Muscles of the Lower Limb

Did you know that there are more than 40 muscles and 30 bones in each lower extremity? The muscles of the lower extremity are some of the largest and most powerful muscles of the body. The main functions of these muscles are to provide a stable base of support for the body, to create movement at the synovial joints of the lower limbs, and to enable locomotion. The muscular system works primarily with the skeletal system and the nervous system (collectively called the neuromusculoskeletal system) to perform these functions.

What are the muscles of the lower limb? The lower limb, or lower extremity, is an anatomical region of the body that consists of the pelvis, hip joint, femur, knee, tibia, fibula, and bones and joints of the foot an ankle. This region includes all of the muscles, tendons, ligaments, nerves, blood vessels and other tissues from the pelvis to the toes. The muscles of the lower limb include the quadriceps, hamstrings, muscles of the hip, and muscles of the lower leg, ankle and foot.

This resource provides a review of the muscles of the lower limbs for massage therapists. It is intended to serve as a convenient reference for massage therapy students in school or those studying for the anatomy and kinesiology sections of the MBLEx. The muscle tables below will also help LMTs who need a refresher of the origins, insertions, actions and nerves of the lower extremity muscles.

Lower extremity muscles for massage therapists

Muscle tissue is one of the primary types of soft tissue that massage therapists target with manual therapy techniques. Your knowledge of muscle origins, insertions and actions (OIA), as well as fiber direction will be especially useful when applying massage and bodywork techniques such as deep tissue massage and assisted stretching.

You can also expect to see some MBLEx test questions about the origins, insertions and actions of muscles on the FSMTB Massage and Bodywork Licensing Exam (MBLEx). Direct questions about muscle OIA, contractions and muscle function will be in the kinesiology content area of the exam. However, you may also need this information to answer questions in the anatomy and physiology content area which covers the muscular, skeletal and nervous systems.

Questions in the pathology section, benefits and techniques section, and treatment planning section of your massage exam may also require you to demonstrate understanding of muscle attachment points and actions. For example, you are expected to know the locations of muscles relative to other structures of the body such as organs and endangerment sites.

Massage therapists learning the muscles and anatomy of the lower extremity must also learn the massage areas of caution for this region of the body. An endangerment site is an area of the body where delicate structures such as blood vessels and nerves are vulnerable to injury from certain types of massage and bodywork techniques or modalities. Some of the endangerment zones on the anterior lower limb include that femoral triangle, the medial thigh, the patella and fibular head, and areas around the medial and lateral ankle bones. Areas of caution for the posterior lower extremity include the greater sciatic notch, greater trochanter, and popliteal fossa.

Overview of the lower extremity and muscle groups

There are several major muscle groups in the lower extremity. As you know, muscles can be grouped in different ways, so there is no definite number of muscle groups. For example, muscles could be broadly grouped by location (e.g. muscles of the thigh, lower leg, and foot). Or they can be grouped by a more specific location such as muscles of the anterior thigh, posterior thigh, medial thigh, and so on.

Studying muscle groups is a good way to learn muscles because the muscles in a group often have several things in common. Muscles in a particular group are typically in the same region, and they often perform a similar action. Muscles in a group may also be innervated by the same nerve, or receive their blood supply from the same artery.

Muscles are most commonly grouped by either their location or their function. And some muscles can fit into more than one muscle group. Muscles that perform more than one action at a joint, or cross over and effect more than one joint will often fit into multiple muscle groups. For example, the long head of the biceps femoris can be grouped with the hip extensors and the knee flexors. Likewise, the gastrocnemius is a knee flexor and an ankle plantar flexor. *Remember that a muscle can only directly create movement at a joint if it crosses that joint. Some of the lower trunk muscles also affect the lower extremities.

*Anatomists generally refer to the femur area as the “thigh”, and the area between the knee and ankle as the “leg”. This distinction is good to know when reading anatomy textbooks or other study materials created by anatomists. I will just use the common vernacular and call the area between the knee and ankle the “lower leg” to avoid any confusion.

Muscle groups of the hip

• Hip flexors. Iliopsoas (iliacus and psoas), rectus femoris, sartorius, pectineus, TFL, abductor longus, brevis and magnus.
• Hip extensors. Gluteus maximus, semitendinosus, semimembranosus, biceps femoris (long head), adductor magnus (posterior part).
• Hip abductors. Gluteus medius and minimus, TFL, sartorius.
• Lateral rotators of the hip.
  • Deep 6 lateral rotators: piriformis, gemellus superior and inferior, obturator internus and externus, quadratus femoris
  • Also: gluteus maximus, sartorius
• Medial rotators. Gluteus medius and minimus, TFL, adductor longus, brevis and magnus, pectineus.

