The Q angle is an abbreviation for the angle of the quadriceps femoris muscle. A way to measure for lower body postural distortion, an exaggerated Q angle can easily lead to knee problems. Although massage therapists typically don’t measure the Q angle, understanding its definition, normal range and potential implications improves a bodyworker’s ability to communicate with clients’ physicians. Additionally, bodyworkers can help relieve some of the problems resulting from an exaggerated Q angle.
What Is the Q Angle?
The degree of the Q angle is determined by measuring two lines superimposed on the lower extremity:
- One line begins at the tibial tuberosity and continues in a superior direction through the midpoint of the patella.
- The second line connects the anterior superior iliac spine (ASIS) with the midpoint of the patella.
The angle between these two lines is the Q angle. There are differing opinions about which quantities constitute an exaggerated Q angle. However, most sources concur that a normal angle in males is 13 degrees and 18 degrees in females.
Because there is some variability in how it is measured, evaluating the Q angle’s role is challenging. However, repeated investigations have shown people with a larger Q angle have a greater likelihood of developing numerous knee complaints. Because women genetically have a larger pelvis than men, they are more likely to have an increased Q angle.
Q Angle Mechanics
An increased Q angle appears to be one factor responsible for reducing knee stability. Understanding the knee’s anatomy helps us understand why an exaggerated Q angle would create problems. Because the quadriceps tendon fits in a groove under the patella, the patella’s ability to track straight is determined by the quadriceps’ angle of pull. With a greater Q angle, the quadriceps pulls the patella more laterally. When the patella is pulled laterally, there is increased stress on the soft tissues surrounding the knee. Conditions commonly resulting from an increased Q angle include:
- Chondromalacia of the patella – degeneration on the underside of the patella
- Patellar tracking disorders
- Patellar dislocation
- Anterior cruciate ligament (ACL) sprains – Women have considerably higher rates of ACL injuries than men.
Bodywork for the Q Angle
While there is little a massage therapist can do to influence a client’s bony structure, his or her impact on the surrounding soft tissues can help relieve exaggerated Q angle stress. Some strategies for accomplishing this goal are listed below:
- As described by Whitney Lowe in the July 2008 edition of Massage Today, an overly tightened vastus lateralis muscle could aggravate a large Q angle’s contribution to a patellar tracking disorder. Using sports massage techniques to soften the vastus lateralis can reduce the additional lateral tension this muscle might be placing on the patella.
- Myofascial release on the patella can assist in loosening a tight lateral patellar retinaculum. If previous scar tissue in this location aids in pulling the patella laterally, cross-friction massage may be useful. However, acute inflammation will make cross-friction massage painful.
- Relaxing and lengthening the muscles that cross the knee takes pressure off the joint and facilitates good patellar tracking. Because they are crucial to knee stability and cross the knee joint, the quadriceps and hamstring muscles are key targets. Proprioceptive Neuromuscular Facilitation (PNF) stretching on these two muscle groups can have a dramatic impact on easing additional forces on the knee.
Talking with a doctor about a client’s Q angle, why it might be exaggerated and what problems it is causing can yield valuable information for an attending bodyworker. In addition, bodyworkers can help clients with knee problems resulting from an exaggerated Q angle by using myofascial release and sports massage techniques on the tissues surrounding the knee.