standing pain and you're younger than 25, you're probably missing something very simple.

Uh, and it's not because you've done something wrong, but you may need something more, uh, someone to investigate and give you specific help. Um, Allie, what can, what have you seen, uh, the most with ballet dancers that maybe has helped them improve how their knee feels pretty quickly? Uh, I have two things and I've actually done both with you, with dancers that we've, uh, both worked with. So I would say that improving their core makes a big difference and then improving their hip function. Also, uh, we had a, I had a dancer that I'd been working with for a while and she kept having knee pain come back.

So I sent her over to you and you spent probably about four, four sessions with her and, uh, she, you had me come into the office and, and, uh, we were saying, look, like, look how much this has improved. And you guys were doing a dance specific motion. It was a plie. So essentially just bending the knees and straightening again, with her body right on top of her hips. And she was so proud and saying, no, no knee pain. And you were, you were like, look, no knee pain. And I said, one second, I reached over and I pulled her shirt tight and she did it again. And her knee pain was back instantly. What happened is, uh, she changed her IAP.

She changed what she was doing in her torso. All the good work that you guys have been working on went out the door when I pulled her shirt tight, because in ballet they're taught to suck in and up to look skinny and there is, there's a memory to that. So as soon as I did that, the knee pain was back and we had to go into a whole nother discussion. Yeah. So, uh, you said IAP, so, uh, intra-abdominal pressure. Um, you mentioned that, so that what's the, you said is what's the common cue in ballet? Is it suck in? Uh, pull up, pull up, back to your spine. So there, there's, um, there is a study that did way back in the day where they're talking about the transverse abdominus and, uh, how it's a, it's a muscle of the core, one of the many.

Uh, and they said, there's a lot of activity when people hollow, they call it hollowing. Um, and so, uh, there's other tactics now, such as, uh, creating pressure into, usually we put our fingers, uh, on the person and have them put pressure or meet our resistance of our fingers, which creates, um, better stability in the core. We're not talking about strength. We're not talking about endurance. It was generally activating like other parts of the system of the core. Such as, uh, internal pressure, which is sacrificed, uh, for the most part with, with, um, pulling, he said pulling up. Yeah. And so you're mentioning like what the, the problem is that is there, there's the aesthetic of dance.

Right. And so what happens like, so in that scenario with that person, when you talk to them about how to manage that in dance, how did that conversation go? Uh, well, I think one of the misconceptions in dance is just simply that if you aren't doing a pull-up or if you aren't sucking in, then you're sticking your belly out. Uh, and there is an aesthetic of looking long and lean, but what, what most dancers don't realize is that when they have proper intra-abdominal pressure, they're not sticking their belly out, they're not sticking their belly out. They don't look larger than they are. They don't look fat.

Uh, they look strong. And there's an aesthetic with the rib cage that I always point out because we don't, it's ballet has so many things that are single cues. Do this with your ribs, do this with your belly, do this with your shoulders. And a big one that we focus on is pulling in or sucking up. And then this rib cage connection, we don't want the ribs to pop out. So when I can show a dancer that having this proper, uh, kind of feeling through the torso actually provides a very long straight line in the front of the belly and their waistline. And we show them that they're not, I call it the Buddha belly.

You're not making a Buddha belly. Look, your belly looks long and lean. Your knees feel better. And you can actually move with brace when you do this, but you have to show it to them and prove it to them because they have years of training and dance teachers telling them other things. So, um, yeah, so that person you're talking about, like, so, um, I was kind of working with them in a setting of the office. Uh, she had a, I think a normal shirt on baggy shirt. Yeah. So sometimes we change the environment, um, such as going back to dance class or being on stage or changing the attire. It changes the scenario.

And as much as, you know, we'd like to believe that, oh, it's just the meniscus. It's just the patellar tendon. No, the, the stabilization matters. And, uh, sometimes wearing like a, uh, what do they call it? Crop tops and stuff like showing like, um, like all these different dance outfits have different. I wonder if you can almost hide them in something like more poofy that way they would feel okay. You know, like that would be part of the choreography. Um, anyways, though, uh, do you ever get any backlash when you suggest that to somebody and they go back to their, uh, their, uh, teacher, does their teacher say, oh, you got a Buddha belly going on.

