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The Q-Angle and Injuries In Women Athletes

A wider pelvis linked to knee pain and injury in women

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Updated September 22, 2006

Women are more prone to several sports injuries than men based simply on biomechanical differences. One such difference is a wider pelvis in women then men. Many sports medicine experts have linked a wider pelvis to a larger "Q" (Quadriceps ) Angle - the angle at which the femur (upper leg bone) meets the tibia (lower leg bone).

It is measured by creating two intersecting lines: one from the center of the patella to the anterior-superior iliac spine of the pelvis; the other from the patellar to the tibial tubercle.

On average this angle is degrees greater in women than in men. It is thought that this increased angle places more stress on the knee joint, as well as leading to increased foot pronation in women. While there may be other factors that lead to increase risk of injury in women athletes (strength, skill, hormones, etc..), an increased Q-angle has been linked to:

Patellofemoral pain syndrome
A high Q-angle causes the quadriceps to pull on the patella and leads to poor patellar tracking. Over time, this may cause knee pain, muscle imbalance

Chondromalacia of the Knee
This wearing down of the cartilage on the underside of the patella leads to degeneration of the articular surfaces of the knee.

ACL injuries
Women have considerably higher rates of ACL injuries men. An increased Q-angle appears to be one factor that causes the knee to be less stable and under more stress.

Treatment Tips for Women:
Orthotics .
Custom-made, flexible orthotics decrease the Q-angle and reduce pronation., put less stress on the knee, and improve the Q angle. The simplest way to decrease a high Q-angle and lower stress on the knee is to prevent excessive pronation. orthotics.

Strengthening Exercises .
Reductions in ACL injuries have been seen with the implementation of the ACL Injury Prevention program designed for women. Strengthening the vastus medialis obliquus can also help increase the stability of the knee joint in women. Strengthening may require special focus on the timing of muscle contractions. Closed-chain exercises (such as wall squats), performed only to 30 degrees of flexion, are currently recommended.

Stretching Exercises .
Stretching of tight muscles and strengthening of weak areas should be included. Muscles commonly found to be tight include the quadriceps, hamstrings, iliotibial band and gastrocnemius.

Review: September 2006

Source:

Naslund J, et al. Comparison of symptoms and clinical findings in subgroups of individuals with patellofemoral pain. Physiotherapy Theory & Practice, June 2006
Loudon JK, et al. The relationship between static posture and ACL injury in female athletes. Journal of Orthopedic Sports Physical Therapy 1996.
Fredericson M, et al. Physical examination and patellofemoral pain syndrome. American Journal of Physical Medicine and Rehab. March 2006.
Kuhn DR, et al. Immediate changes in the quadriceps femoris angle after insertion of an orthotic device. Journal of Manipulative and Physiological Therapeutics. Sept, 2002

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