Muscle groups of the thigh

• Quadriceps. Rectus femoris, vastus lateralis, medialis and intermedius.
• Hamstrings. Semitendinosus, semimembranosus, biceps femoris.
• Hip adductors. Adductor brevis, longus and magnus, gracilis, pectineus.

Muscle groups of the lower leg, ankle and foot

• Plantar flexors. Soleus, gastrocnemius, plantaris, fibularis longus and brevis, tibialis posterior, flexor hallucis longus, and flexor digitorum longus.
• Dorsiflexors. Tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius.
• Inverters of the foot & ankle. Tibialis anterior and tibialis posterior
• Everters of the foot & ankle. Fibularis longus, brevis and tertius.
• Intrinsic muscles of the foot. Four layers (1-4) of intrinsic muscles going from superficial to deep.
  • Layer 1 (most superficial): Abductor hallucis, flexor digitorum brevis, abductor digiti minimi
  • Layer 2: Lumbricals, quadratus plantae
  • Layer 3: Flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis
  • Layer 4 (deepest): dorsal interossei (4), plantar interossei (3)

Muscles of the Pelvis, Hip and Thigh

Muscle	Origin	Insertion	Action	Innervation
Adductor brevis	Inferior pubic ramus and the body of the pubis	Proximal linea aspera on posterior side of femur	Adduction, flexion, and medial rotation of femur at the hip joint	Obturator nerve (L2-4)
Adductor longus	Anterior aspect of pubic body, inferior to pubic crest and lateral of pubic symphysis	Middle third of linea aspera on posterior side of femur	Adduction, flexion, and medial rotation of femur at the hip joint	Obturator nerve (L2-4)
Adductor magnus	Anterior head: inferior ramus of pubis and ischial ramus Posterior head: ischial tuberosity	Anterior head: linea aspera of femur Posterior head: adductor tubercle of femur	Both heads adduct the femur. Anterior head (adductor part): assists with flexion and lateral rotation of femur at hip joint. Posterior head (hamstring part): assists with extension and medial rotation of femur at hip joint.	Anterior head: obturator nerve (L2-4) Posterior head: sciatic nerve (L4-S1)
Biceps femoris	Long head: ischial tuberosity Short head: lateral lip of linea aspera of femur	Head of fibula, lateral condyle of the tibia	Long head: extension and lateral rotation of femur at hip joint. Both heads: flexion of knee and lateral rotation of flexed knee.	Long head: tibial division of sciatic nerve (L5-S3) Short head: common fibular division of sciatic nerve (L5-S2)
Gemellus, inferior	Ischial tuberosity	Medial surface of greater trochanter via obturator internus tendon	Lateral rotation of femur at hip joint	Nerve to quadratus femoris (L4-S1)
Gemellus, superior	Ischial spine	Medial surface of greater trochanter via obturator internus tendon	Lateral rotation of femur at hip joint	Nerve to obturator internus (L5-S2)
Gluteus maximus	Posterior gluteal line of ilium, posterior surface of sacrum and coccyx, sacrotuberous ligament, thoracolumbar fascia	Iliotibial tract and gluteal tuberosity of the femur	Extension and lateral rotation of femur at hip joint	Inferior gluteal nerve (L5-S2)
Gluteus medius	Gluteal surface of the ilium between the anterior and posterior gluteal lines	Greater trochanter of the femur	Abduction and medial (internal) rotation of femur at hip joint; pelvic stabilization	Superior gluteal nerve (L4-S1)
Gluteus minimus	Gluteal surface of the ilium between the anterior and inferior gluteal lines	Greater trochanter of the femur	Abduction and medial (internal) rotation of femur at hip joint; pelvic stabilization	Superior gluteal nerve (L4-S1)
Gracilis	Anterior body of pubis and inferior pubic ramus	Medial surface of proximal tibia via pes anserinus	Hip joint: adduction, flexion and medial rotation of femur. Knee joint: flexion and medial rotation.	Obturator nerve (L2,3)
