If you’ve been suffering from knee pain during or after running, a high Q-angle could be the cause, says Sports Chiropractor Dr Glenn Duffy.


It doesn’t take an expert to know that, if your skeleton is moving out of line as you run, you could end up with an injury. A major spanner in the works of many female runners can be the Q-angle (or Q-factor). This refers to the angle between your thigh bone and your lower leg, when viewed from the front. If this angle is high, problems become more likely.

If you have wide hips and a narrow stance, that is, you naturally stand with your feet close together, your Q-angle is likely to be higher (some people would call this “knock-kneed”). If you also have short legs this effect is worsened. An angle of over 20° is considered abnormal, however we see injuries in many women with angles from 15-20°.


Awkward Angles

Numerous studies show that a higher Q-angle in runners is associated with overuse knee injuries and ultimately increased degeneration. Your kneecap runs along a groove in your knee, and if your knee bends at an awkward angle then it can rub within that groove. The rubbing causes inflammation and more wear and tear (known as patellofemoral pain syndrome).

This results in pain, generally in the front of your knee, which is very often worse when you are going up and down stairs. The knee often twinges during a run, but once you cool down feels stiff and painful, especially if bent and loaded (as in a squat). Sitting bent-kneed for a long time, such as going to the cinema or theatre, can cause a restless ache.


Energy Sapper

As with so many injuries, knee pain resulting from a high Q-angle also indicates a degree of inefficiency. When you run, you should be directing as much of your energy as possible into going forwards, if your knees move sideways excessively you’re wasting energy. This inefficiency may affect your performance, slowing you down and causing you to fatigue quicker.

One common mistake is to assume that this problem originates from your foot alignment and often over-pronation or flat footedness is blamed. Although your foot alignment does affect your knee, you should also consider the effect of the muscular balance from your hip down, and the muscular balance around the knee itself. The root cause of the misalignment can come from any combination of the hip, knee, or foot, but rarely from just one source in isolation.


Have you got it?

It’s important to be properly assessed for the real cause of your symptoms so that that all potential causes are diagnosed and treated effectively. But, to get an idea of whether you might have a high Q-angle, stand facing a mirror in a relaxed stance. Do your knees point inwards? Now squat down by bending your knees only - do they track inwards? Ideally your knees should move straight out over your second toe when you squat. If your knees turn in then it’s probably due to a high Q-angle.

If everything seems fine, repeat the test, but this time with most of your weight on the balls of your feet, leaning forwards slightly. Again, if your knees deviate towards each other, then you may have a high Q-angle.

If you think you may have a high Q-angle it’s best to seek advice from a sports chiropractor. You will certainly need to visit is a specialist running shop when buying shoes to make sure you have the right footwear to support your feet.


Work it

You should also try incorporating some hip strengthening exercises (to build up your abductors) into your training routine.


One simple exercise is to repeat the above squat-test, but control your knee angle so that it does not ride inward. Try doing this both barefoot and with your trainers on. If your trainers are supportive enough, then your knees should be better aligned with them on. You can then do three sets of ten squats (controlling your alignment so that your knee tracks over your second toe) up to three times per week in order to train your hip muscles. Make sure that you do not squat too deep - your knee should not go past 90°. Seek professional help if the exercise causes any discomfort.



Dr Glenn Duffy is the Practice Principal at Care for Health, a Surrey-based clinic with a specialist team of professionals, including sports therapy, physiotherapy, biomechanics and chiropractic, to help athletes to get the best out of their training investment and minimise injuries. For further information, visit: www.care-for-health.co.uk.

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