You got to get rid of that. You know, I don't have never had anyone come back and say, my teacher said I was sticking out my gut, but what happens is they, the teacher asks for a certain aesthetic or cue. So the dancer might be what we worked on in the office. And then the teacher is sometimes not even saying it specifically to them, but it's just saying to the group, pull up, suck in belly up. And the dancer thinks, Oh, it must not be what they're asking for. And then they do it. And then we're in that cycle of back into pain. But for dancers specifically, I always tell them that the last place they're going to make the changes in the studio, in the dance studio.

Because as you pointed out, being in an office setting, being in a place that maybe they don't feel judged for their aesthetic and they can just focus on proper function of whatever they're working on. It's a different mindset. And then they get into the studio and they're looking in mirrors. They're wearing super tight clothing. They're judging themselves against other dancers. The teachers may or may not be giving the best cues. And the teacher honestly doesn't know what they're going through. They don't know what the process is that you as the practitioner or me as the trainer are trying to accomplish.

They just see or hear the dancer hurts or doesn't hurt. That's all they care about. They don't care how it happens most of the time. Yeah. And I know that maybe the, like, I don't love the pull up cue necessarily for various reasons, but either way, though, like if, like what I, a lot of times what I tell people is that we're, we're choosing a new movement option right now. And this doesn't have to be your forever. Clearly you've succeeded a lot of years with doing a pull up type of cue and it's worked for you and your knee feels fine. However, right now it doesn't work. Every time you pull up, it doesn't feel good.

And every time you put pressure in our fingers, it feels better. So for a couple of weeks, humor us, be a blowfish, you know, like do what you got to do to make it. So your knee settles down and then you can go back to your, you know, we call them quote unquote bad habits, but you'll probably succeed. It may not be optimal, uh, at least in the realm of, I think performance and, uh, and so on, but overall it'll work. There's a lot of dancers that don't have any problem while using the, the tuck up cue. Um, when we're talking, you mentioned hips earlier, improving the function of the hips. If you're going to do that, you need to improve the function of the core first, uh, and the pelvis.

And so that's part of the whole puzzle here is like, if you kind of wonder like, well, why does my knee relate to my core? Well, it's because your hips in the way, you know? And so it can improve hip function. It can make it so you're, what do you call it? Happy hip position. Uh, which then decreases the amount of load and, and effort your knee has to do. Um, can you take us through a little bit of, um, uh, conversation you have with people about, uh, their hip relationship to their knee? Yeah, uh, I, I always, I always point out that the hips are a big structure that they're in the middle of everything.

They connect your upper body and your lower body. Uh, and when they feel what a hip motion can feel like when their back isn't bending or getting too involved, or we aren't putting extra work at that moment until the knee kind of makes sense. Uh, they start to realize that, oh, this is a powerhouse for them. Uh, also pointing out that other athletes that aren't so as, as worried about the aesthetic of it, but just the performance of it, get the ball into the basket, get across the field as quickly as possible. When we start pointing that out and they start to think of the things that they do, I, I think sometimes it makes a connection for them that we can train in a different way and then put that into play in ballet class.

But I see a lot that when we, when we can make the core, a stronger piece. And then I think for dancers, a big piece of the puzzle is learning how to have, we call it kind of a neutral pelvis. I don't always love that term, but figuring out what their middle ground pelvis is. What is the, where's the place that they need to be that is not too extended. And then we call it talking in ballet where they, they try to bring their pubic bone up. It also goes with that cue of pull up, uh, when they can figure out how to be in a more neutral pelvis. They, most of the time, again, when you said in that 25 and under population, where we don't really have long-term issues that have created structure, structure issues.

When they can feel that in most of the time, the knee stuff starts to dissipate and it's an, it's an eye opener of, well, maybe my pelvic position is playing a role in how my knees feel. Yeah. In that pelvic position, obviously there, there is no, um, probably the worst thing we could do is like we're saying, oh, like do it this way, not that way. Um, and all of this is, uh, temporary. You don't need to have your spine or your pelvis always in neutral, like, uh, be a movement optimist. But at this point in time, the way you're doing it may contribute to your knee pain, uh, in, in some form. Uh, and so typically we try to add that back in later.

