When we think of ankle injuries, especially in young female athletes, we often blame weak ankles, poor footwear, or unstable surfaces.

But what if the real problem starts higher up the chain?

At the pelvis

The Quadratus Lumborum (QL) is a deep core stabilizer that connects the pelvis to the lumbar spine and ribs. It plays a crucial role in pelvic control, frontal-plane stability, and load transfer during movement.

In most girls, due to wider pelvis angles, increased Q-angle, and less trunk stiffness, the body relies more on the QL and lateral core muscles to stabilize the pelvis during single-leg tasks like running, jumping, or cutting.

If the QL is weak or fatigued, the pelvis drops on one side (Trendelenburg pattern), leading to:

➡️ Knee valgus collapse

➡️ Poor foot alignment

➡️ Compensatory overpronation and ankle instability

Over time, this chain reaction increases the risk of ankle sprains and chronic instability, even if the ankle itself is strong.

✅ Training implication:

Developing unilateral QL and lateral chain strength (side planks, suitcase carries, single-leg RDLs with frontal-plane control) improves pelvic stability, which in turn reduces ground reaction torque transmitted to the ankle.

In short, a stable pelvis creates a stable foot.

Strengthen the QL, and you build protection from the top down.

🔴 Note: The existing research references primarily investigate trunk neuromuscular control and its link to knee or ACL injuries, not directly ankle injuries. Most trunk control studies focus on the knee (especially ACL) because knee valgus collapse is easy to measure in biomechanics labs.

The same kinetic chain instability (pelvic drop → knee valgus → foot pronation) also affects the ankle - but that last step (ankle outcome) has not been studied as thoroughly. So, while no major study isolates the Quadratus Lumborum → ankle injury link directly, the mechanistic pathway is supported by multiple studies on core-lower-limb biomechanics.

📚 References

1. Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Cholewicki J. Deficits in neuromuscular control of the trunk predict knee injury risk: A prospective biomechanical-epidemiologic study. Am J Sports Med. 2007;35(7):1123-1130.

2. Willson JD, Dougherty CP, Ireland ML, Davis IM. Core stability and its relationship to lower extremity function and injury. J Am Acad Orthop Surg. 2005;13(5):316-325.

3. Sanchis-Sanchis R, et al. Sex differences in neuromuscular control: Implications for injury risk in female athletes. Eur J Sport Sci. 2020;20(5):583-592.

- Aadhithya N R
High Performance Coach