Q Angle Injuries and Pain in Women Athletes

woman doing wall squat exercise
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The Q angle is a measurement of pelvic width that is thought to contribute to sports injury risk in women. Women have biomechanical differences from men. Female hormones result in a wider pelvis, making it easier to give birth. But this difference can have consequences when playing sports. Many sports medicine experts have linked a wider pelvis to a larger Q (quadriceps) angle, which is the angle at which the femur (upper leg bone) meets the tibia (lower leg bone).

The Q angle is measured by creating two intersecting lines: one from the center of the patella (kneecap) to the anterior superior iliac spine of the pelvis; the other from the patella to the tibial tubercle. On average, this angle is three degrees greater in women than in men (17 degrees average for women compared with 14 degrees for men).

An increased Q angle places more stress on the knee joint, as well as leading to increased foot pronation.

Women's Sports Injuries Contributed to by the Q Angle

While there may be other factors that lead to increased risk of injury in women athletes (strength, skill, hormones, etc.), an increased Q angle has been linked to the following:

  • Patellofemoral Pain SyndromeA high Q angle causes the quadriceps to pull on the patella (kneecap) and leads to poor patellar tracking. Over time, this may cause knee pain and muscle imbalance. The pain is felt under and around the kneecap. Orthotics and arch supports may be recommended. While linked by some researchers, others have not found the same association, and so this remains controversial.
  • 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. The chief symptom is pain under and around the kneecap.
  • ACL Injuries: Women have considerably higher rates of ACL injuries than men. An increased Q angle appears to be one factor that causes the knee to be less stable and under more stress. However, as with patellofemoral pain, this remains controversial and some studies find no association between the Q angle and knee injuries.

Treatment Tips for Women With Q Angle-Related Injuries

Orthotics

Custom-made, flexible orthotics decrease the Q angle and reduce pronation, putting less stress on the knee. Motion control shoes can correct overpronation, but a custom orthotic will ensure that all elements of the foot and leg dynamics are accounted for and corrected.

Strengthening Exercises to Reduce ACL Injuries in Women

Reductions in ACL injuries have been seen with the implementation of ACL injury prevention programs 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) are currently recommended. It is also important to strengthening the glutes to improve stability. 

Stretching Exercises

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

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  1. Khasawneh RR, Allouh MZ, Abu-el-rub E. Measurement of the quadriceps (Q) angle with respect to various body parameters in young Arab population. PLoS ONE. 2019;14(6):e0218387.  doi:10.1371/journal.pone.0218387

  2. Petersen W, Ellermann A, Gösele-koppenburg A, et al. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2264-74. doi:10.1007/s00167-013-2759-6

  3. Mitani Y. Gender-related differences in lower limb alignment, range of joint motion, and the incidence of sports injuries in Japanese university athletes. J Phys Ther Sci. 2017;29(1):12-15. doi:10.1589/jpts.29.12

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