The Q or quadriceps angle is a measurement of pelvic width that is believed to contribute to the risk of sports injuries in women athletes. Can non-surgical therapies and exercises help rehabilitate injuries?
Quadriceps Q – Angle Injuries
The Q angle is the angle where the femur/upper leg bone meets the tibia/lower leg bone. It is measured by two intersecting lines:
One from the center of the patella/kneecap to the anterior superior iliac spine of the pelvis.
The other is from the patella to the tibial tubercle.
On average the angle is three degrees higher in women than men.
Women have biomechanical differences that include a wider pelvis, making it easier to give birth. However, this difference can contribute to knee injuries when playing sports, as an increased Q angle generates more stress on the knee joint, as well as leading to increased foot pronation.
Injuries
Various factors can increase the risk of injury, but a wider Q angle has been linked to the following conditions.
Patellofemoral Pain Syndrome
An increased Q angle can cause the quadriceps to pull on the kneecap, shifting it out of place and causing dysfunctional patellar tracking.
With time, this can cause knee pain (under and around the kneecap), and muscle imbalance.
Foot orthotics and arch supports could be recommended.
Some researchers have found a link, while others have not found the same association. (Wolf Petersen, et al., 2014)
Chondromalacia of the Knee
This is the wearing down of the cartilage on the underside of the kneecap.
An increased Q angle can be a factor that increases stress and causes the knee to lose its stability.
However, this remains controversial, as some studies have found no association between the Q angle and knee injuries.
Chiropractic Treatment
Strengthening Exercises
ACL injury prevention programs designed for women have resulted in reduced injuries. (Trent Nessler, et al., 2017)
The vastus medialis obliquus or VMO is a teardrop-shaped muscle that helps move the knee joint and stabilize the kneecap.
Strengthening the muscle can increase the stability of the knee joint.
Strengthening may require a specific focus on muscle contraction timing.
Closed-chain exercises like wall squats are recommended.
Glute strengthening will improve stability.
Stretching Exercises
Stretching tight muscles will help relax the injured area, increase circulation, and restore range of motion and function.
Muscles commonly found to be tight include the quadriceps, hamstrings, iliotibial band, and gastrocnemius.
Foot Orthotics
Custom-made, flexible orthotics decrease the Q angle and reduce pronation, relieving the added stress on the knee.
A custom orthotic ensures that the foot and leg dynamics are accounted for and corrected.
Motion-control shoes can also help correct overpronation.
Knee Rehabilitation
References
Khasawneh, R. R., Allouh, M. Z., & Abu-El-Rub, E. (2019). Measurement of the quadriceps (Q) angle with respect to various body parameters in young Arab population. PloS one, 14(6), e0218387. doi.org/10.1371/journal.pone.0218387
Petersen, W., Ellermann, A., Gösele-Koppenburg, A., Best, R., Rembitzki, I. V., Brüggemann, G. P., & Liebau, C. (2014). Patellofemoral pain syndrome. Knee surgery, sports traumatology, arthroscopy: Official journal of the ESSKA, 22(10), 2264–2274. doi.org/10.1007/s00167-013-2759-6
Vaienti, E., Scita, G., Ceccarelli, F., & Pogliacomi, F. (2017). Understanding the human knee and its relationship to total knee replacement. Acta bio-medica : Atenei Parmensis, 88(2S), 6–16. doi.org/10.23750/abm.v88i2-S.6507
Mitani Y. (2017). Gender-related differences in lower limb alignment, range of joint motion, and the incidence of sports injuries in Japanese university athletes. Journal of Physical Therapy Science, 29(1), 12–15. doi.org/10.1589/jpts.29.12
Nessler, T., Denney, L., & Sampley, J. (2017). ACL Injury Prevention: What Does Research Tell Us? Current reviews in musculoskeletal medicine, 10(3), 281–288. doi.org/10.1007/s12178-017-9416-5
Gender identity is a wide spectrum. Can learning the language used to describe various gender identities and non-binary pronouns help explain the difference between gender expression and help in inclusivity?
Non-Binary
Non-binary is a term used that describes individuals who do not identify exclusively as male or female. The term addresses various gender identities and expressions that are outside of the traditional gender binary system, which categorizes individuals as either male or female.
Definition
Non-binary individuals are those whose gender identity and/or expression fall outside of the traditional binary categories of a man or woman. (Human Rights Campaign. (n.d.))
Some non-binary individuals identify as a blend of male and female; others identify as a gender different from male or female; some do not identify with any gender.
The term “non-binary” can also be “enby”/phonetic pronunciation of the letters NB for non-binary, although not every non-binary individual uses this term.
Transgender individuals and non-binary individuals are two distinct groups that are related.
There are some transgender/trans individuals who are non-binary, however, most transgender individuals identify as either male or female. (National Center for Transgender Equality. 2023)
To understand the difference, it can help to know the meanings of transgender, cisgender, and nonbinary: (GLAAD. 2023)
Transgender
An individual who identifies with a gender different from the one assigned at birth.
