Q angle and knee pain

November 25, 2009

What is Q angle?

The Q angle describes the angle of the knee from a frontal view. The Q angle gives an idea how the thigh muscles functions to move the knee and also how the knee cap (patella) tracks in the groove of the knee joint. A normal knee cap should move up and down within the groove with flexion and extension of the knee. When the Q angle is excessive, the knee cap tends to track out of alignment and hence causes wear and tear (degeneration) of the cartilage behind the knee cap.

What is the normal Q angle? The normal Q angle measured in standing is about 15 degrees and anything more than that is considered a risk factor for knee injuries. Ladies tend to have a wider Q angle due to their wider pelvis compared to their males.

Q-angle

How to measure Q angle? The Q angle is an intersection of two lines. First line joins the ASIS (bony protrusion in the front of the pelvis) to the middle of the patella. Second line runs from the protrusion on the top of the shin bone (tibial tuberosity) below the patella and upwards through the middle of the knee cap.

Common injuries related to a wide Q angle:

Iliotibial band friction syndrome (ITBFS)
Anterior knee pain or Patella Femoral Pain Syndrome (PFPS)
Anterior cruciate ligament injury (ACL)

Injuries because of an excessive Q angle can be categorised into 3 main reasons.

1. Muscle imbalance :

A large Q angle pulls the knee cap outwards due to the stronger lateral pull from the quadriceps and tight ITB. Coupled with a weakness of the inner aspect of the quadriceps (Vastus Medialis Oblique, VMO) the knee cap will track laterally instead of smoothly up and down within the knee groove. This maltracking causes the cartilage behind the knee to wear off or degenerate and hence the pain.

2. Biomechanical compensation:

An excessive Q angle can alter the movement pattern especially in the foot. The knee will tend to point inwards (valgus or knock-knee appearance) which encourages the foot to roll inwards (pronates). Over-pronation can lead to a number of injuries especially in runners.

3. Joint laxity/instability:

When the knee point inwards, the ligaments on the inner aspect of the knee gets overstretched and lax, therefore compromising the stability of the knee joint. The Anterior Cruciate Ligament (ACL) also undergoes a lot of stress in this position. Interestingly the larger Q angle in females has been attributed as a main reason why females are at a higher risk of sustaining an ACL injury.

How to manage a wide Q-angle?

You can reduce the risk of injuries by targeting the reasons above.

Muscle imbalance: Stretching on the ITB, strengthening the VMO and Glut medius to enable proper tracking of the knee cap.

Biomechanics: Get a customised orthotics to control excessive pronation and reduce the stress to the knee.

Joint Laxity/Stability: Balancing exercises to train knee proprioception and stability.

Written by lenia.teo · Filed Under Featured, Injury Prevention, Knee, Netball, Running, Soccer, Sports Injury, Women & Sports | View Comments

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	4. Sports Taping – Knee This is a classic favourite. In fast-moving sports where the player has to move quickly and often with fast direction changes makes the game exciting to watch and exhilarating to play. Unfortunately, it also makes it a high-risk sport for knee injuries. Running with sudden stops, cutting side to side, jumping, and pivoting can injure your knee. Taping up the knee helps reduces the risk of injury.
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	6. Sports Taping – Wrist For active sports people who depend on their hands and wrist – basketball, volley ball, baseball, netball or even rugby.
	7. The Pelvic Crossed Syndrome Low back pain is often associated with weak muscles. But we should also remember that weakness and strength is relatively to each other. Strong muscles must be balanced with strong counterparts.
	8. Jaw Pain – What other causes besides the teeth and jaw? Physiothetrapy as a treatment option for jaw pains is often overlooked. Pain around the jaw area can be caused by either (i) a problem in the jaw ( Temporomandibular joint) or (ii) pain that is referred from another structure to the jaw. As you have ruled out option (i), then it is likely your pain is caused by the latter.
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ITB friction animation

November 20, 2009

Iliotibial band friction (ITB) syndrome is a common running injury due to a tight ITB. In a previous article, we explained the reasons why the ITB tightens up. To make it easier to understand how a tight ITB causes friction and inflammation, click here to see an animation of ITBS.

