Biceps Femoris Tendinopathy: Symptoms, Treatment- Ice, Massage, Rehab, NSAIDs

Biceps femoris¹ is a tendon which is present in the hamstring muscle. Any sort of trauma or injury to it causes pain in the external and posterior side of the knee.

The tendons which make up the hamstring muscles² are biceps femoris, semi-tendinosus, and semi-membranosus. These muscles are responsible for flexion of the knee and extension of the hip. Impairments such as inadequate healing of partial rupture or chronic overuse of the muscle results in inflammation of the muscles. This often involves the biceps femoris tendon. This is the only muscle present in the hamstring that is attached to the external region of the posterior part of the knee.

• Tenderness at the site where the tendon enters the bone.
• Swelling at the site where the tendon enters the bone.
• If a person has biceps femoris tendinopathy, then one will have tenderness in the outer part or back portion of the knee. If the tendons apart from the biceps femoris are involved then tenderness is present medially.
• There is pain with resisted flexion of the knee.
• Stiffness of the knee after physical activity or exercise.
• There is tightness of the hamstring muscles resulting in limitation of hip flexion.

• Adequate rest is required.
• Use of ice or cold therapy.
• Consultation with a sports injury professional.
• Anti-inflammatory medications³ can be used for reduction of pain, swelling and inflammation.
• Ultrasound and laser has been found to be beneficial.
• A comprehensive rehabilitation program with exercises focusing on stretching and strengthening is beneficial.
• Eccentric training is found to be quite helpful for treatment of tendinopathy.
• Massage therapy is also found to be quite beneficial.

• Reduction of pain and inflammation.
• Stretching of the muscles to regain mobility and flexibility.
• Muscle strengthening.
• Gradual return to full activity.

Activities or exercises which have the potential to worsen the injury need to be avoided. The injury can be further aggravated if the affected individual works at a place where he has to stand for a prolonged period of time. Adequate rest period if imperative at least till a stage when the acute injury passes off. The acute stage of the injury is the first 48 hours of the injury. This stage may get prolonged with use of the injured tendon and inadequate rest. To know if the acute stage of the injury has passed, the patient needs to flex the knee and if there is no pain experienced then it signifies that the acute stage has passed.

• Ice /cold therapy should be applied at least three times a day for approximately 20 minutes.
• NSAID⁵ such as ibuprofen is useful for reduction of inflammation but it should be taken under the guidance of a physician. Asthmatic individuals should not use this drug.
• If a knee support or a heat retainer is worn, it is extremely helpful. Heat should be used once the acute stage is over. For acute stage, only the cold therapy is recommended.

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