Um, but usually things like, uh, strengthening exercises for the hip and then, uh, improving the core endurance can really help out, uh, with knee pain. Uh, I know that with, and we'll cover a couple of things that we use in, in a little bit, but I know we keep saying 25 and under, uh, the 25 and up population. It's not that these things won't work for you either. It's just that there's more variables, you know, um, and I don't like to say there's more mileage on you, but there's, there's more history. Um, people who, uh, are a little bit more advanced in age, they might have, uh, you know, repetitive ankle turns on one side.

They turn their ankle 15 times, you know, uh, or they hurt their back when they were 20 years old. And then now they're 50 years old and they've had back pain for the last 20 years and now their knee hurts. And so there's other, there's other stones we need to unturn and address too. Uh, there's just more things to sometimes address, but it doesn't mean you can't get better either. Um, do you have stories of people who over 25 who have knee pain that still succeed? Um, I would say in the last few years, most of the dancers I work with are adult dancers over the age of 25. And, uh, it's, it really does fall into the same recipe with little tweaks.

I always say that when you come to me and when we're perfecting this art craft that you do, we're just creating a recipe that works for you. So you, as you were saying, there's not a perfect placement for your hips. It doesn't have to last forever. Um, it's, it's about the recipe, a little bit of that, a lot more of this for you, a little bit of that. But we, I do tend to see that for dancers, dancers move like dancers move, whether you're young or old. Um, the, one of the variables I think that comes for older dancers, I see a lot of females who have given birth. And since that time, then there's a big marker of, um, I'll say dysfunctional movement or movement that is causing dis-ease in their body.

Uh, and most people can kind of tie back to something like that when they're a little bit older, if they've given birth before. Yeah, well, and, and, um, I mean, pregnancy is, uh, I think it has a diagnosis, diagnosis code is actually, it's a condition, medical condition. Um, and it's nine months of doing things differently. And, um, the female body actually, from an anatomical perspective, it actually can take more, uh, it's kind of, the low back is actually, uh, the architecture will take more extension, uh, because of the front loaded, uh, baby weight. Um, so it inherently does that, um, but sometimes people dip their foot into the injury pool and they don't come out of it after pregnancy.

Um, I've seen a lot of people, dancers and not dancers have longstanding hip pain, groin issues, sometimes knee ones, back ones, uh, after pregnancy. And, um, it's, it's really funny. I mean, everybody's different when it comes to pregnancy, but, uh, I feel like in our culture, it's like, you're pregnant. Don't do that. Let me do it for you. But you know what? You had the baby. Yeah, I got to go to work. Can you pick up all this baby stuff and put it in your car? Like you go from like doing not much of anything, some people, uh, into doing a lot and holding a baby too in nursing and so on. Obviously everybody's different.

Some people stay more active. Some people go on bed rest. You know, it's, it's a low, low activity to high activity spike, uh, or just a change of activity. And so sometimes it results in load loading of different joints, including the knee. Yeah, I absolutely agree. And, you know, we're not, this is not the topic of the podcast, but since so many people experience this, uh, you know, most women over a certain age, well, it is a big landmark and it is a big change and you hit it right on the head. It's, you don't do anything, the, if anything, the last few months of your pregnancy, you go through one of the most traumatic things.

Your body will go through. And then one week later, your partner goes back to work. You are left lifting 25 pounds and there is no rehab. There is very little attention to your body after. And then we wonder why, uh, as you're trying to get back into dance, as you're trying to get back into your life, why are my knees hurting? Why are my hips hurting? Well, we did, you were not given the opportunity to take care of your body. Well, you know, too, like if you think about like, so like some people, although they, you know, they have like poor core strength and hips that don't work. Some people, the issue is just too much too soon, or we call it load management.

