Greetings!
Does anyone have any experience with chronic biceps femoris tendinopathy?
I mainly interested in
a) can I stretch or will I aggravate the injury
b) what kind of muscle strenghtening exercises do I have to do?
c) how long before this heals (it’s been bugging me for 4 months now and in this 4 months I have not been doing any physical activity at all! and when I started again the pain during running just slowly crawled back up)…
Thank you for any advice.
Regards,
Mike
a) no stretch was of time and the issue in tension why increase it.
B) eccentric hamstring curls length the muscle to release tension on the tendon.
c) rehab does not have predictable time lines but you said you have not done anything so there will be little to no change without action. the individual changes habits, and structural support over time.
Don’t run slow that is likely the cause, run faster for shorter. uphill over downhill, fresh over tired and be patient to return or you hurry back not to fitness but to re injury.
Thank you for your reply.
May I just ask what did you mean regarding the stretching, should I do it or no? If yes, can you recommend any particular stretch or should I go with the one that’s most prevalent on youtube - https://www.youtube.com/watch?v=xO8CZWtfKDU ?
Also regarding the eccentric hamstring exercise - to my knowledge, Nordic hamstring curls is an eccentric exercise correct? Will this exercise if I do it regularly in conjunction with single leg glute bridge and squats suffice? I prefer to have less exercises than too many. Should lunges be incorporated in the routine aswell or can I do without them?
Thank you
Greetings!
Does anyone have any experience with chronic biceps femoris tendinopathy?
I mainly interested in
a) can I stretch or will I aggravate the injury
b) what kind of muscle strenghtening exercises do I have to do?
c) how long before this heals (it’s been bugging me for 4 months now and in this 4 months I have not been doing any physical activity at all! and when I started again the pain during running just slowly crawled back up)…
Thank you for any advice.
Regards,
Mike
Mike,
I may have to disagree with the advice given above. All except the bit regarding stretching.
First things first, are we talking proximal or distal issue?
Who diagnosed it as biceps femoris?
When did it start in your training?
What kind of running drills are you doing or were you doing? Did you try anything new (speed work, hills, new shoes etc).?
Does it hurt cycling? If you cycle? Does it hurt just during activity or does it linger even afterwards for a while? Or does it abate as soon as activity stops?
How bad is the pain? Causing you to limp?
What, if any strength work are you already doing as part of your routine?
Need quite a bit more info to even think about narrowing it down. But I can say with confidence, and from experience in both areas, isometrics will be your friend for a while as far as strengthening the area. And ditch the stretching.
Need to find out what structure is actually involved, and if it is a tendon, if its reactive or not, and how well it tolerates progressive loading. Tendons benefit the most from early loading at high capacity. They store and release energy, and their capacity to do so is compromised when they are irritated.
Talk to a run specialist in real life, not online. Im happy to help narrow it down, but need to take it to a professional who can initiate a POC. Where are you located?
Stretching does nothing but numb your protecting stretch reflex. Dont stretch people how stretch have the same injury rates as those that dont.
Start with a simpler hamstring curl exercise basic machine , thera band, wife pushing your heel down as you lower slowly. Tendons dont have length,muscles do fix the muscle so the tendons stop trying to do the muscles job.
Never blame a tendon they are reflex only. Muscles control length and deaccelerstions and acceleration.
Thank you for your reply.
May I just ask what did you mean regarding the stretching, should I do it or no? If yes, can you recommend any particular stretch or should I go with the one that’s most prevalent on youtube - https://www.youtube.com/watch?v=xO8CZWtfKDU ?
Also regarding the eccentric hamstring exercise - to my knowledge, Nordic hamstring curls is an eccentric exercise correct? Will this exercise if I do it regularly in conjunction with single leg glute bridge and squats suffice? I prefer to have less exercises than too many. Should lunges be incorporated in the routine aswell or can I do without them?
Thank you
Dont jump right into eccentric stresses.
Youre asking a lot of specific questions that all stress tissue differently. First and foremost, its not possible to prescribe concentric or eccentric exercises because it depends on the location of the issue. Insertional tendon issues need to be treated MUCH differently than mid-substance issues. Eccentrics will greatly irritate insertional tendonopathies because by nature it increases the compressive forces on the site.
This is why I whole heartedly disagree with blanket eccentric prescriptions, especially online.
We still dont know if youre talking knee or proximal hammy at the sit bone.
Lunges, uphill, squats, etc will all increase length at the area if its proximal. If knee, they wont even address the issue because its passive there. Intuitively, what happens when you have a cut on your knuckle and you keep bending the finger? Hurts doesnt it? Likewise, it hurts when you press on it. Same idea here.
