Influence of Tibial Rotation on EMG Activities of Medial and Lateral Hamstrings During Maximal Isometric Knee Flexion

  • Lim, Woo-taek (Dept. of Physical Therapy, College of Health and Welfare, Woosong University)
  • Received : 2018.10.10
  • Accepted : 2018.11.13
  • Published : 2018.11.19


Background: The hamstring muscles in the lower extremity are highly important for knee joint stability and can be classified into medial and lateral hamstrings according to the anatomical position, which have some different functions. To measure the strength of the individual hamstring muscles, manual muscle testing is clinically performed by dividing rotation postures into internal and external postures. However, this has no sufficient scientific background. Objects: This study aimed to test the difference that the tibial rotation would cause in the muscle activity of the medial and lateral hamstrings. Methods: The muscle activities of the biceps femoris, semitendinosus, and semimembranosus were measured in a total of three different postures (neutral position and internal and external rotations) with 3 replications. During the maximal isometric contraction, resistance was constantly provided by the string attached to the strap, not by manual resistance of the examiner. Before and after electromyography measurements, the participants underwent hamstring flexibility measurement using the active knee extension test in the supine position on the treatment table. Results: The semitendinosus had a 12.56% reduction in muscle activity in external rotation as compared with that in neutral position. The biceps femoris and semimembranosus showed reduced muscle activities in both external and internal rotations as compared with those in neutral position. Only the women showed significant decreases in the comparison between pre and post-active knee extension. Conclusion: Only the semitendinosus muscle was consistent with the anatomical speculation. However, the reduction in the muscle activity of the semitendinosus as compared with that in neutral position was only 12.56%, the clinical value of which may be difficult to justify.



Supported by : National Research Foundation of Korea (NRF)


  1. Albertus-Kajee Y, Tucker R, Derman W, et al. Alternative methods of normalising EMG during running. J Electromyogr Kinesiol. 2011;21(4):579-586.
  2. Avers D, Brown M. Daniels and worthingham's muscle testing: Techniques of manual examination and performance testing. 10th ed. Saunders, 2018:266-267.
  3. Bush-Joseph CA, Hurwitz DE, Patel RR, et al. Dynamic function after anterior cruciate ligament reconstruction with autologous patellar tendon. Am J Sports Med. 2001;29(1):36-41.
  4. Fauth ML, Petushek EJ, Feldmann CR, et al. Reliability of surface electromyography during maximal voluntary isometric contractions, jump landings, and cutting. J Strength Cond Res. 2010;24(4):1131-1137.
  5. Ferber R, Osternig L, Gravelle D. Effect of PNF stretch techniques on knee flexor muscle emg activity in older adults. J Electromyogr Kinesiol. 2002;12(5):391-397.
  6. Fiebert IM, Roach KE, Fingerhut B, et al. EMG activity of medial and lateral hamstrings at three positions of tibial rotation during low-force isometric knee flexion contractions. J Back Musculoskelet Rehabil. 1997;8(3):215-222.
  7. Gielen CC, van Zuylen EJ. Coordination of arm muscles during flexion and supination: Application of the tensor analysis approach. Neuroscience. 1986;17(3):527-539.
  8. Hara K, Kubo T, Suginoshita T, et al. Reconstruction of the anterior cruciate ligament using a double bundle. Arthroscopy. 2000;16(8):860-864.
  9. Hicks J, Arnold A, Anderson F, et al. The effect of excessive tibial torsion on the capacity of muscles to extend the hip and knee during single-limb stance. Gait posture. 2007;26(4):546-552.
  10. Iwaki H, Pinskerova V, Freeman MA. Tibiofemoral movement 1: The shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br. 2000;82(8):1189-1195.
  11. Johal P, Williams A, Wragg P, et al. Tibio-femoral movement in the living knee. A study of weight bearing and non-weight bearing knee kinematics using 'interventional' MRI. J Biomech. 2005;38(2):269-276.
  12. Kendall FP, McCreary EK, Provance PG, et al. Muscles: Testing and function, with posture and pain. 5th ed. LWW, Baltimore, MD, 2005:418-419.
  13. Landin D, Thompson M, Jackson MR. Actions of the biceps brachii at the shoulder: A review. J Clin Med Res. 2017;9(8):667-670.
  14. LaStayo PC, Woolf JM, Lewek MD, et al. Eccentric muscle contractions: Their contribution to injury, prevention, rehabilitation, and sport. J Orthop Sports Phys Ther. 2003;33(10):557-571.
  15. Lewek MD, Rudolph KS, Snyder-Mackler L. Control of frontal plane knee laxity during gait in patients with medial compartment knee osteoarthritis. Osteoarthritis Cartilage. 2004;12(9):745-751.
  16. Li G, Rudy TW, Sakane M, et al. The importance of quadriceps and hamstring muscle loading on knee kinematics and in-situ forces in the ACL. J Biomech. 1999;32(4):395-400.
  17. Lynn SK, Costigan PA. Changes in the medial-lateral hamstring activation ratio with foot rotation during lower limb exercise. J Electromyogr Kinesiol. 2009;19(3):e197-205.
  18. Martin E, Lovett RW. A method of testing muscular strength in infantile paralysis. JAMA. 1915;65(18):1512-1513.
  19. Onishi H, Yagi R, Oyama M, et al. EMG-angle relationship of the hamstring muscles during maximum knee flexion. J Electromyogr Kinesiol. 2002;12(5):399-406.
  20. Pandy MG, Shelburne KB. Dependence of cruciate-ligament loading on muscle forces and external load. J Biomech. 1997;30(10):1015-1024.
  21. Passmore E, M. P, H.K. G, et al. The effect of femoral and tibial torsion on muscle and joint function during walking in typically developing children. Gait posture: ESMAC 2016. 2016;49(2):41.
  22. Perotto AO. Anatomical guide for the electromyographer: The limbs and trunk. 5 edition ed. Charles C Thomas Pub Ltd, 2011:244-246.
  23. Perry J, Easterday CS, Antonelli DJ. Surface versus intramuscular electrodes for electromyography of superficial and deep muscles. Phys Ther. 1981;61(1):7-15.
  24. Reinschmidt C, van den Bogert AJ, Nigg BM, et al. Effect of skin movement on the analysis of skeletal knee joint motion during running. J Biomech. 1997;30(7):729-732.
  25. Ristanis S, Giakas G, Papageorgiou CD, et al. The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs. Knee Surg Sports Traumatol Arthrosc. 2003;11(6):360-365.
  26. Roberts TJ, Azizi E. The series-elastic shock absorber: Tendons attenuate muscle power during eccentric actions. J Appl Physiol(1985). 2010;109(2):396-404.
  27. Steiner ME, Brown C, Zarins B, et al. Measurement of anterior-posterior displacement of the knee. A comparison of the results with instrumented devices and with clinical examination. J Bone Joint Surg Am. 1990;72(9):1307-1315.
  28. Surface electromyography for the non-invasive assessment of muscles (SENIAM). Sensor location, Recommendations [Internet]. Cited 2018 Oct. Available from:
  29. ter Haar Romeny BM, Denier van der Gon JJ, Gielen CC. Changes in recruitment order of motor units in the human biceps muscle. Exp Neurol. 1982;78(2):360-368.
  30. ter Haar Romeny BM, van der Gon JJ, Gielen CC. Relation between location of a motor unit in the human biceps brachii and its critical firing levels for different tasks. Exp Neurol. 1984;85(3):631-650.
  31. Wilk KE, Andrews JR. Current concepts in the treatment of anterior cruciate ligament disruption. J Orthop Sports Phys Ther. 1992;15(6):279-293.

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