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Women, the 'Q Angle' SportsMed_0612_ed.qxd 6/18/09 11:55 AM Page 34 Sports Medicine by guest columnist Michael Silva Women, the ‘Q Angle’ and ain is a liar.” Have you ever influences throughout the hips and legs that can weakening of this muscle group. A weakened heard that phrase? What most be changed with proper training and exercise. gluteal area can lead to a pelvis that moves people mean by this expres- Through proper training the female hip and around too much during running which in turn sion is that pain does not truly pelvis can function better with less chance of puts more strain onto hip and thigh muscles that tell you where the cause of injury to the knees. cross the knee. It can also lead to an unstable your problem is located, it Let’s look at some of the muscles in this knee that will drift inward causing increased only tells you where it ended area that influence the knee. One of the largest tension onto the patella and IT Band which up. This is never truer than and most powerful muscles in the human body causes pain to the knee cap and outside of the when you are talking about knee pain in run- is the gluteus maximus, which is the biggest of knee. ners, especially female runners. Knee pain is the three gluteal muscles that make up your but- There is another group of hip muscles that very common in female runners and can be due tocks. The Gluteus maximus functions chiefly are extremely important to the function of the to all sorts of inadequacies throughout the knee, to extend (move back), abduct (move out to the leg—the six external rotators of the hip (they hip, foot, or ankle. Let’s start by discussing one side), externally rotate (turn out) the leg and turn the leg outward). These tiny muscles are common cause of knee pain seen in female run- also helps stabilize the pelvis and lower spine. deep in the hip, extremely difficult to touch, and ners...weak hips and buttocks. Yep, that’s right, The gluteus medius and minimus function are rarely talked about in comparison to the big- ‘‘Pthe buttocks are not just for show—they have a to abduct and internally rotate (turn in) the leg ger, more recognizable gluteal muscles. For all very important function, and a deficit here can as well as helping to stabilize the pelvis. This intensive purposes, these are grouped in with lead to pain in the knee. means that these muscles not only help control the gluteal muscles. This external rotation is It is a very well known fact that the male the movement of the leg, they also help control needed to counteract the influence of such and female body is not architecturally the same. the pelvis, which is the foundation where many things as the ‘Q Angle’ and over-pronation of The female pelvis for example is wider than its leg muscles are attached. Two of the three the feet that both lead to the drifting of the knee male counterpart (this is in preparation for gluteal muscles have a direct connection into inwards. As with the gluteal muscles, weakness potential child birth). This widening of the hips the infamous Iliotibial tract (also known as the in these external rotators can lead to increased leads to an increase in the “Q angle” of the leg. IT band), while all three of them functionally pain at the knee. Some of us in the sports med- The “Q angle” is the angle formed at the knee influence the IT Band. icine field feel that these muscles are as impor- by the femur and the tibia when looking at the The gluteals nowadays act as a cushion for tant to the hip as the rotator cuff is to the shoul- front of the body. While this architectural dif- sitting rather than an explosive lower body der. Just as the rotator cuff in the shoulder needs ference between males and females is some- muscle used for walking and running (as to be strong for the shoulder to function proper- thing one cannot change, there are muscular designed). This lack of use leads to atrophy and ly, these hip rotators need to be strong in order THANKSGIVING DAY, November 26, 2009, 9am Marathon Sports 13th annual gobble gobble gobble Registration info at: www.srr.org ENTRY FEES: $22 before 11/15 and www.runreg.com $30 from 11/16-11/26 Bill@617-629-6666 *First 2000 entries receive long sleeve T-shirts *Pre-race pick up and start: Harvard Vanguard Parking Garage - 40 Holland St, Somerville *Finish line and post race party - The Burren, 247 Elm Street, Somerville 34 New England Runner, July/August 2009 SportsMed_0612_ed.qxd 6/18/09 11:55 AM Page 35 You need to ensure you have adequate Knee Pain strength in the muscles of the hip or for the rest of the leg to function better. Recent studies in Germany found that 20 the tightness and pain will just keep female runners with IT Band syndrome showed significant weakness in the abduction of their involved leg as compared to their healthy leg— coming back. and as compared to other non-injured runners. They also reported full pain relief did not occur until strength was improved to their injured leg. Another study done at the University of Delaware showed that in a group of 18 female Michael Silva is the founder and president of strength & conditioning specialist since 1994. distance runners with IT Band syndrome all Foundation Performance in Pawtucket, RI. He trains and rehabilitates runners of all levels demonstrated an increase in the adduction Michael has been a physical therapist since in the New England area. Log onto www.foun- (inward drift) and internal rotation (turning in) 1999, an exercise physiologist since 1995 and a dationperformance.com to find out more. of the involved knee—a situation that can be counter acted by strengthening the muscles that abduct and externally rotate the leg, the glutes and external rotators. Marathon Sports This information should encourage you to re-evalue your current “nagging knee pain” (if you are unlucky enough to have it) and recon- Athletes of the Month sider if you are doing all you can for it. These IT Band tendonitises, patella tendonitises, patellafemoral syndromes, and chondromalasia problems that you may have are not just tight- ness issues that need stretching and massage. You need to ensure you have adequate strength in the muscles of the hip or the tightness and pain will just keep coming back. Also keep in mind that when you are run- ning there is no rest period for your legs; you are always leaping from one foot to the other with a force several times that of your body weight at the point when your knee and foot hit the ground. These two factors will lead to a magnification of any deficit you may have in your legs. Running is a stressful activity for N N O O S your legs, but with a well-designed auxiliary S A A M program of exercises you can lengthen your M T T T T O running career and lessen the pain involved O C C S along the way. So yes, you distance runners S Y Y B B may need to strength train and “Buns of Steel” O O T T O could be the answer you are looking for to get O H H P rid of your chronic knee pain. P A couple of quick and easy exercises to help strengthen your hips are the single leg Lucas Meyer and Mariko Holbrook bridge and the clamshell. The single leg bridge Ever since former Yale steeple great Lucas Meyer surprised himself with a 5th place starts with you lying on your back, feet flat on 1:05:16 showing at the ING Hartford Half Marathon last fall, the med student has been going the ground, knees bent so your heels are under great guns. Meyer won the Penn Relays Olympic Development 5K in 14:07 and then ran 28:28 your knees. Pull your right knee into your chest for 10,000m at the Penn Relays. Meyer turned back Kenyan Joseph Koech at the Little Rhody with both hands. While keeping your right knee USATF-NE 5K Championship in 14:33 on June 7. Just a week later he placed second in 34:21 as close to your chest as possible use your left at the Litchfield Hills 7M, the only non-foreign runner in the top eight. leg to lift your hips and lower back off the A graduate student could use a free pair of shoes, right? and former Brandeis All ground. Perform 10-20 repetitions on each leg. American Mariko Holbrook is certainly worthy. Mariko won the Penn Relays Olympic The clamshell starts with you lying on your Development 10,000m in 34:40 and placed second overall at the Breakheart Classic 6K in 20:36. left side with knees and hips flexed up in front On May 30, Mariko was the top scorer (17:17) for the runner-up BAA squad at Freihofer’s. On of you (fetal position) right leg on top of left. June 7 she secured the USATF-NE 5K title at Little Rhody with a 17:25 scamper, placing sec- Keeping your pelvis still and your feet touch- ond overall to BU’s Marisa Ryan. ing, lift your right knee off your left so that your right knee is higher than your right hip.
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