Ive been doing this a long time now, you need to desensitize the area and then increase capacity of the tissue. And if its a tendon, it will be treated much differently than if a muscle. Tendons arent just reactive, they store and release energy. They very much are animals of their own.
Find a run specialist who can diagnose you and treat you accordingly.
Cheers.
Thank you for the replies.
I am from Austria.
I have consulted 2 physios and a chiropractic so far and I haven’t gotten any helpful response…chiro told me I have a piriformis syndrome (I have no buttock pain whatsoever), one of the physios just needled my hamstring which hasn’t helped and the second physio told me my problems are connected with the long biceps femoris head being stiff or whatever. My problems are DISTAL. There was a pain on palpation at the biceps femoris tendon insertion on the fibular head just once but even then I figured it must because I have palpated it for so long I have elicited pain. When the second physio palpated, I felt pain when he pressed against the distal and perhaps the middle portion of the biceps femoris muscle so I think this must be it.
But the problem for me was that I only feel pain in the distal third of the lateral thigh during running - it starts around the second or third kilometer and then slowly builds up but I am still able to finish a let’s say 7 km run. I wouldn’t even describe it as pain, more like a bothering sensation, it certainly isn’t sharp, burning or anything like it. It feels like the muscle is absorbing the energy with every touch I make with the ground and then starts to cramp…when I finish the run, the pain gradually subsides during the subsequent hours ( I have been running the past 3 weeks after my 4 month rest that’s why I can write this exact information). I haven’t felt any pain when I went cycling but this was only once at the beggining of my troubles (I currently don’t have time for cycling, running is my jist). So I also thought I could have sciatica as I have a known minor (really minor!) central disc bulging at the L4-L5 but the Lasegue test is negative and I would find it really odd that I’d have sciatika without any lower back or buttock pain whatsoever, no tingling, negative Lasegue…Given that the physio elicited pain by pressing the biceps femoris, I think I have muscular problems, not sciatica.
Next week I’m going to do EMG to know once and for all what’s wrong with me cause I can’t live without trail running. I want to know what’s wrong so i can do the correct exercises to go back into the woods as soon as possible.
Understood. And very frustrating given the varying results. They all seem plausible, as they are all accurate possible differential dx.
Palpation is one thing, eliciting the symptoms with active contraction of the muscle will also help rule in. If neural tension tests or lumbar spine tests dont reproduce symptoms, its unlikely to be of central origin.
Also to note, you can run. And you can complete longer runs. If its not enough to make you terminate activity, and it sets on at a given distance/time, they its another symptom leaning towards a capacity issue in the tissue. Try slowing down your pace, or manipulating cadence. See if that helps reduce symptoms during the run.
Id love to give more, but dont want to overstep my bounds.
Keep plugging away, find a run specialist, even if its online somewhere else in your country. I hate to say it, but a large majority of OP physios just dont get it.
Cheers.
Yes, when I went through the possible causes, the incorrect technique of running also arose. I can’t know for sure as I never was wary of this but I am quite sure I was an overstrider since as I said I mainly do trail runs in the woods where it’s likelier you’re overstride due to ground terrain. Increasing cadence is something I have been working on the past 3 weeks but the pain isn’t going away…I’m getting desperate and I’m really thinking about not doing any sports until next spring. Just strenght exercises and casual walks with my wife during these 12 months. If it isn’t better in a year, then I guess only biking is left for me…
Also I don’t know if this was just a coincidence but if I look back the pain just happens to coincide with the sneaker change - I went from Salomon Xscream I’ve been using for the last 5 years (different pairs of course) to La Sportiva Tempesta GTX. Besides being an overstrider, I am also quite a firm supinator and I have to be frank (I don’t know what I was thinking) I never really did research for what kind of runners these La Sportiva shoes really are. Needless to say I ditched them after my months long rest and went back to the Salomons but as I said the pain is still here and I don’t know if the pain could be connected with the shoe change or was it just coincidental…
Just regarding the above conversation we’ve had also with thriatheletetoth…now that you guys know it’s a distal problem, do you advise me to do eccentric exercises ala Nordic hamstring curls? I would really like to start doing something right away and as I said I can’t go to anybody right now as I’ve exhausted my options in my vicinity regarding physios…it would really mean a lot to me if we could come up with a 3/4 exercise regimen which I could start doing even today…I will look up for a running specialist but given the (corona) situation, I think it may take a month or 2 before I’ll meet them…so to have something to do during this timeframe would really mean a lot to me…right now I have:
(I will be doing planks and side planks on separate days)
and just to be clear, you all recommend no stretching right?
Thank you for your answers.
Cheers
Hello Mike,
I have read your post on chronic biceps femoris tendinopathy and would be very interested to know if you have recovered by now.
