Monday, January 1, 2001

Biomechanics Injuries - Above the Ankles! There's more than just the feet

By Dr. Tim Maggs, © 2001

Sports biomechanics has always put emphasis on the feet. But, sports doctors worldwide are beginning to recognize there's more biomechanics to the runner than just the feet. The general assumption used to be that above the feet, everything was okay. It's time to further eliminate this age-old myth that's has kept many runners sidelined needlessly. Back pain, knee pain, hip problems, radiating nerve pains, bursitis', tendonitis', muscle pulls and more are direct results of biomechanical faults.

Biomechanics Made Easy

The word biomechanics tends to scare people. It's also a general assumption that all doctors know what's wrong. In sports medicine, that assumption is on par with a "can't fail business deal". Most sports doctors don't know biomechanics and totally miss the correct diagnosis and treatment/rehab program appropriate for each runner. So, for those docs and runners who care about the health and longevity of their (patient's) structure, please read on.

Biomechanical Findings

All people tend to be one side dominant, so having symmetry between right and left is wishful thinking. We're not looking for symmetry though. We're looking for a better level of balance between right and left, both muscular and structural. We're looking for improved range of motion in the joints of the spine, pelvis, hips, knees and ankles. We're looking for any hereditary defects that may influence the function of our unique structure. We're ultimately looking for specific defects, whether conditional or constitutional, that can be improved. For if we can improve the balance and function of our structure, there will be exponential gains in our future. We may be able to run longer. We may not suffer with pains and disabilities as much. We may reduce the likelihood of degenerative changes in our joints. We may just enjoy life a little bit more.

Last month we talked about the Q angle in the knees. Upon standing x-rays of the low back, we have the all-important angle of the pelvis. This is known as the sacral base angle, that should fall between 36-42. We have the gravity line in the low back, which represents the weight of the body and where it happens to land in the joints and bones of the lower back and pelvis. You can't believe how distorted the weight distribution is on some people. Add running to the equation, and it's a wonder any low back can tolerate the stress. We have the joint spaces of the spine, better known as disc spaces, that show wear and tear, or degeneration. This is usually suggestive of prior traumas with a subsequent loss of normal joint motion followed by reduced blood flow to the joint, thus increasing the rate of degeneration.

We need to look at range of motion in all joints, both passively (assisted) and actively (unassisted). You'd be amazed to see the subtle losses of motion in certain directions. We need to measure the leg lengths, from the side hip bone to the outside ankle bone. A true, or anatomical short leg, will show a difference in measurement. This type of short leg represents about 5% of the population. The functional short leg (measures the same length but is due to pelvic rotation, abnormal medial arches of the feet, abnormal Q angles in the knees and other distortions), should never be treated with a lift and represents 95% of the population. These are but some of the tests that should be done on all runners, athletes and humans. At least those who care about the future and well-being of their structure?

The Structural Fingerprint® Program

All of the tests described above are part of The SFP. There is such a global need for more doctors to become active in examining the entire structure of runners. Only after a full and complete exam is done can we know what recommendations are appropriate, including treatment, exercises, habit modification, nutritional, orthotics, etc. As I asked a financial consultant recently at a clinic, "Would you ever consider giving financial advice to someone without knowing their specific circumstances?". "Absolutely not", he said.

The corrective program needs to rehabilitate the weak areas of the structure, re-educate the muscles and joints with proper information, such as habits, exercise and motion, and learn how to manage our structures for the rest of our lives. How on earth can any of us hope to keep our castles healthy and functional for 90 years without ever testing them and maintaining them? It's just too illogical an approach.

I have this dream of audio/video taping all of the runners who tell me their story. Sadly, they're all so similar. The only difference usually is the names of the doctors and the location of the injury. "I went to Dr. 1 who found nothing, and then tried Dr. 2 who gave me a pain killer. He sent me to Dr. 3 who gave me a different diagnosis, but his medication didn't work. I then went to a chiropractor who treated me for 2 weeks and discharged me. I saw a physical therapist, but my insurance ran out and now I can't see them anymore. Do you think acupuncture would work?"

