Knee MMT

Knee Flexion

Biceps femoris, Semitendinosus, and Semimembranosus

Origin:

·        Biceps femoris: long head: tuberosity of the ischium and sacrotuberous ligament, short head: linea aspera and lateral condyle of the femur

·        Semitendinosus: ischial tuberosity

·        Semimembranosus: ischial tuberosity

Insertion:

·        Biceps femoris: longhead and short head: lateral head of the fibula and lateral condyle of the tibia

·        Semitendinosus: proximal shaft of the tibia and pes anserine

·        Semimembranosus: medial condyle of the tibia and the lateral condyle of the femur

Nerve Innervation:

·        Biceps femoris: longhead: tibial, shorthead: common fibular

·        Semitendinosus: tibial

·        Semimembranosus: tibial

Patient Position:

·        Prone, with knee flexed to about 45°, and the opposite foot hanging off the table.

Therapist and Patient Instructions:

·        Standing next to the limb being tested, place the resistance hand on the posterior leg just superior to the ankle.  Resistance is in the direction of knee extension or essentially downward toward the table.  The stabilizing hand should be on the posterior thigh over the hamstring tendons.  Ask the patient to, “bring your heel to your buttocks, don’t let me straighten it.”

Alternate test to isolate Semitendinosus and Semimembranosus and Test to isolate the Biceps femoris

Patient Position:

·        Patient positioning is the same as above except to isolate the semitendinosus and semimembranosus the leg should be internally rotated.  Ask the patient to point their toes inward.  To isolate the biceps femoris the leg should be externally rotated, have the patient point their toes outward.

Therapist and Patient Instructions:

·        Hand positioning is the same as above.  The resistance should now be in a down and out direction toward knee extension for the semitendinosus and semimembranosus.  For isolation of the biceps femoris, the resistance will be down and inward.

MMT for Grades 2, 1, and 0

Patient Position:

·        Prone with knee flexed slightly but supported by the examiner at the ankle.

Therapist and Patient Instructions:

·        While supporting the leg at the ankle ask the patient to try and flex their knee.  Palpate the hamstring tendons.

Knee Extension

Rectus femoris, vastus intermedius, vastus lateralis, vastus medialis longus, vastus medialis oblique

Origin:

·        Rectus femoris: anterior spine of the ilium and posterior acetabulum

·        Vastus intermedius: upper 2/3 of the shaft of the femur

·        Vastus lateralis: linea aspera, greater trochanter, and intertrochanteric line of the femur

·        Vastus medialis longus: linea aspera and intertrochanteric line of the femur, and the tendons of adductor magnus and longus

·        Vastus medialis oblique: linea aspera and supracondylar line of the femur, and the tendon of adductor magnus

Insertion:

·        Rectus femoris: base of the patella

·        Vastus intermedius: base of the patella

·        Vastus lateralis: lateral patella

·        Vastus medialis longus: medial patella

·        Vastus medialis oblique: patella

Nerve Innervation:

·        Rectus femoris: femoral

·        Vastus intermedius: femoral

·        Vastus lateralis: femoral

·        Vastus medialis longus: femoral

·        Vastus medialis oblique: femoral

Patient Position:

·        Sitting, the patient can lean backward slightly to relieve hamstring tension and can place his/her hands on the table for stability.  The knee should be in extension.

Therapist and Patient Instructions:

·        The therapist should be on the side of the limb being tested.  The resistance hand should be placed on the anterior leg just above the ankle.  Resistance is given downward in the direction of knee flexion.  The stabilizing hand should be on the posterior thigh just above the knee to prevent any rotation.  Make sure that the patient is not hyperextended at the knee before performing the test as this might lock it into position.  Ask the patient to, “straighten your leg and don’t let me bend it.”

MMT for Grades 2, 1, and 0

Patient Position:

·        Patient is supine.

Therapist and Patient Instructions:

·        The therapist should palpate the quadriceps tendon between the thumb and two to four fingers.  Ask the patient to, “try and push the back of your knee down and into the table.”

 

 

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