Effects of hip stability training versus standard care on Q-angle and pain in marathon runners with patellofemoral pain syndrome: A retrospective cohort study
- 1Department of Sports Training, Huaibei Normal University, Huaibei, Anhui, China
- 2Department of Sports, Zhengzhou Technical College, Zhengzhou, Henan, China
- 3Department of Public Course Teaching (Department of Physical Education), Hubei College of the Arts, Wuhan, Hubei, China
Abstract
Objective: Hip stability training may influence the quadriceps angle (Q-angle) and pain, but the clinical relevance of static Q-angle changes remains uncertain. This study compared hip stability training with standard care for Q-angle, pain, and function in marathon runners with Patellofemoral Pain Syndrome (PFPS). Methods: We identified 487 marathon runners with PFPS, of whom 312 met the eligibility criteria. After 1:1 propensity score matching, 94 runners were retained in each group: hip stability training (Hip-STAB) and standard care (Control). Outcomes were assessed at baseline (W0) and at 4, 8, and 16 weeks (W4, W8, W16). Primary outcomes were standing Q-angle, visual analog scale pain during running (VAS-Run; 0–100 mm), and Anterior Knee Pain Scale (AKPS; 0–100 points). Results: Both groups improved over 16 weeks. Linear mixed-effects models showed significant time effects for Q-angle, VAS-Run, and AKPS (all p < 0.001), but no significant time-by-group interactions for Q-angle (p = 0.190), VAS-Run (p = 0.302), or AKPS (p = 0.317). Bonferroni-adjusted post-hoc comparisons did not identify significant between-group differences at W16. The association between Q-angle reduction and VAS-Run improvement was significant in the Hip-STAB group (r = 0.35, 95% CI 0.16 to 0.52, p < 0.001) and the Control group (r = 0.44, 95% CI 0.26 to 0.59, p < 0.001). Conclusions: Hip-STAB and standard care were each associated with improvements in static Q-angle, running pain, and function, but Hip-STAB was not superior to standard care. The correlation between Q-angle and pain changes should be interpreted as an association rather than evidence of a causal biomechanical mechanism.
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BibTeX
@article{bai2026effects,
title = {{Effects of hip stability training versus standard care on Q-angle and pain in marathon runners with patellofemoral pain syndrome: A retrospective cohort study}},
author = {Donghuan Bai and Xiaodong Cao and Shuolei Feng},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0357057},
url = {https://doi.org/10.1371/journal.pone.0357057},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Effects of hip stability training versus standard care on Q-angle and pain in marathon runners with patellofemoral pain syndrome: A retrospective cohort study
AU - Donghuan Bai
AU - Xiaodong Cao
AU - Shuolei Feng
PY - 2026
DA - 2026/09/17
JO - PLOS One
DO - 10.1371/journal.pone.0357057
UR - https://doi.org/10.1371/journal.pone.0357057
AB - Objective: Hip stability training may influence the quadriceps angle (Q-angle) and pain, but the clinical relevance of static Q-angle changes remains uncertain. This study compared hip stability training with standard care for Q-angle, pain, and function in marathon runners with Patellofemoral Pain Syndrome (PFPS). Methods: We identified 487 marathon runners with PFPS, of whom 312 met the eligibility criteria. After 1:1 propensity score matching, 94 runners were retained in each group: hip stability training (Hip-STAB) and standard care (Control). Outcomes were assessed at baseline (W0) and at 4, 8, and 16 weeks (W4, W8, W16). Primary outcomes were standing Q-angle, visual analog scale pain during running (VAS-Run; 0–100 mm), and Anterior Knee Pain Scale (AKPS; 0–100 points). Results: Both groups improved over 16 weeks. Linear mixed-effects models showed significant time effects for Q-angle, VAS-Run, and AKPS (all p < 0.001), but no significant time-by-group interactions for Q-angle (p = 0.190), VAS-Run (p = 0.302), or AKPS (p = 0.317). Bonferroni-adjusted post-hoc comparisons did not identify significant between-group differences at W16. The association between Q-angle reduction and VAS-Run improvement was significant in the Hip-STAB group (r = 0.35, 95% CI 0.16 to 0.52, p < 0.001) and the Control group (r = 0.44, 95% CI 0.26 to 0.59, p < 0.001). Conclusions: Hip-STAB and standard care were each associated with improvements in static Q-angle, running pain, and function, but Hip-STAB was not superior to standard care. The correlation between Q-angle and pain changes should be interpreted as an association rather than evidence of a causal biomechanical mechanism.
SN - 1932-6203
ER -