Erbil Polytechnic University

Erbil Health Technical College

Physiotherapy Department
Subject: evaluation method and outcome measure
Stage: Second / forth Semester
Study Year: 2020-2021

supervised by:
TCH/ Mardin Salem

prepared by:
Shakar M Omer
CONTENT ………………………………………………………………………………………………………………………. PAGE/ NO
Introduction………………………………………………………………………………………………………………………………………….3

Structure and Function of muscle………………………………………………………………………………………………………….3

Biceps Femoris: Short Head ………………………………………………………………………………………………………………….4

Biceps Femoris: Long Head …………………………………………………………………………………………………………………..4

Semitendinosus……………………………………………………………………………………………………………………………………..4

Semimembranosus ………………………………………………………………………………………………………………………………5

Manual Muscle Testing: Knee Flexion…………………………………………………………………………………………………..5

Hamstring injury………………………………………………………………………………………………………………….………….6-7

Gentle exercises and stretches………………………………………………………………………………………………………………7

References……………………………………………………………………………………………………………………………………………..8

2
Introduction:

The hamstrings are a group of muscles that cross the hip and knee joints and are responsible for walking,
running, jumping, and many other physical activities. The hamstrings flex the knee joint and extend the
thigh backward to propel movement.

Located at the backs of the legs, the hamstrings are the opposing muscles to the quadriceps. Because the
hamstrings originate at the sitting bones, they are naturally stretched while sitting. However, long periods
of sitting may affect how they function and lead to tightness.

Hamstring injuries are quite common. In fact, they are the most prevalent injury in sports. Learn how the
hamstrings function and why strengthening and stretching exercises can help prevent injury from
occurring (and reoccurring)

Structure and Function

The semitendinosus, semimembranosus, and biceps femoris muscles comprise the hamstring

muscle group. Beginning at the pelvis and running posteriorly along the length of the femur, the

majority muscles within the hamstring complex cross both the femoroacetabular and tibiofemoral joints.
The short head of the biceps femoris is an exception to this rule as it originates from the lateral lip of the
femoral linea aspera, distal to the femoroacetabular joint. For this reason, some argue that the short head
of the biceps femoris is not a true hamstring muscle. Unlike the short head of the biceps femoris, all other
hamstring muscles originate from the ischial tuberosity. The proximal, long head of the biceps femoris
and semitendinosus muscles are linked by an aponeurosis which extends approximately 7 cm from the
ischial tuberosity. The distal hamstrings form the superolateral (biceps femoris) and superomedial
(semimembranosus and semitendinosus) borders of the popliteal fossa. The gastrocnemius primarily
forms the inferior border of the popliteal fossa. The hamstring muscle group plays a prominent role in
hip extension (posterior movement of the femur) and knee flexion (posterior movement of the tibia and
fibula). Concerning the gait cycle, the hamstrings activate beginning at the final 25% of the swing phase
generating extension force at the hip and resisting knee extension. The hamstring muscles also play an
essential role as a dynamic stabilizer of the knee joint. Operating in tandem with the anterior cruciate
ligament (ACL), the hamstrings resist anterior translation of the tibia during the heel strike phase of the
gait cycle

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Muscles
Biceps Femoris: Short Head
 Origin: Lateral lip of the linea aspera
 Insertion: The fibular head and lateral condyle of the
tibia
 Function: Knee flexion and lateral rotation of the
tibia
 Innervation: Fibular (common peroneal) nerve
 Vascular supply: Perforating branches of the deep
femoral artery

Biceps Femoris: Long Head

 Origin: Ischial tuberosity
 Insertion: The fibular head and lateral condyle of the tibia
 Function: Knee flexion, lateral rotation of the tibia, and hip extension
 Innervation: Tibial nerve
 Vascular supply: Perforating branches of the deep femoral artery

Semitendinosus
 Origin: Lower, medial surface of the
ischial tuberosity
 Insertion: Medial tibia (pes
anserinus)
 Function: Knee flexion, hip extension
and medial rotation of the tibia (with
knee flexion)
 Innervation: Tibial nerve
 Vascular supply: Perforating branches
of the deep femoral artery

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Semimembranosus
 Origin: Ischial tuberosity

 Insertion: Medial tibial condyle

 Function: Knee flexion, hip extension and
medial rotation of the tibia (with knee
flexion)
 Innervation: Tibial nerve
 Vascular supply: Perforating branches of the
deep femoral artery

Manual Muscle Testing: Knee Flexion:

Patient Positioning
Grades 3 to 5 - Patient is in prone, knee extended
Grades 0-2 - Patient is in side lying, knee extended ('gravity minimal' position)

Therapist Position
Therapist to stand at test side in prone
If patient is in side lying, therapist to stand behind the patient support the lower leg through
movement as required.