We've got a long road to travel, but until each and every runner has close access to a full and complete biomechanical exam, I'll continue my mission to elevate the awareness of such a program. And please, don't let your criteria be pain and disability before you consider one. Actively running is always more attractive than being desperate and injured.

Do You Know Your Q Angle?

by Dr. Timothy J. Maggs, © 2001

In my quest to make biomechanics as commonplace as the daily number or as important as the daily weather report, I'm going to push your limits of tolerance and talk about the all-important Q angle. When looking at the biomechanics of an athlete, one of the more important measurements is that of the Q angle.

The Q angle represents the relationship and alignment between the pelvis, leg and foot. This measurement is extremely important, especially for athletes. Repetitive and continual stress through the lower back, pelvis, hip, knee and ankle can and will produce injuries in athletes, especially those with abnormal Q angles. This type of structural defect must be determined, improved and corrected as much as possible as mere symptomatic care will only produce a false and detrimental sense of security to the athlete.

Measuring the Q Angle

In the standing position, the knee-cap (patella) should be somewhat positioned over the bump at the top of the shin bone (tibial tubercle). The other anatomical landmark of importance is the ASIS, which is the bony protuberance at the very top of the quadricep muscle. This is the bone that sticks out on each side of the body just below the level of the navel.

A normal Q angle will have the patella rotated slightly more towards the mid-line than the tibial tubercle. To get the Q angle, mark a point at the center of the tibial tubercle, and draw a line straight through the center of the patella. This is the first line in the angle. Now draw a line from the center point of the patella up to the ASIS. This will form the second line of the angle.

A normal angle should typically fall between 18°-22°, with males usually at the lower end and females at the upper normal end. An abnormal Q angle will typically be increased from normal. This automatically increases the vulnerability to tracking problems, as well as other low back, pelvis, leg and foot problems. This occurs due to an unleveling of the pelvis with interference to the alignment of the lumbar spine. There will often be a compensatory imbalance in the upper back and neck as well.

An abnormal Q angle becomes further complicated when accompanied by a functional or anatomical short leg. Many people, especially runners, suffer with the short leg syndrome. But, what many don't realize is that the majority of these syndromes are functional short legs rather than anatomical short legs. A functional short leg is the short leg that isn't actually short, it's just the appearance of a short leg due to some structural defect (such as an abnormal Q angle). Too often a lift is recommended for this situation, and the problems now become compounded. Remember, a lift should only be used when the measurement from the outside hip bone to the outside ankle is different on both legs. And the lift should never equal the difference. Lift therapy should begin with 1/3 to 1/2 of the measured leg length difference.

Fixing the Q Angle

It's a daunting task to begin to improve the Q angle. Every structural defect may have some influence on it, and finding the most important defects is somewhat important. Needless to say, a thorough biomechanical exam should be the first step. The evaluation of the feet is the first place to start. Pronation will very often be an underlying contributor to an increased angle. Orthotics or some type of insert is usually recommended.

Standing x-rays of the low back, with measurements of the gravity line and sacral base angle, are also important. You never know if the chicken or the egg came first, and so it goes with these findings. The gravity line and the sacral base angle will greatly benefit from proper treatment and the implementation of corrective exercises, but if they're not included in your quest to correct the Q angle, it will become impossible to efficiently recommend proper treatment or exercises. If that's too confusing, try this---don't ignore your pelvis and low back if you suffer with an increased Q angle. And again, if unable to find someone to help you with this information, feel free to call or e mail me with any questions.


The sports world and sportsmedicine industry has failed greatly (to date anyways) in stressing the importance of the biomechanics of athletes. Bridges are checked for structural flaws each year, kid's teeth are checked for alignment, cars have alignment checks, but who's checking people (runners)? We've accepted getting acute crisis care only after we're injured. Every athlete would do well to begin today to look at their structures and begin to make corrective changes as soon as possible. It's a small price to pay to stay out on the roads. Have a great month.