Knee pain is a very common issue that runners, cyclists and those that are very active in the gym can encounter. One predisposing factor is the Quadriceps Angle (Q Angle). In this writing we will discuss what it is, the relationship of the Q Angle to potential knee pain and potential prevention and treatment strategies.
What is the Q Angle?
The Q angle is the angle between the Quadriceps muscle and patellar tendon (This is the tendon that runs from your knee cap to the top of the Tibia (shin bone). This angle is achieved by drawing two lines that intersect.
The first line is drawn from the Anterior Superior Iliac Spine (ASIS) to the center of the patella (knee cap). The second line runs from the Tibial Tuberosity (the bony protuberance just below the knee cap on the Tibia bone) and through to the center of the patella. The angle between the two intersecting lines is the Q angle.
What is the significance of the Q-angle?
The Patella (knee cap) has to track properly on an area of the Femur (thigh bone) called the Trochlear Groove. This is a groove where the knee cap sits and moves through when the knee is flexing and extending. When the knee is extending the Quadriceps muscles pull the knee cap superiorly (towards the head). In proper mechanics the knee cap should move on the Trochlear Groove like rails for a train. Unfortunately at times the knee cap gets “pulled” out of it’s “rails” and can potentially cause knee pain. A Patellar tracking issue, PatelloFenoral Syndrome (PFS) can ensue.
According to Author David J Magee, normal Q Angles should be: Males: 13 degrees Females: 18 degrees
What activities may potentially cause knee pain with individuals that may have less than desirable Q Angles?
Basically any activities that require leg extension (that is straightening the leg) for prolonged or consecutive repetitions performed chronically may potentially cause knee pain. The Q Angle maybe a big predisposing reason for the development of knee dysfunctions.
Below are just a few examples of activities:
What can happen if the Q angle is less than 13 OR GREATER THAN 18?
Generally what can happen is that the Patella will have issues tracking correctly on the Trochlear Groove during motions of the knee. Over time this can cause pain, usually located at the front of the knee. Of course this is one common example but there are other conditions that may result from Q Angles greater or less than the desired "normal" angles but for this writing, I am discussing issues with Patellar tracking.
In the above diagram, it illustrates the pull of the three superficial Quadriceps muscles (Rectus Femoris, Vastus Medialis and Vastus Lateralis), the fourth Quadricep muscle, Vastus Intermedius sits deep to these muscles.
In normal these muscles should pull the Patella smoothly on the Trochlear Groove. As an example, if the Q Angle is greater than 18 degrees, what can happen is that the angle of pull becomes more lateral, displacing the Patella "off" the Trochlear Groove.
This may cause knee pain, which needs to be corrected, potentially through therapy.
Prevention and treatment
If you are encountering knee pain, regardless if you might suspect that part of the cause is because of issues with the Q Angle, here are a few things that may help:
Get assessed by a rehabilitation professional such as a Massage Therapist, Chiropractor or Physiotherapist. They can help build a program to assist with managing and relieving the pain.
Stretch: Typically what can occur is that the lateral thigh muscles (and lateral structures such as the IT Band) along with the Quadriceps and hip muscles can become very tight and require more focused stretching. The tightness can potentially pull the Patella laterally and thus the importance of stretching these structures.
Foam Rolling: This may help loosen the areas that was mentioned previously. This can be an adjunct to stretching.
Strengthen the muscles of the inner thigh. In particular the Vastus Medialis muscle. This "innermost" Quadricep muscle tends to be weak, on individuals who have Patellar tracking issues. This muscle pulls the knee cap towards the midline and helps keep it in the Trochlear Groove. What can happen is that there could be an imbalance of the lateral thigh muscles and the medial thigh muscles, causing dysfunction. It is advised that one seek the assistance of a professional to develop a strengthening program for this muscle.
Finally, you will want to be aware of your footwear. When was the last time you changed them? How active are you? Are they losing the support, that they were intended for. If unsure always have a professional to help you with your footwear.
If you are very active, injuries will occur. It is usually a matter of time and the degree of the injury. The Q Angle is something to be aware of as a potential predisposing factor. Just know that there are avenues to assist you in your goal for training pain free.
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