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 | 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 | Comments