Anatomy, Bony Pelvis and Lower Limb, Posterior Thigh Muscles


Article Author:
Jacob Vaughn


Article Editor:
Wayne Cohen-Levy


Editors In Chief:
Susan Jeno
Sarah Fabiano


Managing Editors:
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Frank Smeeks
Kristina Soman-Faulkner
Benjamin Eovaldi
Radia Jamil
Sobhan Daneshfar
Saad Nazir
William Gossman
Pritesh Sheth
Hassam Zulfiqar
Steve Bhimji
John Shell
Matthew Varacallo
Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Hajira Basit
Phillip Hynes
Kavin Sugumar


Updated:
5/20/2019 2:14:22 AM

Introduction

The muscles composing the posterior thigh compartment are collectively, and more commonly, known as the hamstring muscles. These three major muscles, consisting of the biceps femoris short and long head, semitendinosus, and semimembranosus play significant roles in everyday life as they participate in the complex movements of standing, walking, and running. 

Structure and Function

Except for the short head of the biceps femoris, the other posterior thigh muscles span the length of the femur and coss both the hip and knee joints. Spanning from the posterior pelvis to the proximal tibia and fibula, the posterior thigh muscles provide motion to both the femoroacetabular joint (hip joint) and tibiofemoral joint (knee joint). The long head of the biceps femoris, semitendinosus, and semimembranosus originate from the ischial tuberosity of the pelvis extending distally on the posterior side of the femur eventually crossing the knee — the biceps femoris crossing laterally while semimembranosus and semitendinosus cross medially. The short head of the biceps femoris originates independently from the lateral linea aspera of the posterior femur before joining with the long head of biceps femoris to span the knee.

The superior or proximal borders of the popliteal fossa, posterior to the knee, is created by the hamstring muscles descending and crossing the joint. The superior-lateral border of the popliteal fossa is created by biceps femoris while the superior medial border forms from semimembranosus and semitendinosus.

As a group of muscles, the hamstring muscles primarily work to extend the hip (movement of the femur directly posteriorly) and flex the knee (movement of the tibia and fibula directly posteriorly). These actions are significant components of the multi-joint movements of standing up from a seated position and normal gait. The ability to remain stable while standing is also largely attributed to the actions of the hamstring muscles by allowing the body to remain erect above lower extremities securely fixed at the hip joint. The hamstrings additionally provide minor rotation pull on the lower extremity based on their lateral or medial insertion points distally (biceps femoris provides external rotation, semitendinosus/semimembranosus provides internal rotation).

Embryology

The entire human body originally derives from the embryonic ectoderm, mesoderm, or endoderm. Muscles, connective tissue, bones, blood vessels, and more form from the mesoderm. The posterior muscles of the thigh are no exception to this rule and can be traced back embryologically to their origin from the mesoderm. Specifically, the posterior thigh muscles derive from the paraxial mesoderm (somites) of the lower limb buds (L3 to L5) on the anterior surface of each bud. Around week 7 to 8 of gestation, the lower limbs begin to rotate medially to their final position resulting in the posterior location of these muscles.

Blood Supply and Lymphatics

For muscle blood supply, see muscles section below.

The posterior thigh compartment deep to the fascia lata, where the hamstring muscles reside, drains through lymphatic vessels to the deep inguinal lymph nodes along with the popliteal nodes which drain some additional areas of the distal lower limb. The deep inguinal nodes continue to drain into the external iliac nodes, then to the common iliac nodes, eventually draining into the cisterna chyli/thoracic duct.

Nerves

The sciatic nerve exits the pelvis via the greater sciatic foramen before coursing into and through the posterior thigh, deep to the long head of biceps femoris, before bifurcating at the superior border of the popliteal fossa into the tibial and common peroneal nerve.

The posterior femoral cutaneous nerve also exits the pelvis through the greater sciatic foramen. However, the posterior femoral cutaneous nerve travels superficial to the long head of biceps femoris before traveling down the midline of the posterior thigh deep to the fascia lata until it reaches the popliteal fossa.

See muscles section below for innervation of muscles.

Muscles

BICEPS FEMORIS LONG HEAD

  • Origin: Common (conjoint) tendon from the superior medial quadrant of the posterior ischial tuberosity (with semitendinosus)
  • Insertion: Majority onto the fibular head; also the lateral collateral ligament of the knee and lateral tibial condyle
  • Action: Flexion of the knee, and lateral rotation of the tibia; extension of the hip joint
  • Innervation: Tibial nerve (a portion of the sciatic nerve)
  • Arterial Supply: Perforating (muscular) branches of profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery

BICEPS FEMORIS SHORT HEAD

  • Origin: Lateral lip of linea aspera, the lateral intermuscular septum of the thigh, and lateral supracondylar ridge of femur
  • Insertion: Majority on the fibular head; and lateral collateral ligament of the knee, and lateral tibial condyle
  • Action: Flexion of the knee, and lateral rotation of the tibia
  • Innervation: Common peroneal nerve (a portion of the sciatic nerve)
  • Arterial Supply: Perforating (muscular) branches of profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery

SEMIMEMBRANOSUS

  • Origin: Superior lateral aspect of the ischial tuberosity
  • Insertion: The posterior surface of the medial tibial condyle
  • Action: Extension of the hip, flexion of the knee, and medial rotation of the tibia (specifically with knee flexion)
  • Innervation: Tibial nerve (a portion of the sciatic nerve)
  • Arterial Supply: Perforating (muscular) branches of profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery

SEMITENDINOSUS

  • Origin: The common (conjoint) tendon from the superior medial quadrant of the posterior ischial tuberosity (with biceps femoris long head)
  • Insertion: Superior aspect of the medial tibial shaft (into the distal portion of the pes anserinus along with the gracilus and sartorius muscles)
  • Action: Extension of the hip and flexion of the knee, medial rotation of the tibia (specifically with knee flexion)
  • Innervation: Tibial nerve (a portion of the sciatic nerve)
  • Arterial Supply: Perforating (muscular) branches of profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery

Physiologic Variants

Variations in hamstring muscles and their attachments are rare. One variation that noted in current research is the distinct origination of the biceps femoris long head and semitendinosus from separate tendons attached to the ischial tuberosity opposed to their more common, shared, origination from the common (conjoint) tendon to the ischial tuberosity.[1]

Additional isolated variations have appeared through cadaver dissections. Of note, a lack of union between the short and long head of biceps femoris, while still inserting into the fibular head on one cadaver. On another, two anomalous muscles, one arising as a “third head of biceps femoris” and another as an independent muscle inserting into semitendinosus, were seen on post-mortem dissection.[2]

Surgical Considerations

Surgical treatments involving the hamstring muscles are rare as conservative treatment for injuries is the preferred first-line management. Patients may present with ecchymosis over the posterior thigh and a stiff-legged gait to avoid flexion at the hip and knee. Patients with avulsion injuries of the proximal hamstring muscles from their origin may benefit from surgical treatment of their injuries regarding pain levels and functional outcomes, particularly if they are young and active. Surgical procedures have been shown to have better results when used in the treatment of more severe avulsion injuries as well as being performed on more acute injuries in comparison to chronic avulsion injuries.[3] The decision to indicate a patient for surgery depends on the distance that the tendon has retracted as well as the chronicity of symptoms. 

Other surgical considerations regarding the hamstring muscles include autografting hamstring tendons for the reconstruction of the ACL in patients with tears. Removal of the semitendinosus and sometimes gracilus tendons from their insertions site into the pes anserinus for use in ACL repairs has been shown to have advantages over other autograft methods (such as using the patellar tendon) with less post-operative knee pain and an overall easier recovery following surgery.[4]

Clinical Significance

Hamstring muscle injuries are currently one of the most common injuries suffered by athletes. Patients largely report strains due to quick changes in speed and excessive lengthening of the hamstrings due to a particular inciting event or experiencing proximal tendinopathy resulting from excessive use over long periods. Two types of acute hamstring strains appear in the current literature. Type 1, involving mainly the proximal tendon muscle junction of the biceps femoris, results during the terminal deceleration of the swing phase of running as the patient prepares to plant their foot resulting in eccentric contraction of the muscle.[5] Type 2 hamstring strains result from the extensive lengthening of the muscle resulting in overstretching and injury to the proximal tendon area of the semimembranosus muscle. These types of injuries most commonly occur during actions involving flexion of the hip with an extension of the knee.[6] Of these two types of injuries, type 2 has been shown to require more time to fully heal and return to sports in comparison to type 1.[7]

Clinically, patients typically describe hamstring muscle strains as beginning acutely during physical activities involving the lower body with a sharp or stabbing pain in the proximal posterior thigh with increasing pain with active extension of the hip or flexion of the knee. A possible pop and/or delayed appearance of ecchymosis around the area of pain presents in more extreme cases.[8] On physical exam, patients generally exhibit pain in the posterior thigh with passive stretching of the hamstring muscles and with activation or use of the hamstring muscles. Plain radiographs of the pelvis may show a small avulsion fracture from the ischial tuberosity; however, an MRI is necessary if the radiographs are negative, and a high index of suspicion exists.[9] Treatment for hamstring injuries largely resolves around decreasing inflammation and damage near the time of injury with resting of the muscles, NSAIDs, and icing. Following initial treatment of the injury, varying progressions of physical therapy are used to progress patients back to full use of their hamstrings while avoiding re-injury, a very common occurrence with hamstring injuries.[10][11] Researchers have explored additional treatment modalities in pursuit of faster recovery, including the use of intramuscular corticosteroid injections and administration of platelet-rich plasma (PRP) all with varying results and efficacy at this time.[12][13]


  • Image 10015 Not availableImage 10015 Not available
    Image courtesy S Bhimji MD
Attributed To: Image courtesy S Bhimji MD

Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Anatomy, Bony Pelvis and Lower Limb, Posterior Thigh Muscles - Questions

Take a quiz of the questions on this article.

