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Concept: Thigh muscles


Why do some hamstring and quadriceps strains take much longer to repair than others? Which injuries are more prone to recurrence? Intramuscular tendon injuries have received little attention as an element in ‘muscle strain’. In thigh muscles, such as rectus femoris and biceps femoris, the attached tendon extends for a significant distance within the muscle belly. While the pathology of most muscle injures occurs at a musculotendinous junction, at first glance the athlete appears to report pain within a muscle belly. In addition to the musculotendinous injury being a site of pathology, the intramuscular tendon itself is occasionally injured. These injuries have a variety of appearances on MRIs. There is some evidence that these injuries require a prolonged rehabilitation time and may have higher recurrence rates. Therefore, it is important to recognise the tendon component of a thigh ‘muscle strain’.

Concepts: Muscle, Strain, Injuries, Injury, Flexion, Extension, Sprain, Thigh muscles


Acute adductor injuries account for the majority of acute groin injuries; however, little is known about specific injury characteristics, which could be important for the understanding of etiology and management of these injuries. The study aim was to describe acute adductor injuries in athletes using magnetic resonance imaging (MRI). Male athletes with acute groin pain and an MRI confirmed acute adductor muscle injury were prospectively included. MRI was performed within 7 days using a standardized protocol and a reliable assessment approach. 156 athletes presented with acute groin pain of which 71 athletes were included, median age 27 y (range 18-37). There were 46 isolated muscle injuries, and 25 athletes with multiple adductor injuries. In total, 111 acute adductor muscle injuries were recorded; 62 adductor longus, 18 adductor brevis, 17 pectineus, 9 obturator externus, 4 gracilis and 1 adductor magnus injury. Adductor longus injuries occurred at three main injury locations; proximal insertion (26%), intramuscular musculotendinous junction (MTJ) of the proximal tendon (26%) and the MTJ of the distal tendon (37%). Intramuscular tendon injury was seen in 1 case. At the proximal insertion 12 of 16 injuries were complete avulsions. This study shows that acute adductor injuries generally occur in isolation from other muscle groups. Adductor longus is the most frequently injured muscle in isolation and in combination with other adductor muscle injuries. Three characteristic adductor longus injury locations were observed on MRI, with avulsion injuries accounting for three quarters of injuries at the proximal insertion, and intramuscular tendon injury was uncommon. This article is protected by copyright. All rights reserved.

Concepts: Muscle, Nuclear magnetic resonance, Magnetic resonance imaging, Muscular system, Hip, Thigh muscles, Medial compartment of thigh


Study Design Cross-sectional. Objectives To determine if quadriceps atrophy was present in people with patellofemoral pain (PFP), and whether vastus medialis oblique (VMO) was selectively involved. Background It has been suggested that selective atrophy of VMO relative to vastus lateralis could be associated with PFP, despite a lack of studies investigating individual quadriceps muscle size in individuals with PFP. Methods The quadriceps muscle size of 35 participants with PFP (22 with unilateral and 13 with bilateral symptoms) and 35 asymptomatic control participants matched for age and gender were measured using real-time ultrasound. The thickness of the VMO, vastus lateralis, vastus medialis, rectus femoris, and vastus intermedius were measured. Paired samples t-tests were used to compare muscle thickness between limbs in those with unilateral PFP, and independent t-tests were used to compare muscle thickness between groups with and without PFP. Results In those with unilateral PFP, the thickness of all portions of the quadriceps muscle was statistically smaller in the symptomatic compared to the asymptomatic limb: VMO (P = .038), vastus medialis (P<.001), vastus lateralis (P = .005), vastus intermedius (P = .013), rectus femoris (P = .045). No difference was found for the thickness of any portions of the quadriceps in people with PFP compared to asymptomatic controls: VMO (P = .148), vastus medialis (P = .474), vastus lateralis (P = .122), vastus intermedius (P = .466), rectus femoris (P = .508). Conclusion Atrophy of all portions of the quadriceps muscles is present in the affected limb of people with unilateral PFP. There was no atrophy of the quadriceps in individuals with PFP compared to those without pathology. Selective atrophy of VMO relative to vastus lateralis was not identified in people with PFP. J Orthop Sports Phys Ther, Epub 25 Jun 2015. doi:10.2519/jospt.2015.5852.

Concepts: Statistics, Muscle, Knee, Vastus lateralis muscle, Rectus femoris, Quadriceps femoris muscle, Vastus medialis, Thigh muscles


The aim of this study was to describe thigh muscle activation during cycling using intramuscular electromyographic recordings of eight thigh muscles, including the biceps femoris short head (BFS) and the vastus intermedius (Vint).