Iliacus	Upper 2/3 of iliac fossa; iliac crest	Lesser trochanter of femur via iliopsoas tendon	Flexion of thigh or trunk at hip joint	Femoral nerve (L1-3)
Obturator externus	External (anterior) surface of obturator membrane, and the lateral and medial margins of obturator foramen	Trochanteric fossa of femur	Lateral (external) rotation of femur when hip is extended. Abduction of femur when hip is flexed. Stabilizes hip joint.	Obturator nerve (L3,4)
Obturator internus	Internal (posterior) surface of obturator membrane, and the lateral and medial margins of obturator foramen	Medial surface of greater trochanter of the femur	Lateral (external) rotation of femur when hip is extended. Abduction of femur when hip is flexed. Stabilizes hip joint.	Nerve to obturator internus (L5, S1)
Pectineus	Anterior pubic bone	Pectineal line of femur (inferior to lesser trochanter)	Adduction, flexion, and medial rotation of femur at hip joint. Pelvic stabilization.	Femoral nerve (L2-4)
Piriformis	Anterior surface of sacrum	Greater trochanter of femur (apex)	Lateral (external) rotation and abduction of femur at hip joint	Nerve to piriformis (S1,2)
Popliteus	Lateral condyle of femur	Posteromedial surface of proximal tibia	Initiates knee flexion by “unlocking” the extended knee. Medial rotation of lower leg when knee is flexed.	Tibial nerve (L4-S1)
Psoas major	Vertebral bodies, transverse processes, and discs of T12-L5 vertebrae	Lesser trochanter of femur via iliopsoas tendon	Flexion of thigh at hip joint. Forward and lateral flexion lumbar trunk if thigh is in fixed position.	Branches of lumbar plexus (spinal nerves) L1-L3
Quadratus femoris	Ischial tuberosity (lateral border)	Intertrochanteric crest of femur	Lateral rotation of femur at hip joint. Stabilization of the hip joint. Adduction or abduction depending on femur position.	Nerve to quadratus femoris (L4-S1)
Rectus femoris	Anterior inferior iliac spine and superior rim of acetabulum	Patella and tibial tuberosity via the patellar ligament	Extension of knee joint, and flexion of the thigh at the hip joint	Femoral nerve (L2-4)
Sartorius	Anterior superior iliac spine (ASIS)	Medial surface of proximal tibia (pes anserinus)	Hip joint: flexion, abduction and lateral rotation of femur Knee joint: flexion and medial rotation of tibia	Femoral nerve (L2,3)
Semimembranosus	Ischial tuberosity	Medial condyle of tibia	Extension of hip, flexion of knee, medial rotation of flexed knee	Tibial division of sciatic nerve (L5-S2)
Semitendinosus	Ischial tuberosity (common tendon with long head of the biceps femoris)	Medial surface of proximal tibia (pes anserinus)	Extension of hip, flexion of knee, medial rotation of flexed knee	Tibial division of sciatic nerve (L5-S2)
Tensor fasciae latae (TFL)	Anterior part of iliac crest and lateral surface of ASIS	Lateral condyle of tibia via iliotibial tract	Flexion, abduction and medial rotation of femur at hip joint. Knee extension and lateral rotation at knee when flexed. Stabilization of hip and knee when weightbearing.	Superior gluteal nerve (L4-S1)
Vastus intermedius	Anterior and lateral surface of the upper 2/3 of femur	Patella and tibial tuberosity via the patellar ligament	Extension of knee joint	Femoral nerve (L2-4)
Vastus lateralis	Greater trochanter, anterior and lateral femoral shaft, and linea aspera of femur	Patella and tibial tuberosity via the patellar ligament	Extension of the knee joint and stabilization of the patella	Femoral nerve (L2-4)
Vastus medialis	Medial lip of linea aspera and medial intermuscular septum	Patella and tibial tuberosity via the patellar ligament	Extension of the knee joint and stabilization of the patella	Femoral nerve (L2-4)