Um, I don't know if you were having, um, some of the people that you work with were like the, all of a sudden the choreography changes, the, and they have to do a bunch of, um, grand plies. So the ones where you go all the way down, all of a sudden you do take 200 grand plies a day. And you're like, well, I haven't done more than 50 in a day. So if you think about, if you hold a baby up, like you're holding a baby against your chest, can you pick up something you drop without you? Like it's, it's a, it's a grand plie. Like you can't, you can't hip dominant that you can't deadlift, whatever you pick up.

You have to squat or lunge. And it's a lot of volume on your knees. Um, anyways. Yeah. No, the, the volume is a big thing that, uh, I think dancers don't take into consideration or sometimes they do, but I don't, it's, I don't think it's at the full grasp of it. We, around a performance season, I, when we get towards the holidays for a lot of dancers, it's nutcracker. They go from taking class anywhere from five to 15 hours a week. And then they add another 10 hours of rehearsal. Not only is it more volume, but it's the same movement because it's choreography. So it's the same motion on the same leg over and over and over.

Uh, and they become very one-sided, which is one of the challenges of dance is we all, we always say we have a good side and a bad side. Or I have a good standing leg or a bad standing leg. And most of that doesn't come from your personal preference. It comes from the type of choreography that you're exposed to. And then doing that choreography over and over and over. And your body starts to have a bias. Uh, and we have to balance that out. And a lot of time that starts with the hips. You know, uh, this probably, I don't know if it's a good answer to this, but is there a, you call it a character in nutcracker?

That would have the highest tendency based upon the choreography for knee pain. Oh, I don't, I don't know what answer. I want to say most of them. Um, there's not one person that does like more. No, I mean, there's a, as you, as we've said, there are movements that won't bother some and will bother others. There's the, the Russian dance. That's to talk about grand plies, grand plie, pop up, grand plie, pop up. It has that traditional Russian motion. And if I tried to do that because I don't do that motion right now and I haven't trained for it, my knees would feel it. Uh, but that dancer probably feels okay because they've been training for it.

But if that's all that they did and didn't do other things, they would start to notice it. But if you took Clara and said, now you have to do Russian like that, she would probably feel it with her knees. Yeah. Now we can obviously diagnose them with patellar tendonitis or like conglomerular patella. Like you can stick a label on it, you know, like there's, there's diagnosis you can throw around, which wouldn't be wrong. But at the same time, if she just conditioned her body better to do the Russian, she probably wouldn't have it, you know, like, so the, the excessive loading can create the diagnosis.

It doesn't make it so the area becomes damaged, but it makes it become painful. And then you get labeled with a diagnosis and treat it appropriately, or just say, or they usually tell them just don't do it. No. Yeah. Take six weeks off is a common when you could find a practitioner. Most of the time it's honestly, most of the time it's like a general MD that says, I'll just take time off. And then dancers don't, can't hear that because that's not the sport that they're in and they ignore it and they don't take care of it. So there are many practitioners who will know how to work with you to modify, modify is one of the biggest things for dancers.

I think in a year, you will experience a time where you have to make a choice of how to modify your movement. So you can keep dancing or keep moving and that's okay. The modification shouldn't last forever, but if your volume is up, we're in nutcracker season and you are working to make your knees feel better with someone like you, then if you need to cut out some of your grand plies, fine. Just for a short time so that you can build to perform, build to a better, stronger knee. That's, that's okay. But we, I think we forget that modification isn't always a bad thing. It just needs to be purposeful.

Yeah. The, uh, I know in, in, in some sports there is like, like they modify it, you know, in practice, it's like, uh, let's just, uh, not take as many swings in baseball in lieu of playing and swinging all in the game. Um, and so you're cutting down your volume a little bit, um, in some sports, you actually almost get to the point of the injury, probably in any given game football, maybe, you know, a lot of contact, but you know, you're kind of saving, uh, saving a little bit of the reps for the game or the performance while not having to, um, expose your body to an injury pool, like continually throughout the week, but also recognizing that you're sticking your foot in, you know, and that's just, that's, that's your choice.

