My massage therapist dug her thumbs into two quarter-sized attachment points on either side of the very top of my shin—the exact spot my tailor says a hem hits most flatteringly for a woman because it is the slimmest part of her leg. Apparently slim = painful. As I winced, writhed and hyperventilated on the massage table, she suggested my pes anserine and biceps femoris attachments were a bit adhered and, thus, “a little trigger pointy.” No kidding.
The pes anserine is the convergence of the semitendinosus of the hamstring and two adductor tendons—the gracillis and sartorius (aka the tailor’s muscle—ha! hemlines, tailor, get it?). It anchors on the front big-toe side of the shin. The biceps femoris (another hamstring) attaches opposite the pes anserine on the pinkie-toe side of the knee.
In recovering from a full knee reconstruction, I had diligently followed my surgeon’s instructions to strengthen and tighten my thighs, but no one had told me to work my adductors or release these attachments to balance out the work. As a result, I overused my quads and hamstrings, ignored my inner thighs and stretched nothing. The good news was I had a pretty stable knee, the bad news was it hurt because it was compressed on three sides and weak on the fourth. The better news was now that I had, ahem, embodied my pes anserine and biceps femoris attachments, I could use the YTU Therapy Balls, instead of my massage therapist’s thumbs, to relieve my hamstring tightness and stimulate my adductors in order to begin strengthening them. See the video I’ve attached to do it yourself.
Learn more about the muscles of the knee and ways to support knee health in these blogs:
Relieving Knee Pain: Get Knee Deep in Knee Knowledge
I have noticed my left knee slightly rotates inwardly when I straighten my knees fully in downward facing dog. I have no knee pain nor discomfort at knee. This Hamstring Adductor Therapy Ball Exercise may be helpful addressing the possible cause of left knee rotation, tightness and imbalanced of adductors and hamstrings in my left knee. Thank you for great article and movie that gave me insight into my knee issue.
I love self care and self massage with Therapy Balls!!
I love this post my husband has had knee replacement and has not regained all the mobility he could this will be a great roll out for him
Good warning Christine. I have told a few people to tread lightly when hitting this attachment point. I suggest light skin rolling initially with the YTU balls then moving on to light compression.
Another great blog Christine! Focusing on the attachments is something that can easily be overlooked. The instructions of surgeons and orthopaedic doctors alike, much to often leave out key information and stick to rehabbing the general muscles. Even more inspiration to empower ourselves through education and practice and roll our way to better health care and pain free living!
After reading your post and watching the video I am even more fascinated by the mechanics of the knee. I was unaware that the semitendinosus and the tendons of gracillis and sartorius converged at pes anserine although I recently heard the term “goose foot” at a YTU training. Thank you for shedding light on this anatomical nick name! . I look forward to adding this ball sequence to my routine.
Loved this post’s perspective; reminds me of how tight my hamstrings can get– and how pinpointing painful trigger spots with massage and ‘deep-pressured’ rolling, helps alleviate the tenderness!!
In my YTU teacher training today one of the students did this same knee routine and I thought it was fabulous. What a creative way to massage an area that has so many muscles attach to it. I am amazed at all the ways that the YTU therapy balls can be used to find our underused, overused and abused blind spots.
It’s 6:00 am on the last day of our intensive 7 day training, so I’m a bit loopy. But my love of anatomy & desire to go deeper, know more, and experience my body in a different way has led me to YogaTuneUp and our instructors have led us to their blogs. It’s with this spirit in mind that I say this: I adore the fact that there is something in my body called the PES ANSERINUS. I never knew about it, I’ve just palpated it on my own leg, and once I did my body ‘remembered’ an old pain from my intense running days that I couldn’t isolate before. God, am I with the right crowd. Thanks, Christine. I love the way you love anatomy too.
Being in the YTU Level 1 training is truly like looking through a scrapbook of your childhood and finally being able to put some pieces together. I was a gymnast and a sprinter up until 15, and my knees always hurt. My movement patterns were all about strength along the frontal plane!
wow. i have had three arthroscopic surgeries on my left knee and have been in physical therapy more than that many times for consequential/concurrent knee problems and i have been in the fitness profession for YEARS and i have never come across such a well detailed and thoroughly articulated problem-solving technique for a COMPLETELY overlooked area that I honestly never thought much about. thanks for posting the video too. it helps a great deal.