Muscles of the Lower Leg, Ankle and Foot

Muscle	Origin	Insertion	Action	Innervation
Abductor digiti minimi (foot)	Tuberosity of the calcaneus, plantar aponeurosis	Base of proximal phalanx of the 5th digit, and 5th metatarsal	Abduction and flexion of 5th toe at the metatarsophalageal (MTP) joint	Lateral plantar nerve (S1-3)
Abductor hallucis	Tuberosity of the calcaneus (medial side)	Base of the proximal phalanx of the great toe (hallux)	Abduction and flexion of great toe at the metatarsophalageal (MTP) joint	Medial plantar nerve (S1-3)
Adductor hallucis	Oblique head: bases of metatarsals 2-4 Transverse head: heads of metatarsals 3-5	Base of proximal phalanx of the great toe (lateral side)	Adduction and flexion of great toe at MTP joint (moves toe toward midline of foot)	Lateral plantar nerve (S2,3)
Extensor digitorum brevis	Calcaneus (superior and lateral surfaces)	Extensor expansion of toes 2-4	Extension of toes 2-4 at MTP and IP joints	Deep fibular (peroneal) nerve (L5-S1)
Extensor digitorum longus	Lateral condyle of tibia, anterior surface of proximal 2/3 of fibula. Interosseous membrane	Dorsum of lateral 4 toes via extensor expansions	Extension of lateral 4 toes at the MTP and IP joints	Deep fibular (peroneal) nerve (L5-S1)
Extensor hallucis brevis	Superolateral surface of the calcaneus	Base of proximal phalanx of the great toe (dorsal surface)	Extension of great toe at the MTP joint	Deep fibular (peroneal) nerve (L5-S1)
Extensor hallucis longus	Anterior shaft of fibula (middle third); interosseous membrane	Base of distal phalanx of the great toe	Extension of great toe at the MTP and IP joints. Assists with dorsiflexion of ankle at talocrural joint.	Deep fibular (peroneal) nerve (L5,S1)
Fibularis (peroneus) brevis	Lateral surface of fibula (distal third)	Base of 5th metatarsal	Plantar flexion of ankle at the talocrural joint, and eversion of the foot at the subtalar joint.	Superficial fibular (peroneal) nerve (L4-S1)
Fibularis (peroneus) longus	Head and lateral shaft of fibula (upper two thirds)	Base of 1st metatarsal and medial cuneiform (plantar surface)	Plantar flexion of ankle at the talocrural joint, and eversion of the foot at the subtalar joint.	Superficial fibular (peroneal) nerve (L4-S1)
Fibularis (peroneus) tertius	Anterior surface of fibula (distal third), and adjacent interosseous membrane	Shaft of the 5th metatarsal bone (dorsal surface)	Dorsiflexion of ankle at the talocrural joint, and eversion of the foot at the subtalar joint.	Deep fibular (peroneal) nerve (L5,S1)
Flexor digitorum brevis	Tuberosity of the calcaneus (medial side), plantar aponeurosis, intermuscular septum.	Base of middle phalanx of digits 2-5 (plantar side).	Flexion the metatarsophalangeal & proximal interphalangeal joints of digits 2-5. Supports longitudinal arch of foot.	Medial plantar nerve (S1,2)
Flexor digitorum longus	Posterior surface of tibia	Bases of distal phalanges of digits 2-5 (plantar surface)	Flexion of metatarsophalangeal and interphalangeal joints of digits 2-5. Assists with plantar flexion of ankle at the talocrural joint.	Tibial nerve (L5,S1)
Flexor hallucis brevis	Cuboid, medial and lateral cuneiform bones	Medial head: medial side of proximal phalanx of the great toe (plantar surface). Lateral head: lateral side of proximal phalanx of the great toe (plantar surface).	Flexion of great toe at the MTP joint	Medial plantar nerve (L4-S1)
Flexor hallucis longus	Posterior surface of fibula (distal 2/3)	Base of distal phalanx of the great toe (plantar surface)	Flexion of MTP and IP joints of the great toe. Assists with plantar flexion of ankle at the talocrural joint, and inversion of the foot at the subtalar joint.	Tibial nerve (L5-S2)
Gastrocnemius	Medial head: posterior surface of medial femoral condyle. Lateral head: posterior surface of lateral femoral condyle.	Posterior calcaneus via the calcaneal (Achille’s) tendon	Flexion of knee joint. Plantar flexion of ankle (talocrural) joint	Tibial nerve (S1,2)
Plantaris	Lateral epicondyle and supracondylar line of femur; oblique popliteal ligament	Posterior calcaneus via the calcaneal (Achille’s) tendon	Flexion of knee joint. Plantar flexion of ankle (talocrural) joint	Tibial nerve (S1,2)
Soleus	Soleal line of tibia, posterior head and upper shaft of fibula	Posterior calcaneus via the calcaneal (Achille’s) tendon	Plantar flexion of ankle (talocrural) joint	Tibial nerve (S1,2)
Tibialis anterior	Lateral condyle and proximal shaft of tibia. Interosseous membrane	Medial cuneiform and base of 1st metatarsal	Dorsiflexion of ankle (talocrural) joint. Inversion of subtalar joint.	Deep fibular (peroneal) nerve (L4-S1)
Tibialis posterior	Interosseous membrane and posterior shafts of tibia and fibula	Tuberosity of the navicular bone and adjacent tarsals. Bases of metatarsals 2-4 (plantar surface).	Plantar flexion of ankle (talocrural) joint. Inversion of subtalar joint. Supports medial longitudinal arch of foot.	Tibial nerve (L5,S1)