So you don't have to do Nutcracker, like you can, you can choose to not do it if your knee isn't tolerated. But, um, since we are on the Nutcracker and this is probably going to release right around Nutcracker season, then, uh, why don't we talk about some things that you typically suggest to the, to the people that you train to help them condition their body to do well in Nutcracker and maybe offset potential knee pain? Yeah. Um, my biggest, my biggest one that will sound simple is take a rest day. Nutcracker season means that most of my dancers go from dancing five days a week, which is a lot to dancing seven days a week for eight to 12 weeks in a row.

So, and then they go right into audition season and then they go into, uh, competition season and then we go to summer intensives and then right back at Nutcracker. So make sure you're taking a rest day so that your body can recoup and you're giving yourself adequate nutrition and water and rest. And you're taking care of your mental state, uh, with your exercises. Uh, I always suggest that you think about your core work in a very simple way. If you have never worked with me, uh, then you're thinking of something that works your front belly, your side belly, your whole body together, like a plank.

Some glute exercises, and then some standing work like squats or deadlifts. So you have five really simple categories to make sure that you're hitting kind of as a warmup for yourself. Dancers are known for stretching as a warmup, which is not a warmup. Stretching is its own classification. It's its own thing. So your warmup should be something that gets your blood pumping and then uses the muscles that you're going to be using in ballet. Stretching is not that category. So, uh, before class and then during rehearsals, if you can keep one of the hard things about rehearsal is you move for 20 minutes and then you stand for 40 and then you move for 10 and then you stand for 30 or you sit down.

So it's a lot of hot, cold, hot, cold. So when you're getting ready to go back onto the floor, you're not sitting in your stretch. You're doing five minutes of front belly, side belly, whole torso, glutes, and standing things to warm yourself up. And I think if you can do that, you're going to take care of your body a little bit better for the season. You know, I already, uh, bring something up before where, um, I don't know if this is with nutcracker since I'm not in, not a dancer, but with, um, you mentioned that there's warmup in every class. Sometimes people take multiple classes one after another.

Um, did they need to warm up between classes? Is it the same warmup? Um, do you know what I mean? No, uh, in an ideal world, you remember that you're, you, you go into the studio before you take class. So there's a lot of parts of being a dancer, which is why it's hard. So you go in before you take class and you do a warmup and this would ideally be something that gets your blood moving and you start firing up the muscles that you're using. No stretching yet. Then you would take class and ballet classes designed pretty well. You start with plies and you start moving your feet and your legs into higher ranges.

But in between those exercises are your times to make sure that your body is prepared for the next exercise. And I would think of this in an activation realm, again, not in the stretching. Then when we get towards the middle of class and end, that's when you're going to start seeing more stretches into it. Now, if you're taking multiple classes or multiple rehearsals, your warmup is in between each thing is still looking similar, but maybe not as intense as it had to be at 9am in the morning. But we're not, I don't want to misquote this, but I remember reading something that was talking about the capacity of your muscles.

And if we're looking at the power and capacity that it has in its fullness before you stretch, especially before you passive stretch, that's 100%. After you sit in a stretch or after you stretch, it can take anywhere from one to, I think, four or five hours for that ability to come back to your muscle to be able to move and fire and have the power. We focus so much on flexibility as dancers that we don't always think about how we're supporting, creating stability and stabilizing the area, which would be your hips, your core and your knees so that you can perform all day in that rehearsal. Yeah, I know that you're referencing that there's been, there's been various studies where they talk about it.

Usually on soccer players, they do it. They measure sprint time. I forget what distance, but it didn't really matter. Then they stretch the hamstrings and they sprint again and it's significantly worse. And, um, I remember one time I was working with this, uh, this, this, uh, one athlete, they were about to go out and do a, um, this was a weight training athlete. And they said, I'm going to do, um, power cleans. Uh, and I said, okay, so what do you want from me? And, uh, she says, I want you to stretch my, stretch my leg. I said, why you're going to do power cleans? Uh, and she said, it works for me.

And, uh, so we did it. Um, but you know, knowing that it would probably decrease her performance, that's what she wanted. Um, either way though, um, there is benefits to stretching. And obviously if you, uh, have pain and stretching reduces your pain, uh, and it was prescribed to you, it's probably easier to just do something with less power and performance and eliminate the pain. Uh, but if you're feeling good, why, why, why mess with it? You know, um, for the, for the last few minutes of this podcast, why don't we just, um, uh, you, since you're more in tune with the dance world and what dancers are thinking, what are some common things that, that dancers will believe about their knee or what they've been told to do?