Concepts: Muscle, Biceps brachii muscle, Electromyography, Muscular system, Thigh, Extension, Thigh muscles, Phonomyography


Groin injuries are common in soccer and often cause time-loss from training. While groin injuries have been linked to full effort kicking, the role of inside passing is unclear. Therefore, the purpose of this study was to investigate hip joint kinematics and muscle force, stress and contraction velocity for adductor longus and gracilis during inside passing. 3D kinematics of ten soccer players (23.4 yrs; 77.5 kg; 1.81 m) were captured with a motion capture system inside a Footbonaut. Muscle force and contraction velocity were determined with AnyBody Modelling System. Gracilis muscle forces were 9% lower compared to adductor longus (p = 0.005), but muscle stress was 183% higher in gracilis (p = 0.005). Contraction velocity reveals eccentric contraction of gracilis in the last quarter of the swing phase. Considering the combination of eccentric contraction, high muscle stress and the repetitive nature of inside passing, gracilis accumulates high loads in matches and training. These results indicate that the high incidence of groin injuries in soccer could be linked to isolated pass training. Practitioners need to be aware of the risk and refrain from sudden increases in the amount of pass training. This gives the musculoskeletal system time to adapt and might avoid career threatening injuries.

Concepts: Energy, Force, Hip, Classical mechanics, Gracilis muscle, Adductor magnus muscle, Thigh muscles, Adductor brevis muscle


Determining the magnitude of quadriceps and hamstring muscle volume asymmetries in healthy individuals is a critical first step towards interpreting asymmetries as compensatory or abnormal in pathological populations. The purpose of this study was to determine the magnitude of whole and individual muscle volume asymmetries, quantified as right-left volume differences, for the quadriceps and hamstring muscles in a young and healthy population. Twenty-one healthy individuals participated: eleven females age = 22.6 ± 2.9years and ten males age = 23.2 ± 3.4years. Whole muscle group and individual muscle volume asymmetries were quantified within the context of absolute measurement error using a 95% Limits of Agreement approach. Mean muscle asymmetries ranged from -3.0-6.0% for all individual and whole muscle groups. Whole muscle group 95% limits of agreements represented ± 11.4% and ± 8.8% volume asymmetries for the hamstrings and quadriceps respectively. Individual muscle asymmetry 95% limits of agreements ranged from ∼ ± 11-13% for the vastii muscles while the biceps femoris short-head(± 33.5%), long-head(± 20.9%) and the rectus femoris (± 21.4%) displayed the highest relative individual asymmetries. Individual muscle asymmetries exceeded absolute measurement error in 70% of all cases, with 26% of all cases exceeding 10% asymmetry. Although whole muscle group asymmetries appear to be near the 10% assumed clinical threshold of normality, the greater magnitude of individual muscle asymmetries highlights the subject- and muscle-specific variability in volume asymmetry. Future research is warranted to determine if volume asymmetry thresholds exist that discriminate between healthy and pathological populations. Statement of Clinical Significance: Muscle volume asymmetries displayed in healthy individuals provide a reference for interpreting asymmetries in pathological populations. This article is protected by copyright. All rights reserved.

Concepts: Muscle, Muscular system, Flexion, Extension, Rectus femoris, Hamstring, Copyright, Thigh muscles


This meta-analysis was performed to analyze serial changes in thigh muscles, including quadriceps and hamstring muscles, from before to one year after total knee arthroplasty (TKA). All studies sequentially comparing isokinetic quadriceps and hamstring muscle strengths between the TKA side and the contralateral uninjured limb were included in this meta-analysis. Five studies with 7 cohorts were included in this meta-analysis. The mean differences in the strengths of quadriceps and hamstring muscles between the TKA and uninjured sides were greatest three months after surgery (26.8 N∙m, 12.8 N∙m, P<0.001), but were similar to preoperative level at six months (18.4 N∙m, 7.4 N∙m P<0.001) and were maintained for up to one year (15.9 N∙m, 4.1 N∙m P<0.001). The pooled mean differences in changes in quadriceps and hamstring strengths relative to preoperative levels were 9.2 N∙m and 4.9 N∙m, respectively, three months postoperatively (P = 0.041), but were no longer significant after six months and one year. During the year after TKA, quadriceps and hamstring muscle strengths were lowest after 3 months, recovering to preoperative level after six months, but not reaching the muscle strength on the contralateral side. Relative to preoperative levels, the difference in muscle strength between the TKA and contralateral knees was only significant at three months. Because decrease of strength of the quadriceps was significantly greater than decrease in hamstring muscle strength at postoperative three months, early rehabilitation after TKA should focus on recovery of quadriceps muscle strength.

