The Popliteus, the Tiny Muscle of

Knee Pain
ANATOMY

The popliteus tendon originates on the lateral surface of the

lateral femoral condyle (in front of and below the lateral
collateral ligament origin) and also from the fibular head. It
also has an origin stemming from the posterior horn of the
lateral meniscus. The tendon then courses under the lateral
collateral ligament, descends into the ‘popliteal hiatus’, and
becomes extra-articular (outside the knee joint) before joining
its muscle belly. It inserts into the tibia above the popliteal
line. It is therefore a relatively horizontal muscle lying deep in
the back part of the knee.

FUNCTIONS

The popliteus is believed to have a number of functions, made

possible by its unique ability to reverse its origin and
insertion, depending on whether the femur or the tibia is
fixed.

1.Internal rotation of the tibia in an already extended knee.

Due to the contour of the femoral condyles, this internal
rotation of the tibia ‘unlocks’ an extended knee. In essence it
initiates knee flexion.
2.External rotation of the femur on a tibia that is fixed, as in
the stance phase of gait. It is an important controller of knee
rotation during the stance phase of locomotion.
3.Helps to bring the knee out of a position of full extension.
4.Helps the PCL (posterior cruciate ligament) maintain
stability by preventing excessive posterior translation of the
tibia.
5.Helps to withdraw the lateral meniscus during knee flexion.
6.Provides some rotary stability of the femur on the tibia.
7.Prevents excessive external rotation and varus rotation of
the tibia during knee flexion.
I have heard it said that the popliteus can contract to up to
300% after knee surgeries such as meniscal repair, and ACL
and PCL reconstruction. Inability to fully extend the knee
after such surgeries may be a result of a hypertonic popliteus.
Let’s now look at some of the functions to see where and why
an overactive popliteus can become such a problem.

It’s ability to initiate knee flexion makes it an antagonist for

the quadriceps and a synergist for the hamstrings and
gastrocnemius. Inhibition of the quadriceps, either of all four
or one in particular, may cause facilitation of the popliteus.
Inhibition of the vastus medialis is very common. Inhibition
of the hamstring group, especially the biceps femoris, may
also cause facilitation of the popliteus.

The hamstrings group is the main torque producer for knee

flexion. It helps control tibial rotation during the stance phase
of gait. The lateral hamstrings (biceps femoris) actively
externally rotate the tibia on the femur but also control
internal rotation of the tibia on the femur in stance phase of
gait. The medial hamstrings (semitendinosus and
semimembranosus) control external rotation of the tibia on
the femur in stance phase of gait.A poorly functioning
hamstring due to weakness or pathology may result in a
compensatory overuse of the popliteus to control tibial
rotation in stance phase.

KINETIC CHAIN ANALYSIS

In the superficial back line, there is a chain from the bottom

of the foot, through the calf muscles, to the popliteus, to the
hamstrings, and the gluteus maximus. In the extension phase
of gait, these muscles work together. Inhibition of one or
more of these muscles may cause another muscle in this chain
to become facilitated. The popliteus may become facilitated
due to inhibition of the gluteus maximus. The popliteus can
also become facilitated due to inhibition in the superficial
front line. Inhibition of the extensor hallucis longus, rectus
femoris, and psoas commonly cause facilitation of the
popliteus. In internal rotation of the tibia, inhibition of the
medial head of the gastrocnemius may cause facilitation of
the popliteus. In external rotation of the femur, inhibition of
the biceps femoris may cause facilitation of the popliteus. I
have also seen compensation patterns involving the popliteus
due to inhibition of the neck extensors, flexors, and rotators.

It is very important to consider the popliteus not only when

dealing with knee pain, but also when dealing with complex
kinetic chain compensations. Never underestimate this tiny
but critical muscle.

Thanks to Chris Mallac for his excellent

article. http://www.sportsinjurybulletin.com/archive/poplite
us.html