What is the Catch?

     Knee problems are a common ailment for many people whether they are dancers, athletes, or simply life enthusiasts. A frequent problem in the knee is a catch or lock or what some refer to as a "trick" knee. As bellydancers our knees are essential in driving the movements and forces of the legs and pelvis. Shimmies are one example and the importance of a quality shimmy cannot be underestimated. A catching sensation or locking motion in the knee, especially if there is associated pain, is not conducive to smooth and safe dancing. There are different causes for a knee catch and the most commons reasons are discussed here. 

     A sticking sensation often associated with pain near the kneecap or patella (pa TEL ah) may be an alignment problem, osteoarthritis, or the result of cumulative trauma or joint stress. It is often generically referred to as "patellofemoral pain." The sticking or grinding sensation, which can sometimes be heard, is called crepitus (KREP i tes). Women and runners are especially susceptible to this type of knee injury. Women have wider hips than men; therefore, women have a larger q-angle (q=quadriceps). This is the angle of the patellar tendon in relation to the main pull or force of the quadriceps muscle. The pull tends to alter the knee mechanics and cause the patella to track toward the outside. Runners also tend to stress the knees' mechanics, especially if their leg muscles are not conditioned above and middle to the patella. A physical exam of the knee by a qualified practitioner and obtaining appropriate x-rays can identify the cause. Treatment consists of specific knee extension (quadriceps) exercises, focused near the patella. Lastly, either a knee sleeve with a cutout for the kneecap or with a strap can assist in a tracking problem.

     Another cause of knee catching is a loose piece of bone within the knee, called an osteochondral (OS te o KON dral) fragment or a "joint mouse," because the loose bone can migrate inside the joint. An x-ray can identify the culprit. People may not realize they have a loose fragment if the piece is small and does not cause a problem. In that case, it is best to leave it alone. However, a large piece or multiple pieces that cause pain or impair knee function require surgical removal.

     A painful snap that is sometimes audible may be a plica (PLY kah). A plica is a ridge or fold of tissue that arises from a membrane or lining inside the knee joint. A plica may become thickened or inflamed, and pain worsens with exercise. X-ray alone will not identify a plica. An MRI is the best study to identify the "soft tissues" such as plicas, ligaments, and cartilage. However, sometimes even an MRI will not detect this type of structure. If RICE treatment (rest, ice, compression, elevation), medication, and rehabilitative exercises do not resolve the pain and snapping, then it may be necessary to have an arthroscopic knee exploration in order to identify and correct the problem.

     Lastly, certain types of meniscal (me NIS kal) tears cause painful catching or locking of the knee. These are cartilage tears that may occur as an isolated injury or may occur in association with a ligament tear. The original injury is usually the result of a sudden, twisting motion or a fall. This is followed by knee pain and stiffness and possibly swelling. Occasionally, only minor trauma, such as walking up a flight of stairs or arising from a squat, will cause a meniscal tear. Small tears near the outside rim of the meniscus may heal. Two subtypes of tears that cause catching are flap tears and longitudinal tears. If large enough, the longitudinal tear sometimes lifts up, like the motion of a bucket- handle.

     Therefore, this is known as a "bucket-handle tear." The tears or flaps can bunch-up inside the joint during knee movement; hence one feels a catch or lock. An MRI is the best study in determining the size and type of tear. A trial period of RICE treatment, pain control, and rehabilitation gives the cartilage a chance to heal on its own. However, if there is recurrent pain, locking, significant ligament damage, or joint instability then surgical repair is usually indicated.

     If you have a knee that catches or locks, please consider seeing your physician to determine the next best course of action. Do not ignore persistent pain as this may lead to worse problems such as arthritis. Always keep your own safety and health in mind when bellydancing so that you may continue to enjoy the dance for many years to come.