And then I could answer medically. Uh, that's a good question. Uh, I think that dancers get told that if they have knee pain, their quads might be too tight and then they get recommended by someone who should not be recommending anything. To maybe, uh, foam roll or take a ball and massage out the quad. Yeah. So, um, I probably for all these, all these things that, um, they're probably given because they've worked for somebody over time. Um, I can't discount that, you know, like you look on a, I don't know if they had dance forums, but they have like forums of all these different things. And someone says, you know, I had knee pain.

I stretched it. I foam roll it. It went away. It did. It worked for them. And then all of a sudden it, there, it gets to you and then you feel better or you don't. And if it doesn't work for you, it's not right. Like we mentioned earlier, there's a general timeline thing should improve in, uh, uh, quad stretching may or may not be the thing. In fact, if your knee is a flexion intolerant knee, like we say, it's a, like, it doesn't tolerate full grand play. When you stretch the quad, you put it in flexion, you provoke it. Like you're creating your own problem unknowingly. Uh, in that case, uh, you may try something different.

Um, something like hamstring curls might work a little bit better, glute facilitation, or even treating the knee in the opposing direction. Such as if it's fully bend, if full bend bothers it and it creates pinching or swelling, you would treat it with the opposite. Um, and usually that's like a knee extension protocol. I think PTs have things like they call it quad sets and so on, uh, something that is challenging extension, which is not painful. And it pumps the knee, um, pumps the knee nutrients around and helps the cartilage and so on. Um, another one, well, another issue that's really common is hyperextension in the knee joint.

And dancers love hyperextension because it makes their line or the aesthetic of their body look more like what dance is asking for. Um, but when they have pain and maybe when they're starting to straighten their knee, uh, dance teachers or people will tell them just to pull up in their, their kneecap more, which essentially in my experience means that they end up trying to push their kneecap back towards the back of their body, towards their hamstring. Um, and they end up going into more hyperextension and creating more pain. Yeah. The hard thing is like, so I'm not quite sure how many dancers have hypermobility.

Uh, I know a lot. So I know you, but, um, people are typically hypermobile in different locations too. And so there's, um, I think it's bite and scale you can do, uh, which is a series of tests. Would you see if your elbows are hyperextended? Can you fit, uh, your whole finger, like, uh, create a bracelet around your own wrist? Can you bring your fingers back and touch your own wrist? Uh, knee extension is one of them. And so there's things that would, um, uh, test to see reasonably speaking, if you have like a, um, uh, kind of, kind of like a, um, connective tissue disorder, uh, which would be a variety of different things.

Uh, however, I know you've done a podcast with an expert on that before. Um, uh, simply put at least for, uh, for coaching of that, uh, anytime you use like an internal cue, like bring your kneecap, bring your quad, bring your hip. Like that's you trying to command your own body to do something and it's, uh, generally subpar when it comes to, uh, interventions and coaching someone through movement. Um, I think what was one of the, the, the dance cues it's, I want you to blow in the wind, like a ribbon. You know, it's like, it's not you, it's the ribbon, right? Um, or I know you use push the floor, spread the floor.

And so it links up the joints a little bit better and it creates stabilization around the knee rather than putting it in a wonky position and then putting your whole body weight onto it. And so, um, that's going to take a little bit more of a coaching cue to correct. I wouldn't call it a disorder and maybe a laxity problem, but, um, uh, there's probably more in your court. Now, uh, how long does it take for someone to actually incorporate a, like better stacking in the knee when they actually dance without having to think about it too much? Yeah. I mean, the honest answer is it can take a few months.

It's, it's a hard one. It's a really hard one, especially if you're getting cues that are not helpful to you. Again, a cue is just something that works for you. And, uh, we, in the dance world and in the coaching world, I think we, we stick with cues that seem to work. And then if you're a good coach, when you see something that's not working, instead of saying, oh, you're not strong enough or you're not getting it, you think, how can I change my cue to help this person get it? In the dance world, generally we have very similar cues that have been, I mean, I had the same cues that were passed down from my teachers and they're still being taught today now 50 to 80 years later.

