Author: Mr Oliver Eaton BSc (Hons), PG.Cert – Orthopaedic Specialist
Reviewed by: Mr William Sharples BSc (Hons) – Pain Management Expert
Last Updated: September 2025
In this article, you will learn everything you need to know about bicep femoris tendonitis and the most effective ways to treat it, including an advanced treatment called Prolotherapy.
Introduction
Biceps femoris tendonitis is a common overuse injury affecting the hamstring tendon at the back and outer side of the knee. It often impacts athletes, runners, and those who perform repetitive knee flexion or sudden acceleration, as these groups are at higher risk for biceps femoris tendonitis due to the demands of their activities. Early diagnosis and targeted treatment are essential for a full recovery and to prevent recurrence.1
Epidemiology and Prevalence
Biceps femoris tendinopathy is a frequent overuse injury, particularly among individuals who regularly engage the hamstring muscle group in high-intensity or repetitive activities. The biceps femoris tendon is especially vulnerable in sports that demand rapid acceleration, deceleration, or sudden changes in direction—such as soccer, football, and track and field. Research indicates that the prevalence of biceps femoris tendinopathy can reach 10-15% among athletes participating in these demanding sports. While this condition can affect anyone, it is most commonly seen in adults aged 20 to 40, a group often involved in regular physical activity. Recognizing the epidemiology and prevalence of biceps femoris tendinopathy is crucial for both athletes and healthcare providers, as it underscores the need for targeted prevention and early intervention strategies to reduce the risk of injury within this muscle group.
Anatomy and Function of the Biceps Femoris
The biceps femoris muscle is a key component of the hamstring muscle group, which is located at the back of the thigh and plays a vital role in lower limb movement. This muscle has two distinct heads: the long head, which originates from the ischial tuberosity of the pelvis, and the short head, which arises from the lateral lip of the linea aspera on the femur. Both heads merge to form the biceps femoris tendon, which attaches to the fibular head on the lateral aspect of the knee joint. The biceps femoris muscle is responsible for knee flexion and hip extension, making it essential for activities such as running, jumping, and walking. Proper function of the biceps femoris and its tendon is critical for stabilizing the knee and supporting dynamic movements, highlighting the importance of this muscle group in both athletic performance and everyday mobility.
What Is Biceps Femoris Tendonitis?
Biceps femoris tendonitis is inflammation or degeneration of the tendon where the biceps femoris muscle, one of the hamstring muscles, attaches to the fibular head near the knee at the back and outer side of the knee on the lateral side. It can result from overuse, repetitive use, poor biomechanics, muscle imbalances, or inadequate warm-up. The condition may present as pain, swelling, or tenderness at the outer knee, and patients may experience pain especially during running, jumping, or bending the knee.2
Pathophysiology and Mechanisms
Biceps femoris tendinopathy develops as a result of repetitive strain and microtrauma to the biceps femoris tendon. Over time, these stresses can lead to inflammation, degeneration, and even partial tears within the tendon tissue. The underlying pathophysiology involves a combination of biomechanical and molecular factors, including altered load distribution, reduced blood flow, and changes in the structure of collagen fibers. Muscle imbalances, improper training techniques, and insufficient recovery periods can further increase the risk of developing tendinopathy. As the tendon becomes compromised, its ability to withstand normal forces diminishes, leading to pain and dysfunction. Understanding these mechanisms is essential for clinicians and patients alike, as it informs the development of effective strategies to treat biceps femoris tendinopathy and prevent recurrence.
Symptoms of Biceps Femoris Tendonitis
- Sharp or aching pain at the outer side or back of the knee
- Tenderness at the fibular head or tendon insertion
- Swelling or mild warmth over the tendon
- Pain with running, walking, or knee flexion
- Stiffness or weakness in the hamstring
- Muscle spasms in the posterior thigh (in some cases)
- Popping or snapping sensation (in some cases)
- Difficulty straightening the leg
Diagnosis
Diagnosis is based on a physical exam, medical history, and sometimes imaging (ultrasound or MRI) to assess the extent of tendon injury. Proper diagnosis is essential to ensure effective treatment and optimal recovery.