Concepts: Muscle, Knee, Muscular system, Thigh, Knee replacement, Flexion, Quadriceps femoris muscle, Thigh muscles


We aimed to investigate neuromuscular activation of thigh muscles during track cycling at various speeds. Eight male competitive cyclists volunteered to participate in this study. Surface electromyography of the vastus lateralis, biceps femoris and adductor magnus muscles of the bilateral legs was recorded during track cycling on velodromes with a 250-m track. The participants were instructed to maintain three different lap times: 20, 18 and 16 s. The average rectified value (ARV) was calculated from the sampled surface electromyography. Significantly higher ARVs were observed in the right compared to left leg for the biceps femoris muscle during both straight and curved sections at 18- and 16-s lap times (P < 0.05). In the biceps femoris muscle, significant changes in ARVs during the recovery phase with an increase in speed were seen in the right leg only (P < 0.05). There were no significant differences in ARVs between the straight and curved sections for all three muscles (P > 0.05). From our findings, it was suggested that during track cycling on a velodrome the laterality of the biceps femoris muscle activity is a key strategy to regulate the speed, and fixed neuromuscular strategies are adopted between straight and curved sections for thigh muscles.

Concepts: Muscle, Electromyography, Extension, Human leg, Sprint, Thigh muscles, Track cycling, Velodrome


Abstract This study aimed to investigate the effects of forward trunk lean on hamstring muscle kinematics during sprinting. Eight male sprinters performed maximal-effort sprints in two trunk positions: forward lean and upright. A three-dimensional musculoskeletal model was used to compute the musculotendon lengths and velocity of the biceps femoris long head, semitendinosus, and semimembranosus muscles during the sprinting gait cycle. The musculotendon lengths of all the three hamstring muscles at foot strike and toe-off were significantly greater during the forward trunk lean sprint than during the upright trunk sprint. In addition, a positive peak musculotendon lengthening velocity was observed in the biceps femoris long head and semimembranosus muscles during the late stance phase, and musculotendon lengths at that instant were significantly greater during the forward trunk lean sprint than during the upright trunk sprint. The present study provides significant evidence that a potential for hamstring muscle strain injury involving forward trunk lean sprinting would exist during the stance phase. The results also indicate that the biceps femoris long head and semimembranosus muscles are stretched during forward trunk lean sprinting while contracting eccentrically in the late stance phase; thus, the elongation load on these muscles could be increased.

Concepts: Present, Muscle, Strain, Biceps brachii muscle, Muscular system, Flexion, Extension, Thigh muscles


BACKGROUND:An injury to the hamstring muscle complex is the most common injury in soccer. Ultrasound of acute hamstring injuries is often used as a clinical tool for diagnosing hamstring injuries and guiding players in when they can return to play. PURPOSE:To (1) investigate the characteristic sonographic findings of acute hamstring injuries in soccer players, (2) compare the mean injury severity (time to return to play) in injured players with and without sonographically verified abnormalities, and (3) correlate the length of the injured area and absence from soccer play (time to return to play) to investigate if ultrasonography can be used as a prognostic indicator of time to return to play. STUDY DESIGN:Case series; Level of evidence, 4. METHODS:Players from 50 teams participating in 1 of the top 5 Danish soccer divisions were followed in the period from January to December 2008. Of 67 players with acute hamstring injuries, 51 underwent ultrasonographic examination of the injured thigh and were included in this study. RESULTS:Ultrasonographic examinations were performed 1 to 10 days after injury (mean, 5.2 ± 3.0 days), and sonographic findings were present in 31 of 51 cases (61%). Two thirds of the injuries were to the biceps femoris muscle and one third to the semitendinosus muscle. No total ruptures were documented. The 51 acute hamstring injuries resulted in absence from soccer of a mean 25.4 ± 15.7 days per injury, with no significant difference between players with and without sonographically verified abnormalities (P = .41). No correlation existed between the length of the injured area and injury severity (r = 0.19, P = .29). CONCLUSION:The biceps femoris is the most commonly injured hamstring muscle detected by ultrasound, and more than half of the injuries are intramuscular. Because neither the presence of sonographic findings nor the size of the findings was correlated with time to return to play in injured soccer players, the prognosis of hamstring injuries should not be guided by these findings alone.

Concepts: Injury, Correlation and dependence, Medical ultrasonography, Prognosis, Flexion, Extension, Hamstring, Thigh muscles