So, uh, if you're a dancer who's working on this and then you have it in the office with a lot of thought, then you go in the studio and you're getting cues that are almost, that will say triggering to you or making you redo a form or habit that we is not desirable for your knee. Uh, it can take time. So you really have to, in, as the dancer, I always tell them when you hear pull up, when you hear straighten your knees, you're thinking, push the floor, you're thinking, uh, be a rubber band, whatever it is. So that when you hear that there's a switch and it's not, we're retraining our brain to think of something different, but it can take some time.

Yeah. Okay. Um, any other important one before we finished up on the podcast today? Um, I think that, uh, the knee placement over the toes gets discussed a lot. Oh, don't put your knee past your toe. Yeah. Not putting your knees over toes is completely false. Like, um, we've known that for years. It's taken a long time to trickle into the actual, um, uh, athlete and general population community. I'm not quite sure who, who originally said, don't ever put your knees over your toes, but it's completely false. Um, try to do a grand play without putting your knees over your toes. You can't, you will fall backwards.

Like there's, it's impossible. Try to walk up and downstairs without putting your knees over your toes. You can't like, it's impossible. Now, if you did a, uh, a squat, like with as much load as you possibly can over on your back, like a back squat, um, your knee is still going to go over your toes a little bit, but it's not as far, you know? So, um, yes, put your knees over your toes, do your body a favor, unless it hurts in that case, reduce it and then add it back in. Um, but yeah, that's completely false. Um, I'll change, I'll reserve the right to change my mind and it's all circumstantial, but right now, uh, yeah, don't bother with that idea.

Yeah. And I think dancers, if you're a dancer listening, if you were to watch yourself or a good professional dancer in slow motion, like taking off for a grand jette or even transitioning through a single leg to do a double pial. So cone on point or something like that, you're going to see that their weight, their knee goes past their toe. And just to clarify, as a dancer brain, we're not talking about, um, like the turnout or the placement of the knee in line with the shin over the toe. We're talking about how far the knee can travel past the toes in your plie or grand plie. Yeah. This is a motion that it's a transition motion for dancers.

It's something that means you've shifted your weight and moved into the next thing. It's grand plie is a stat is a more static position, but the rest of the time that you use that it's very much a motion. And that is where most people's knees hurt. So if you want to work on that outside the studio, you've got to mimic in some ways what is actually happening in the studio. It's fine. Uh, one of my friends did a re a workshop recently about knees, ankles, feet, and in my office. And, uh, he did a section because it's, it's just so generally like blown out of proportion. He says, uh, okay, so, uh, now we're going to work on the knee.

I'm going to put my knee over my toe, my knee over my toe. Watch out, watch out front row. My knee cap's going to explode. Watch out bits and pieces all over your face. Just joking. It won't happen. Um, completely false at this point in time. Anyways. Uh, cool. Uh, how can everyone reach out to you, Allie? Uh, I'm on Instagram and my website is align fitness by Allie. Uh, and you can reach out and let me know that you've heard us here and you have questions. I'm happy to answer them. Uh, Sebastian and I work pretty closely and, uh, we're always open to collaborate. So it's a good little team. Yeah.

It's good stuff. Uh, so, uh, subscribe to the podcast guides. If you haven't already, we do some periodic things on dance. Uh, Allie, is your podcast still active right now? Or did you pause it for a little bit? It's still active. It's not as, I don't post as often, but it's still there. So she goes mainly a lot of dance related topics. Um, it's, it's all dancers. It's called beyond the point, beyond the point, you know, point has an E on it. No one, no one ever knows that. I did. I, the dancers know that it's very dance specific. So yeah, listen to her podcast. Uh, she does a really good job at doing dance specific topics.

Um, but yeah, subscribe to this podcast. If you want to learn some more, uh, about knees and hips and shoulders and so on, we don't always cover dancers specifically, but there's a lot of good information. on the podcast. I think that you guys would enjoy really well. Yep. Cool. We'll see you guys next time.