A thorough differential diagnosis is necessary to distinguish biceps femoris tendonitis from other causes of posterior thigh pain, such as sciatic nerve irritation or compression, which can mimic musculoskeletal injuries. The clinical examination often includes assessment of the fibular head and tendon insertion site, as well as provocative tests like the bent knee stretch test and evaluation of pain during knee extension. Imaging can reveal changes in the biceps femoris tendons, such as thickening, inflammation, or partial tears, and help localize the specific injury site for targeted treatment. Early diagnosis helps guide effective treatment and reduces the risk of chronic pain.3
Complications and Consequences
When biceps femoris tendinopathy is not addressed promptly, it can result in a range of complications that impact both function and quality of life. Persistent pain and inflammation may lead to chronic discomfort and restricted movement, making it difficult to participate in sports or even perform daily activities. In severe cases, ongoing tendinopathy can increase the risk of tendon rupture or significant muscle injury, potentially resulting in long-term disability. Athletes may experience a decline in performance, while others may find their overall mobility and independence affected. Early recognition and management of symptoms are vital to prevent these adverse outcomes and support a full recovery from biceps femoris tendon injuries.
Treatments for Biceps Femoris Tendinopathy
Treatment depends on the severity and cause of the tendonitis. Options include:
- Rest and activity modification: Avoid activities that aggravate pain.
- Ice and anti-inflammatory medications: Reduce pain and swelling.
- Pain management strategies, including medication and other interventions, to alleviate discomfort.
- Physical therapy and conditioning exercises: Restore flexibility, strength, and correct muscle imbalances.
- Stretching and strengthening exercises: Target the hamstrings and supporting muscles.
- Massage therapy: Relieve muscle tension and promote healing.
- Gradual return to sport: Follow a structured rehabilitation plan to prevent re-injury.
- Surgical intervention: Rarely needed, reserved for severe tendon ruptures or chronic cases unresponsive to conservative care.
For stubborn cases that do not respond to conventional therapies, advanced treatments such as platelet rich plasma injections—often performed under ultrasound guidance—may be considered to promote the healing process by enhancing blood flow and delivering growth factors.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat bicep femoris tendonitis. Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits. Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with bicep femoris tendonitis. As prolotherapy is helping to treat the root cause of bicep femoris tendonitis, it is deemed to be a permanent fix, preventing the symptoms from returning.
Disclaimer: The information provided in this section is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Prolotherapy may not be suitable for everyone, and outcomes can vary. Always seek the guidance of a qualified healthcare professional regarding your specific medical condition or treatment options. Never disregard professional medical advice or delay seeking it because of information you have read here.
Recovery and Prevention
Most people recover well with a combination of rest, physical therapy, and gradual return to activity. Supporting the healing process with appropriate rehabilitation exercises is essential to restore tendon strength and function. Recovery time varies: mild cases may heal in 2-4 weeks, while more severe injuries can take several months. It is important to warm up before strenuous activity to prepare the muscles and reduce the risk of injury. Improper training or muscle imbalances can increase tension on the biceps femoris tendon, raising the risk of injury. Key risk factors for biceps femoris tendonitis include previous injuries, muscle imbalances, and limited flexibility. Weak or stiff gluteal muscles and quadriceps can disrupt muscle balance, increasing the likelihood of reinjury. Activities performed for extended periods, such as running or cycling, can worsen pain or delay recovery. Overuse injuries are common in athletes, so adopting preventive strategies is crucial. Prevent recurrence by warming up properly, maintaining flexibility, and addressing muscle imbalances.4
Deterrence and Patient Education
Preventing biceps femoris tendinopathy starts with adopting safe and effective training habits. Incorporating regular strengthening exercises and hamstring stretches into your routine can help maintain tendon health and reduce the risk of injury. It is important to allow adequate recovery time between intense workouts and to avoid repetitive activities that place excessive strain on the biceps femoris tendon. Maintaining a healthy weight and engaging in balanced physical activity also play a role in prevention. Patient education is a cornerstone of effective deterrence—healthcare professionals should provide clear guidance on proper exercise techniques, early recognition of symptoms, and the importance of seeking timely medical advice. By staying informed and proactive, individuals can minimize their risk of developing biceps femoris tendinopathy and support long-term musculoskeletal health.