For example, someone assigned male at birth/AMAB, but identifies as a female is a transgender woman.
Cisgender
An individual whose gender identity follows the one they were assigned at birth.
For example, someone assigned female at birth/AFAB and identifies as a woman.
Non-binary
An individual who identifies with a gender outside the traditional binary of male and female.
This can include individuals who identify as genderqueer, agender, or genderfluid and others.
Using Pronouns
Using non-binary pronouns is a way to show respect and validation for an individual’s gender identity. Here are some recommendations on how to use pronouns: (National Center for Transgender Equality. 2023)
Ask for the individual’s pronouns
It’s recommended to avoid assuming an individual’s pronouns based on appearance or stereotype.
If unsure of someone’s pronouns, ask respectfully.
“What pronouns do you use?”
“Can you share your pronouns with me?”
Practice using the pronouns
Once you know an individual’s pronouns, practice using them.
This can be accomplished by using their pronouns when referring to them in conversation, emails, written forms, and/or other types of communication.
If you make a mistake, apologize and make the correction.
Gender-neutral language
If unsure of an individual’s pronouns, or if someone uses gender-neutral pronouns like they/them, use gender-neutral language instead of gendered language.
For example, instead of saying he or she, you can say they or their name.
Continue Learning
Learn as much as possible about identities and pronouns to better understand and support the LGBTQ+ community.
Injury Medical Chiropractic and Functional Medicine Clinic wants to help create a more inclusive and affirming environment for everyone.
Members of the military perform physically and psychologically demanding jobs every day. Research has found that conservative medical care, like chiropractic treatment, can absolutely help with back pain.
A study has shown that chiropractic treatment brought serious relief to female veterans with back pain.
Causes
The causes of back pain can be viewed as being mechanical, organic or idiopathic. Spinal conditions can be congenital or from birth and can be an acquired disorder that develops later in life.
Mechanical pain is triggered by spinal movement and involves spinal structures, like the facet joints, intervertebral discs, vertebral bodies, ligaments, muscles or soft tissues.
Organic pain is attributed to disease, like spinal cancer.
Idiopathic means the cause is unknown.
Back Pain & Female Veterans
Low back pain is a musculoskeletal condition and for female veterans has become a chronic condition. For these women, the condition seems to stem from repeated and prolonged deployments as contributors/causes to more prolonged injuries.
Female veterans had a higher rate of service-related disability compared to male veterans.
Having to live with a disease or chronic condition can impact the quality of life significantly. It can result in short- or long-term disability, it affects individuals financially from time off work and reroutes those financial resources to health care needs.
Chiropractic Research
Researchers reviewed 70 female veterans that utilized chiropractic treatment for their back pain.
The average patient was:
Around 35-40-years old
Veteran patients were included in the study by:
Visiting a chiropractic clinic over a 7-year period
Between 18 – 70 years old during treatment
Needed at least two treatments
Treatments included:
Flexion-distraction therapy
This is gentle intermittenttraction, along with manual pressure applied to the back.
Myofascial release
Massage therapy to muscles, joints, ligaments.
Spinal manipulative therapy
This involves the chiropractor�s hands performing�a high-velocity thrust to regions within the low back.
Spinal mobilization
Similar to spinal manipulative therapy, but with gentler repetitive motions around the affected area.
These treatments were applied alone or in combination, guided by:
The nature of the back pain complaint
Response
Pain severity
Patient’s preference
The patient’s tolerance of the various treatments
To help measure how effective the treatment was, the research team used the Back Bournemouth Questionnaire.
Pain is a complex biological process that involves both physical and mental health factors.
The test is one way to understand the multi-dimensional nature of pain.
Other factors to consider, specifically with military veterans were other health conditions like:
Post-traumatic stress disorder
Military sexual trauma
By comparing the patients Back Bournemouth Questionaire results at the beginning of treatment and then at the end, researchers found that these patients� low back pain improved by 85% with chiropractic treatment.
The American College of Physicians Clinical Practice Guidelines includes and stresses that doctors refer patients first to a chiropractor/physical therapist and undergo spinal manipulation as the recommended non-drug treatment for back pain before recommending medications or surgery.
The guidelines focus on:
Exercise
Stress reduction
Integrative therapies
Chiropractic spinal manipulation�treatment has been shown to effectively treat back pain for everyone.�
We focus on what works for you and strive to create fitness and better the body through researched methods and total wellness programs. These programs are natural and use the body�s own ability to achieve goals of improvement. To all of our veterans, we thank you for your service.
Get Rid of *LOW BACK PAIN* with Custom Foot Orthotics | El Paso, TX.
Approximately 80 percent of the population will experience some type of back pain sometime throughout their lifetime.
Custom-made functional foot orthotics can help support and promote the natural alignment of the spine.
NCBI Resources
It is important to know the cause of back pain to figure out the proper treatment plan. Otherwise, one could receive treatment for the wrong diagnosis and exacerbate the existing injury.
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