The Q Angle and Injuries In Women Athletes

A wider pelvis is linked to knee pain and injury in women's sports

woman doing wall squat exercise
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What is the Q angle and how does it contribute to women's sports injury risks? As a woman, there are biomechanical differences that result in a greater risk of some sports injuries than a man faces. The wider pelvis that women have compared to men makes it easier to give birth, but it is a difference with consequences when playing sports. 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).

The Q angle 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 ​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). It is thought that this increased angle places more stress on the knee joint, as well as leading to increased foot pronation in women.

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.
  • Chondromalacia of the KneeThis 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 injuriesWomen 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 with Q Angle-Related Injuries

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


    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