Heat or cold: How should ballet dancer treat a sore knee?

I dance ballet, and on one of the jumps, called a tour jeté, I used to land more heavily on my right heel. Done repetitively, it caused some trauma to the left uppermost corner of my right kneecap. I've since modified my technique, but I still land with my weight more on the heel on some of the jumps. Eventually, I feel pain, and it is difficult to kneel on that knee. (I don't have the same experience with my left knee.)

At night, I apply a microwaveable heat compress and leave it on my right knee overnight. It does take away the pain, and in the cold mornings, I don't feel any stiffness. I've used ice and heat packs on my painful knee. The ice pack numbs the knee, but once the numbness wears off, the pain is back. However, when I apply a heat pack, the pain does go away, and my knee doesn't feel stiff.

I would like to know what it is about the heat that takes away the pain and prevents stiffness. Does the heat function primarily as a pain reliever without actually treating the problem? And short of not doing this particular jump, what can be done to treat my knee condition?



Let's start with that heat compress all-nighter. It's not such a good idea, says Dr. Nancy Kadel, associate professor of orthopedic surgery at UC San Francisco and medical director of the Healthy Dancers Clinic at the ODC Dance Commons in San Francisco. "You don't want to go to sleep with heat on," she says, because those compresses can retain heat for a long time and may burn the skin.

Instead, she recommends applying heat for about 15 to 20 minutes before going to bed, then again in the morning, especially if you're going to a dance class.

Heat makes your injury feel better because it helps increase blood flow, Kadel says. "The blood vessels expand, causing more blood flow to the area, which can make sore, stiff muscles and joints feel better. The blood flow helps the elasticity of the muscles around the joints and reduces muscle spasms."

That said, you should first make sure that applying heat is the right thing to do. Any swelling or redness indicates inflammation -- and that should be treated with ice, not heat, Kadel says, since heat will only exacerbate the swelling. Apply ice for 15 to 20 minutes as well.

Kadel can't diagnose your injury, but she does recommend that you see a physical therapist, athletic trainer or physician who specializes in treating dancers. Although you sound aware of what you're doing during the jump and are trying to correct it, someone who has experience working with dancers can more closely analyze your movements and tweak your technique and recommend exercises if weak muscles need shoring up.

-- Jeannine Stein

Other resources:

The International Assn. for Dance Medicine & Science, which promotes medical, scientific and educational endeavors that enhance the treatment and training of dancers.

The Performing Arts Medicine Assn., a medical resource for performing artists.