Take Quiz
A soldier crawling along a ditch in live round training incautiously raised his rear. An untimely bullet shattered his ischial tuberosity. Which of the following muscles would you expect to still be still functional?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 22-year-old male presents to the clinic following a sports-related injury occurring one day prior. The patient reports experiencing a popping sensation with immediate pain in his left knee upon planting his foot while twisting and attempting to change directions. The patient is diagnosed with a complete anterior cruciate ligament (ACL) tear and is scheduled for reconstructive surgery in the coming weeks. Which of the following muscles has a direct attachment to a tendon that is commonly harvested for an autograft for ACL reconstruction?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Following a motor vehicle accident, a patient is found to have a deep penetrating laceration to the proximal posterior thigh. After stabilizing the patient, the wound is explored, and the sciatic nerve is found to be partially damaged. Over the next week, the patient is found to have damage to the sciatic nerve mainly associated with the fibers supplying the common peroneal nerve. Which of the following muscles is most likely to have diminished function due to this damage?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 47-year-old female patient presents to the orthopedic outpatient clinic for the evaluation of anterior knee pain. The patient notes one week of intermittent pain with palpation on the anterior knee slightly distal and medial to the tibial tuberosity. Following a complete history and physical, the patient is diagnosed with pes bursitis and instructed to take NSAIDs for pain relief and to follow-up if the pain persists. Which of the following muscles has an attachment site located where this patient is experiencing pain?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Following a traumatic fall from a height, a patient is found to have a fracture of the pelvis involving the ischial tuberosity. Which of the following muscles of the lower extremity would be most likely affected by a fracture to this location?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
While exploring a laceration wound on the posterior aspect of a patient's knee, the clinician notices the tendons composing the superior medial border of the popliteal fossa has been transected. Which of the following nerves is responsible for the innervation of the two muscles affected by this transection?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Anatomy, Bony Pelvis and Lower Limb, Posterior Thigh Muscles - References

References

Koulouris G,Connell D, Hamstring muscle complex: an imaging review. Radiographics : a review publication of the Radiological Society of North America, Inc. 2005 May-Jun;     [PubMed]
Chakravarthi K, Unusual unilateral multiple muscular variations of back of thigh. Annals of medical and health sciences research. 2013 Nov;     [PubMed]
Bodendorfer BM,Curley AJ,Kotler JA,Ryan JM,Jejurikar NS,Kumar A,Postma WF, Outcomes After Operative and Nonoperative Treatment of Proximal Hamstring Avulsions: A Systematic Review and Meta-analysis. The American journal of sports medicine. 2018 Sep;     [PubMed]
Frank RM,Hamamoto JT,Bernardoni E,Cvetanovich G,Bach BR Jr,Verma NN,Bush-Joseph CA, ACL Reconstruction Basics: Quadruple (4-Strand) Hamstring Autograft Harvest. Arthroscopy techniques. 2017 Aug;     [PubMed]
Chu SK,Rho ME, Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play. Current sports medicine reports. 2016 May-Jun;     [PubMed]
Askling CM,Tengvar M,Saartok T,Thorstensson A, Acute first-time hamstring strains during slow-speed stretching: clinical, magnetic resonance imaging, and recovery characteristics. The American journal of sports medicine. 2007 Oct;     [PubMed]
Askling C,Saartok T,Thorstensson A, Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level. British journal of sports medicine. 2006 Jan;     [PubMed]
Ali K,Leland JM, Hamstring strains and tears in the athlete. Clinics in sports medicine. 2012 Apr;     [PubMed]
Koulouris G,Connell D, Imaging of hamstring injuries: therapeutic implications. European radiology. 2006 Jul;     [PubMed]
Heiderscheit BC,Sherry MA,Silder A,Chumanov ES,Thelen DG, Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. The Journal of orthopaedic and sports physical therapy. 2010 Feb;     [PubMed]
Sherry MA,Johnston TS,Heiderscheit BC, Rehabilitation of acute hamstring strain injuries. Clinics in sports medicine. 2015 Apr;     [PubMed]
Levine WN,Bergfeld JA,Tessendorf W,Moorman CT 3rd, Intramuscular corticosteroid injection for hamstring injuries. A 13-year experience in the National Football League. The American journal of sports medicine. 2000 May-Jun;     [PubMed]
Hamid MS,Yusof A,Mohamed Ali MR, Platelet-rich plasma (PRP) for acute muscle injury: a systematic review. PloS one. 2014;     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Physical Therapy. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Physical Therapy, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Physical Therapy, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Physical Therapy. When it is time for the Physical Therapy board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Physical Therapy.