Hyperextension and Bowleggedness

Considered by many to be part of the singular beauty of a ballet dancer, the hyperextended knee is actually a misalignment that can cause serious injury. Bowleggedness, on the other hand, doesn’t endanger a dancer’s health, yet can be just as frustrating, because the lines of the body don’t conform to the dance aesthetic.

As a dance teacher, it’s important to be able to identify these tendencies in your students and work with them accordingly. Fortunately, both are relatively easy to diagnose, and there are some simple ways you can help your dancers perform to the best of their abilities and avoid injury at the same time.
Hyperextension is the extension of a joint beyond its normal range of motion. It occurs in the knee when the joint extends beyond a straight line, causing a convex curve at the back of the leg. Dancers with hyperextended knees tend to have very loose ligaments, also known as ligamentous laxity, which allows the knees to lock back. Typically, this condition exists from birth.

While hyperextension generally results from loose ligaments, bowleggedness is a bone misalignment that’s caused by the way the tibia and femur articulate, or connect with each other. Bowlegs occur when the bottom part of the femur is longer on the lateral side than on the medial side, thus forming an uneven connection with the tibia and causing the legs to curve outward. (The reverse condition, knock-knees, occurs when the femur is longer on the medial side, causing the legs to curve inward.)

Neither hyperextension nor bow-leggedness, if properly addressed, needs to be a hindrance to a dancer’s progress. As a teacher, it’s important for you to stay attuned to physical differences so you can help your students work in the way that’s best for them. With a little guidance from you, they’ll be on the straight path to success. 

All About Hyperextension

How to Identify It?
When dancers with hyperextended knees stand in a turned-out first position and allow their knees to lock back, their knees will touch, but there will be a space between their heels. These dancers will also have a tendency to put their weight on their heels, tilt their pelvises and sway their lower backs.
 
What Are the Dangers?
While it may be tempting for your students to exploit this natural tendency, experts agree that dancing with hyperextended knees is not a good idea. According to Tressa Gorman Crehan, associate director of the University at Buffalo dance department and a professor of anatomy and kinesiology for dancers, hyperextension “can cause trauma to the knee capsule, and eventually, depending on the severity, can cause tearing or strain on the ligaments in the back of the knee.” The anterior cruciate ligament, which helps prevent the tibia (the lower leg bone) from moving too far forward in relation to the femur (the thigh bone), is particularly susceptible to injury.

“The ligaments really can’t be repaired too well,” Gorman Crehan adds. “And the muscles around them become overstretched, and therefore weaker, so they can’t function as well either.” Repeated hyperextension of the knee also places high levels of stress on the lower leg, and can lead to shin splints. In more extreme cases, it can result in tibial fractures.

How to Address the Problem?
“So many dancers have hyperextended knees,” says Emily Sandow, a physical therapist at the Hospital for Joint Diseases in New York City. “The nature of the business is to have loose ligaments. What’s important is how you use the hyperextension, how you control it.” One way to guide your students is to encourage muscle development to help strengthen the knee so it doesn’t drop back into hyperextension. “Dancers—especially ballet dancers—don’t like to have bulky muscles,” she says. “So they hang out in their ligaments and rely on them to hold them up. Since dancers are so overstretched already, you don’t want to rely on [the ligaments] too much.” Sandow recommends instructing students to keep their quads “gently active” in order to prevent the knee joint from slackening, as well as strengthening the knees, quads and hamstrings. 

It’s also a good idea to ask hyperextended dancers not to straighten their knees completely, even though their knees feel straight only when they are completely locked. “You really have to get them to retrain, and at first they will feel like they’re bending their knees the whole time,” Gorman Crehan says. “Show them the lines in the mirror.” You might find it helpful to cue them with phrases such as “pull the knees up actively” or “find the breath behind the knee.”

Experts say that dancers can safely hyperextend the knee of the non-weight-bearing leg in positions such as tendu or arabesque, as long as they don’t experience any pain.

All About Bowleggedness

How to Identify It?
Bowleggedness is most evident when dancers stand in first position parallel. In this case, their feet will be close together but there will be a wider space between their legs.

What Are the Dangers?
Because of the skewed position of the knee over the foot, bowleggedness can cause some alignment problems in the foot. It’s always a good idea, in cases of misalignment, to consult with a physician to ensure that dance will not cause further injury. Because bowlegged dancers cannot achieve the conventional lines demanded by ballet, they may force their bodies into potentially injurious positions. 

How to Address the Problem?
“Whereas you can start to use muscle development to help hyperextension,” says Gorman Crehan, “bowleggedness cannot be changed, because it is a skeletal condition.” With this in mind, your instruction should be geared more toward helping dancers move according to their bodies’ natural alignment, rather than forcing them to adhere to an aesthetic that is just not physically possible for them.

For instance, says Sandow, dancers can be frustrated if they’re in a fifth position and their thighs aren’t touching. “The teacher has to recognize that this is the shape of the body,” she says. “I’m treating one preprofessional dancer right now who keeps telling me how her teacher wants her to cheat, even to turn in a little, because that will get her legs closer together,” she adds. “But she should really work in her natural turnout, and a little space between the legs is okay as long as she’s dancing well.”

Parents may send children with bowleggedness to dance class because they’re hoping it will help them with coordination, and dance is indeed a great way to improve balance and muscle structure. For these students, Gorman Crehan recommends starting with classes that are not extremely technical, such as creative movement. Because dance necessarily places a premium on uniformity, it’s important to be sensitive to your students’ differences and to understand that they may be shy about them. “Instruct them privately about how to adjust things,” Gorman Crehan suggests, “so you do not always isolate them during class and embarrass them.”

Students with relatively mild cases of bowleggedness can become very advanced dancers, but teachers should be clear with them about the challenges.

“I think they need to talk to the parents and children if they become serious students, so they understand that things are going to be harder, or they’re not always going to be able to achieve a particular look,” Gorman Crehan says. On the bright side, adds Sandow, dancers “don’t have to feel like it’s a career ender.”