[…] The Slimmest Part of Your Knee: It’s Not Just About Hemlines […]
[…] The Slimmest Part of Your Knee: It’s Not Just About Hemlines […]
Wow! Thanks for highlighting such a an overlooked area. I can’t believe massaging this area would be so sensational. I always thought of the knee area as utilitarian and just a hinge. After trying out your massage techniques, I can definitely say there’s life around my knees.
A total blind spot! I have never thought of this part of my leg before. Thank you for sharing this knowledge. It will be interesting to see if the tenderness goes away with frequent ball massage or if its like something that’s always tender due to the fact that we use these muscles daily.
Wow!! Such a great idea of how to use the balls! I am going to try this on my self and have my mom try them too. I like how the balls are in their tote so you can not only keep them together, but also create some more friction with them. Thanks!
Thanks for a great tip and connecting the importance of creating strength with the adductor muscles in helping with knee pain especially the gracilis as it crosses the knee and then inserts at the medial shaft of the tibia. I love this simple ball exercise to help roll out these muscles and any adhesions around the attachments. I also like the analogy with the tailor’s muscle and hem line as this is a great way to teach students about the adductor muscles and attachments.
i can relate! due to many different factors ( scoliosis, and overpronation of my feet), I had constant knee pain. i tried everytng, but finally went to a physical therapist who told me i needed to strengthen my adductors! it made all the difference in alleviating my knee pain. thanks christine for bringng awareness to his issue.
This seems like a great exercise to realive pain in those two tendons. i found myself having to place a block under my hip to create some more resistance, but this worked great once I did that. The pes anserine is a very unique tendon because you have three different musclces coming into one spot, the gracilis, the sartorius and the semitendinosus and all are primarily resposible for different actions of the body. In this particular case it sounds like the sartorius and semitendinosus are strongth enough but the poor gracilus is neglected. A good way to strengthen this muscle adductor slides with a blanket. So after you have helped the area stretch out using the ball technique provided give the addctor slides a try at another session!
I was surprised at how much this released my hamstrings. I am going through my yoga teaching certification and 2 hours of yoga every day takes a toll on the muscles! I have tried to foam roll my hamstrings to get them to release but it does not penetrate the muscle deep enough. Using this video to release those tendons and ligaments has given me a “new normal” as my instructor, Owen, likes to say! It’s true!
I hardly recognized you with the long hair. Great article and video I can’t wait to try rolling out those muscles. I personally have a torn mediscus cartilege so i’ve had to struggle with some similar issues, I’m sure this will be helpful.
Thank you for the great articles and video Christine I start to have leg issues when I take yoga classes daily. My hamstrings and gluteus become painful. I will start to do this massage with YTU therapy balls. I was surprised, when I found this video, that I can use therapy balls to the knees. Very very useful!
Thanks for the article and video! My mom has been recovering from a total knee replacement, and as her Rolfer/daughter I’ve been working on her. In her case, it’s been really distinct that the pes anserine and the biceps femoris tendons were the place that gave her the most agony, and also, unfortunately, got the most ignored in her PT. Now she has your video too! Thanks!
I agree with what Emily said about it being overlooked. I had a minor, yet restrictive, knee injury a few years ago (even saw a physical therapist for it) and was instructed to use rollers on the pes anserine and biceps femoris (which I did do). The results I achieved after watching this video were better than anything I had felt doing what the PT had instructed me to do for my knee. Thank you!
This is a part of the body that gets overlooked and overused. I liked your analogy to the slim part of the leg…. and I thought the video was really nice. Clear and concise, I forget how many tendons and ligaments we have right around our knees.
Great videos for the knees. I especially like the one for the pes anserine. I myself had an itching and need to get into this tender area. I like the way you position your body so that you are comfortable and “relaxed” and the techniques you used effectively get in there.