Case Studies
Case Study 1: Biceps Femoris Tendonitis in a Runner
Background: A 32-year-old runner developed pain at the outer knee after increasing training intensity.
Treatment: Rest, physical therapy, and prolotherapy.
Outcome: Full recovery and return to running within 5 weeks.
Case Study 2: Chronic Biceps Femoris Tendonitis in a Footballer
Background: A 40-year-old footballer with 8 months of persistent outer knee pain.
Treatment: Prolotherapy and targeted rehabilitation.
Outcome: 80% pain reduction and return to play within 2 months.
Case Study 3: Recurrent Tendonitis in a Cyclist
Background: A 45-year-old cyclist with repeated biceps femoris tendonitis.
Treatment: Strengthening, flexibility program, and prolotherapy.
Outcome: No further recurrences and improved cycling performance.
Frequently Asked Questions
What causes biceps femoris tendonitis?
Common causes include overuse, poor biomechanics, muscle imbalances, inadequate warm-up, and repetitive knee flexion.2 Overuse injuries are particularly common in athletes and can result from repetitive and prolonged stress on the biceps femoris tendon. The biceps femoris muscle has two heads—long and short—which both attach to tendons that connect muscle to bone, and either or both heads can be affected. Tendinopathy refers to a chronic degenerative condition of tendons, which is different from acute inflammation seen in tendonitis.
How is biceps femoris tendonitis diagnosed?
Diagnosis is based on physical exam, history, and sometimes imaging (ultrasound or MRI) to assess the injury.3
Can biceps femoris tendonitis heal without surgery?
Yes, most cases heal with rest, physical therapy, and regenerative treatments like prolotherapy. Surgery is rarely needed.
Is prolotherapy safe and effective for biceps femoris tendonitis?
Yes, prolotherapy is considered safe when performed by experienced practitioners and has shown positive outcomes for tendon injuries in clinical studies.5
How long does recovery take?
Mild cases may heal in 2-4 weeks, while severe injuries can take several months. Adhering to a rehab plan is key.
When should I see a specialist?
If you have severe pain, swelling, bruising, or difficulty walking, see a specialist for diagnosis and treatment.
Contact ProHealth Clinic Today for Your FREE 15-Minute Discovery Call
Don’t let bicep femoris tendonitis control your life any longer. Join the thousands of patients who have found lasting relief through prolotherapy at ProHealth Clinic.
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Author Bio
Having performed over 10,000 procedures, Mr Oliver Eaton is one of the UK’s leading practitioners in the field of treating bicep femoris tendonitis, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with bicep femoris tendonitis and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
Connect with Oliver Eaton on LinkedIn
Mr Eaton’s expertise has been featured in many national news and media publications, including The Telegraph, The Daily Mail, The Daily Express, Women’s Health Magazine, and The Scotsman.
References
- Askling CM, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med. 2007;35(2):197-206. View Study
- Heiderscheit BC, Sherry MA, Silder A, et al. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther. 2010;40(2):67-81. View Study
- Connell DA, Schneider-Kolsky ME, Hoving JL, et al. Long-term prognostic value of clinical assessment and MR imaging in acute hamstring injury: comparison with degree of muscle tear. Radiology. 2004;232(2):712-718. View Study
- Orchard J, Best TM, Verrall GM. Return to play following muscle strains. Clin J Sport Med. 2005;15(6):436-441. View Study
- Rabago D, Slattengren A, Zgierska A. Prolotherapy in Primary Care Practice. Prim Care. 2010;37(1):65-80. View Study
Disclaimer: This article is for informational purposes only and does not substitute for professional medical advice. Always consult your healthcare provider before making treatment decisions.