Written by chyetuan.chng · Filed Under Injury Management, Knee, Running, Video | View Comments

4 signs that you may not be ready for Yoga

November 14, 2009

After our recent article, “Is Yoga Bad For You?“, we had a lot of questions on what are the signs that they need to look out for and if they are ready for yoga. Read more

Written by Sylvia Ho · Filed Under Back Exercises | View Comments

Improving Your Chances for a Successful Back Surgery

November 12, 2009

Spine-Health.com recently listed 5 ways to improve your chances in their article, “5 ways to minimise failed back surgery and continued back pain”¹. One of the 5 ways was – “Be Ready to Rehabilitate”. We would like to add one more way to improve your chances – Pre-Habilitation. Read more

Written by Sylvia Ho · Filed Under News on the Spine, Spinal Conditions, Treatment Options | View Comments

Tai Chi Reduces Knee Osteoarthritis Pain in the Elderly

November 10, 2009

Researchers from Tufts University School of Medicine have found that patients over 55 years old with knee osteoarthritis have lesser knee pain and better improvement in their physical functions with Tai Chi.

http://www.flickr.com/photos/edwinylee

Knee osteoarthritis is a degenerative condition that not only causes pain but also lead to poor muscle function, decreased knee proprioception, impaired physical functions and even psychological distress.

Tai Chi is an ancient Chinese exercise that encompasses mind and body approach to enhance muscle function, balance, flexibility and reduce pain, depression and anxiety may be a good approach to treat knee osteoarthritis.

In the research, Dr Jordan and his team randomly divided 40 participants of age 55 and above, suffering with osteoarthritis knee pain for most of the days in the past months into two groups – the Tai Chi group and Control group. All participants had to attend 60 minutes of either intervention two times weekly for 12 weeks.

A range of measuring tools that mainly measure pain, physical function, balance tests, self efficacy and depression were taken at the first week, 12 weeks, 24 weeks and 48 weeks of the interventions.

The Tai Chi group was taught 10 modified forms of exercise from the classical Yang style. Each session included 10 minutes of self massage and a review of Tai chi principles; 30 minutes of Tai Chi movements; 10 minutes of breathing technique; and 10 minutes of relaxation.

The control group on the other hand was taught stretching for 10 minutes and attended 40 minutes wellness education including osteoarthritis as a disease, diet and nutrition, therapies to treat osteoarthritis, or physical and mental health education.

The results showed that participants who continued Tai Chi after 12 weeks had more long-lasting benefits with lesser knee pain and better physical functions compared with the control group.

The researchers suggested that Tai Chi is an effective exercise to treat pain and physical impairment for patients with severe osteoarthritis knee but notes the need to carry out more research to further understand the mechanism of Tai Chi in osteoarthritis knee.

Reference:

Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial, C C Wang, C H Schmid, P L Hibberd, R Kalish, R Roubenoff, R Rones and T McAlindon, Osteoarthritis and Cartilage 2008;16:S32-33

Written by lenia.teo · Filed Under Latest Research Findings | View Comments

Office Ergonomics or the lack of it.

November 9, 2009

A large number of people who seek medical help for their musculoskeletal problems usually present with neck, shoulder and back pains. These clients are often deskbound at work and with the increase use of computers, it is no wonder the incidence of spinal pains is on the rise.

The repetitive stress associated with our work environment can be minimized with an understanding of the flaws of mass produced furniture, combine with a little effort and common sense in altering and re-organizing our work station. Below are some of the complaints most office workers express. Read more

Written by Sylvia Ho · Filed Under Ergonomics, Featured, Workplace Health | View Comments

Areas of Physiotherapy

November 6, 2009

Physiotherapy is an extremely wide field of study. It can be classified into different areas of focus, patient age groups, gender and type of activities (or sub-specialties). As a result, people often get confused about what it is, who it is for and what it does. Most often one gets to learn about physiotherapy you come into contact with it for your own health matters or know someone close who is undergoing treatment. We will look at some of the basic classifications to help clear some of the confusion around this wide and complex field.

Main Areas of Physiotherapy

Source: Flickr jasonvance

Broadly, physiotherapy can be segregated into 3 main areas – Musculoskeletal, Cardio-Respiratory (sometimes also referred to Cardio-Pulmonary) and Neurology.

