Semimembranosus Tendinitis

What is Semimembranosus Tendinitis

Semimembranosus tendinitis often causes pain on the back inner side of the knee.

Tendinitis is a condition in which tendons become irritated or swollen. Tendons are bands of tissue that attach muscles to bones and help with joint movements. The semimembranosus tendon attaches one of the muscles on the back of the thigh (hamstring muscles) to the hip bone and the shin bone (tibia). This tendon helps in straightening the hip and bending the knee.

What are the causes?

This condition is caused by stress on the tendon, which may result from:

  • A sudden increase in training or in the intensity of your training.
  • Overuse of the knee joint.
  • Your body trying to compensate for other leg injuries.

What increases the risk?

The following factors may make you more likely to develop this condition:

  • Doing activities that involve:
    • Repeated or strenuous use of your knee and hip, such as distance running, triathlons, climbing, cycling, or weight lifting.
    • Running down hills.
  • Not warming up properly before activity.
  • Having:
    • Flat feet.
    • Improper knee alignment, such as bowed legs.
    • Poor strength and flexibility.
    • Osteoarthritis in your knee.

What are the signs or symptoms?

Symptoms of this condition include:

  • Pain or tenderness in the back inner part of the knee. The pain may:
    • Spread (radiate) up the back of the thigh or down the back of the calf.
    • Get worse during and after exercise that involves use of the knee or hip joints.
  • Swelling in the affected area.
  • A crackling sound when the tendon is moved or touched.

How is this diagnosed?

This condition may be diagnosed based on your symptoms, your medical history, and a physical exam. Your health care provider may also order tests such as an X-ray, ultrasound, or MRI to confirm the diagnosis or to rule out other conditions.

How is this treated?

Treatment for this condition may include:

  • Resting your legs and limiting activities that cause pain.
  • Using medicines taken by mouth or placed on the skin to help reduce pain and inflammation.
  • Applying ice to the area during the first 1–2 days to reduce swelling.
  • Injection of a medicine into the affected area (cortisone shot) to reduce pain.
  • Wearing a knee brace or sleeve on your knee to keep it from bending.
  • Working with a physical therapist on exercises to improve strength and flexibility in your leg.
  • Ensuring that you wear shoes that fit properly.

In some cases, surgery may be needed if other treatments do not help.

Follow these instructions at home:

Managing pain and swelling

  • If directed, put ice on the injured area:
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Wear a knee sleeve or compressive bandage as told by your health care provider.
  • If directed, apply heat to the affected area before you exercise. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
    • Place a towel between your skin and the heat source.
    • Leave the heat on for 20–30 minutes.
    • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.

Activity

  • Avoid activities that cause pain.
  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do exercises as told by your health care provider.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

  • Do not ignore pain in or behind your knee. If you have pain, you should stop your activity, rest, and apply ice.
  • Warm up and stretch before being active.
  • Cool down and stretch after being active.
  • Give your body time to rest between periods of activity.
  • Make sure to use equipment that fits you.
  • Be safe and responsible while being active to avoid falls.
  • Maintain physical fitness, including:
    • Strength.
    • Flexibility.
    • Cardiovascular fitness.
    • Endurance.
  • If you have flat feet, wear arch supports (orthotics).

Contact a health care provider if:

  • Your pain gets worse or does not get better with treatment.
  • You hear a popping sound or feel a new popping sensation in your knee.
  • You have increased swelling around your knee.

Get help right away if:

  • You cannot move your knee.

Semimembranosus Tendinitis Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your thigh. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Hamstring stretch, supine

  1. Lie on your back. Loop a belt or towel across the ball of your left / right foot The ball of your foot is on the walking surface, right under your toes.
  2. Straighten your left / right knee and slowly pull on the belt to raise your leg. Stop when you feel a gentle stretch behind your left / right knee or thigh.
    1. Do not allow the knee to bend.
    1. Keep your other leg flat on the floor.
  3. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your thigh. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise B: Straight leg raises (hip extensors)

  1. Lie on your belly on a bed or a firm surface with a pillow under your hips.
  2. Bend your left / right knee so your foot is straight up in the air.
  3. Squeeze your buttock muscles and lift your left / right thigh off the bed. Do not let your back arch.
  4. Hold this position for __________seconds.
  5. Slowly return to the starting position. Let your muscles relax completely before you do another repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Bridge (hip extensors)

  1. Lie on your back on a firm surface with your knees bent and your feet flat on the floor.
  2. Tighten your buttocks muscles and lift your bottom off the floor until your trunk is level with your thighs.
    1. You should feel the muscles working in your buttocks and the back of your thighs. If you do not feel these muscles, slide your feet 1–2 inches (2.5–5 cm) farther away from your buttocks.
    1. Do not arch your back.
  3. Hold this position for __________ seconds.
  4. Slowly lower your hips to the starting position.
  5. Let your buttocks muscles relax completely between repetitions.

If this exercise is too easy, try doing it with your arms crossed over your chest.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Hamstring eccentric, prone

  1. Lie on your belly on a bed or on the floor.
  2. Start with your legs straight. Cross your legs at the ankles with your left / right leg on top.
  3. Using your bottom leg to do the work, bend both knees.
  4. Using just your left / right leg alone, slowly lower your leg back down toward the bed. Add a __________ weight as told by your health care provider.
  5. Let your muscles relax completely between repetitions.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Squats

  1. Stand in front of a table, with your feet and knees pointing straight ahead. You may rest your hands on the table for balance but not for support.
  2. Slowly bend your knees and lower your hips like you are going to sit in a chair. Keep your thighs straight or pointed slightly outward.
    1. Keep your weight over your heels, not over your toes.
    1. Keep your lower legs upright so they are parallel with the table legs.
    1. Do not let your hips go lower than your knees. Stop when your knees are bent to the shape of an upside-down letter “L” (90 degree angle).
    1. Do not bend lower than told by your health care provider.
    1. If your knee pain increases, do not bend as low.
  3. Hold the squat position __________ seconds.
  4. Slowly push with your legs to return to standing. Do not use your hands to pull yourself to standing.

Repeat __________ times. Complete this exercise __________ times a day.

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