To Test
Patient actively flexes the knee through range.
For grades 4 to 5 apply resistance through the distal tibia and fibula in a direction opposite to flexion To
satisfy grade 5 'normal muscle' performance criteria, the patient must have the ability to move through
complete range of motion (active resistance testing) OR maintain an end point range (break testing)
against maximum resistance.

5
 Hamstring injury
A hamstring injury is a strain or tear to the tendons or large muscles at the back of the thigh.
It's a common injury in athletes and can occur in different severities. The 3 grades of
hamstring injury are:
 grade 1 – a mild muscle pull or strain
 grade 2 – a partial muscle tear
 grade 3 – a complete muscle tear
The length of time it takes to recover from a hamstring strain or tear will depend on how
severe the injury is.
A minor muscle pull or strain (grade 1) may take a few days to heal, whereas it could take
weeks or months to recover from a muscle tear (grade 2 or 3).

What causes hamstring injuries?

A hamstring injury can occur if any of the tendons or muscles are stretched beyond their limit.
They often occur during sudden, explosive movements, such as sprinting, lunging or jumping. But
they can also occur more gradually, or during slower movements that overstretch your hamstring.
Recurring injury is common in athletes and sportsmen, as you're more likely to injure your hamstring if
you've injured it before.
Regularly doing stretching and strengthening exercises, and warming up before exercise, may help
reduce the risk of injuring your hamstring.

How do I know if I've injured my hamstring?

Mild hamstring strains (grade 1) will usually cause sudden pain and tenderness at the back of your
thigh. It may be painful to move your leg, but the strength of the muscle should not be affected.
Partial hamstring tears (grade 2) are usually more painful and tender. There may also be some
swelling and bruising at the back of your thigh and you may have lost some strength in your leg.
Severe hamstring tears (grade 3) will usually be very painful, tender, swollen and bruised. There may
have been a "popping" sensation at the time of the injury and you'll be unable to use the affected leg.

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Rest and recovery from a hamstring injury
Recovering from a hamstring injury may take days, weeks or months, depending on how severe it is.
A completely torn hamstring may take several months to heal and you'll be unable to resume training
or play sport during this time.

Gentle exercises and stretches

Returning to strenuous exercise too quickly could make your injury worse, but avoiding exercise for too
long can cause your hamstring muscles to shrink and scar tissue to form around the tear.
To avoid this, you should start doing gentle hamstring stretches after a few days, when the pain has
started to subside.
This should be followed by a programme of gentle exercise, such as walking and cycling, and hamstring
strengthening exercises.
Your GP can give you further advice and, if necessary, refer you to a physiotherapist for a suitable
exercise programme.
To avoid injuring yourself again, you should only return to a full level of activity when your hamstring
muscles are strong enough. Your physiotherapist or GP will be able to advise you about this.
Many people need to avoid sports for at least a few weeks, but the length of time you need off will
depend on the severity of your injury.

7
References:

https://www.verywellfit.com/hamstring-muscle-anatomy-and-stretches-3498372
https://www.researchgate.net/publication/338127807_Anatomy_Bony_Pelvis_and_Lower_Limb_Ha
mstring_Muscle
https://www.ncbi.nlm.nih.gov/books/NBK546688/#:~:text=The semitendinosus%2C
semimembranosus%2C and biceps,the femoroacetabular and tibiofemoral joints.n
https://www.nhs.uk/conditions/hamstring-
injury/#:~:text=A%20hamstring%20injury%20is%20a,2%20%E2%80%93%20a%20partial%20muscle%2
0tear
https://www.physio-pedia.com/Manual_Muscle_Testing:_Knee_Flexion