Musculoskeletal – This is the area that deals with injuries related to the muscles, bones and joints of the human muscle and skeletal system. Conditions such as back pain, tennis elbows and ankle sprains fall into this category. Private clinics outside of the hospital setting typically focus on this area. This area is sometimes referred to as Orthopaedics.
Cardio-Respiratory – This area deals with conditions related to the lung and circulatory system (e.g. heart). Conditions such as fall into this category are bronchial asthma, chronic obstructive lungs disease and pneumothorax. Generally, this is an in-patient area. Meaning patient are still warded in the hospital such as after cardiac surgery. Out-patient care such as chest percussion treatment is sometimes called upon for patient who suffers from attacks of chest congestion and find it difficult to breath.
Neurology – This area deals with rehabilitation of patients recovering from neurological condition such as stroke, cerebral palsy. Stroke depending on its severity often lead to partial paralysis of some part of the body. Neuro-physiotherapy helps the patient to recover some of the mobility and control of these body parts. This is often confused with the Musculoskeletal area of physiotherapy as it includes improving muscle strength and control. The key difference here is the source of the muscular dysfunction.

Patient Demographics

Each of these areas can be further broken down into three broad age classification – pediatrics, adult and geriatrics.

Pediatrics deals with young infants and children. Teenagers typically are classified as adult though these age group do have specific needs that needs to be managed separately such growth spurts in the bone structures.

Adults are the largest group of patients for physiotherapy as they represent the bulk of the population. However, with a rapidly aging population, geriatric physiotherapy for older adults is increasingly playing a larger role in the community.

Gender Classification

Men and women sometimes have different requirements when treating certain conditions dues to the difference to their physiology. Some are clearly visible such as the bone structure. One example is women having wider hips than men. This difference plays an importance role in the treatment of knee pains.
Other differences are not as visible such as hormonal difference such estrogen and its impact on bone density as women age.

Activities and Sub-specialties

With each area, there are further sub-specialties such as sports physiotherapy. Sports physiotherapy is a sub-specialty of the Musculoskeletal area. It can be further classified to the various patient demographics. Treating young children and teenagers the same as adult with sports physiotherapy can led to irreparable damage to their growth and subsequently adult musculoskeletal frame.

Another example of sub-specialty is women health and in particularly pregnant women and post-natal women.

So the next time, if you get confused with an explanation of what is physiotherapy, remember that the other person is most likely talking about another area of this wide field and that you are both most probably right!

Written by Sylvia Ho · Filed Under Spinal Conditions, Sports Injury, Women & Sports, Workplace Health | View Comments

Different Compensation Strategies During Jogging by Low Back Pain Sufferers

November 2, 2009

I am sure all athletes have experienced the effects of muscle fatigue. You will use your body differently, trying to compensate by moving your limbs in a more comfortable way. Try going down stairs right after a marathon and you get the picture.

running form

An interesting question is, do everyone compensate using the same strategy? Apparently not. A recent study¹ shows people with recurrent low back pain jogs with a different compensation strategy compared to healthy individuals after a set of fatiguing lower back muscle endurance exercise.

The exercise was to hold the lower back in an extended position until their muscles shows signs of fatigue on surface electromyography (EMG).

The low back pain group was found to jog with a more extended or arched lower back and had more hip movements whereas the normal healthy group runs with a more forward flexed trunk. This may be why it is a common for people with chronic low back pain to complain of hip muscle soreness and fatigue after endurance exercises.

It is a known fact that chronic low back pain sufferers have poor core muscle function. This adaptation of running with an extended back may be a strategy to stabilise the lower back without the need to use core muscles and yet able to continue running. On the other hand, healthy individuals are able to use their core muscles as a natural trunk stabiliser and prevent unnecessary movements.

Parallels can be drawn with long hours of sitting where the body requires muscle endurance to sustain in a single position. When fatigue sets in, the body may adopt a different strategy to try to protect the back and inadvertently creates a wrong movement pattern or mal-adaptation. Therefore, correcting wrong movement patterns and strengthening of the core muscles are important aspects of treating chonic low back pain.

Reference:

1. Hart JM, Kerrigan DC, Fritz JM, Ingersoll CD. Jogging Kinematics After Lumbar Paraspinal Muscle Fatigue Journal of Athletic Training. 2009; 44(5):475–481

Picture: www.amercianrunning.org

Written by chyetuan.chng · Filed Under Latest Research Findings, News on the Spine, Running | View Comments