I have been suffering from the same problem for almost a year now. Two doctors and one fysiotherapist have not succeeded in helping me so far. An ultrasound did not show any muscle damage or inflammation, so I’m scheduled for an MRI -scan next week.
Do you still suffer from chronic biceps femoris tendinopathy, and if not, would you care to share which treatment(s) proved successful for you?
Many thanks in advance!
Katrien
Hello Mike,
I have read your post on chronic biceps femoris tendinopathy and would be very interested to know if you have recovered by now.
I have been suffering from the same problem for almost a year now. Two doctors and one fysiotherapist have not succeeded in helping me so far. An ultrasound did not show any muscle damage or inflammation, so I’m scheduled for an MRI -scan next week.
Do you still suffer from chronic biceps femoris tendinopathy, and if not, would you care to share which treatment(s) proved successful for you?
Many thanks in advance!
Katrien
point of order: this is a massive issue among folks on this forum board. it’s just not always called what you’re calling it. note the archived threads here, and the size of them.
I had horrible hamstring problems for years. What finally fixed me was Nordic Curls. It has been used in Europe quite successfully the past 5 years to stem the surge of hamstring injuries in soccer players. The hamstring functions in a way unlike other muscles when running. It comes under great eccentric action when the keg extends and makes the foot strike.
It’s a great alternative for runners to try instead of running of to the closest doc/pt/chiro, etc.
Greetings Katrien!
After 15 months, I have to report that the problem unfortunately still persists. I’ve had no luck with different physios who tried to sell me diagnoses such as ITB syndrome, piriformis syndrome, fascial issue…
Truth to be told, I still don’t know what is wrong with me that’s the worst part. I’ve had MRIs done from the lumbar spine down to the knee and nothing of significant was found. Only a 2 cm lymph node / / fibrous tissue / venous malformation in the subcutaneous tissue in the distal posterolateral left thigh which (coincidentally) corresponds to the location where I’ve first felt pain during running at the end of last January. None of the doctors I’ve been to could tell me if this finding could be the source of my symptoms and even if it was I was advised it would be better to be left alone.
The pain has subsided during last summer which could correspond to me stopping running. But I could walk and hike for kilometers with no significant issues, although I remember I’ve had some sore pain at the end of a 13 km hike last June.
I still think my hamstring, or more precisely biceps femoris is the origin of my problems. New thing for me is that if I could ride a bike with no problems last summer I have unfortunately learned yesterday that this is not unfortunately the case anymore since I felt soreness about 30 minutes into a quick leisury ride. When I stopped, stretched a bit and walked a bit it went away.
Why I am quite sure it is my hamstring (biceps femoris)? Because when I do the exercise that one of the manual therapists I visited showed me - it’s the same position as for the classic hamstring stretch - you put a leg on a height, let’s say a third stair but then you do not lean forward and grab your toes but you flex the knee just a little bit and press hard into the ground with your heel (of the leg that is on the stair) and then you try to activate the hamstring as much as possible. Well when I do this, for example after the bike ride, I cannot activate the left hamstring (like it isn’t there lol) and there is pain, this time real pain not soreness in the back of the thigh…in the right leg, I can feel and activate the hams with no problem.
Regarding the reply Snowman gave you - my problem is that I do not have any imaging signs of any hamstring problem, let alone high hamstring tendinopathy. MR is normal, US is normal, EMG is normal. But I have chronic soreness and truth to be told, I don’t know what to do anymore. I am quite sure that if I had high hamstring tendinopathy, severe enough to last 15 months, that I would some imaging signs of edema in that region…so I guess you can understand me that I don’t think it would be productive for me to start doing the high hamstring tendinopathy protocol when it’s quite likely this isn’t the source of my problems…
Regarding the reply j7 gave you - I was advised against doing nordic curls since I could hurt the hams even more…
Good morning Mihel,
Thanks very much for sharing your story!
Even though neither of us seem to have found the magic remedy so far, it still feels helpful to share experiences about what works and what does not work.
For me it was very easy to determine the trigger of my biceps femoris injury, namely a long bike ride in May 2020. I had not been cycling for years, so it was too much too soon, and more importantly I used a badly fitted bike which was not my one.
After that day I did not resume cycling as I felt pain, even when walking up the stairs and standing on one leg with bent knee. Unfortunately I temporarily had to give up running as well, wich I had been doing for seven years without a single injury.
Due to corona I did not see a doctor or a physiotherapist right away.
I used inflammatory cream for two weeks, which alleviated the pain quite well. After I stopped using the cream, a mild soreness did return however, which made me decide running was still not a good idea. I started foamrolling but did no stretching. And instead of running or cycling, I went on long hikes up to 30 km, causing no discomfort whatsoever.
After three months of relative rest (only walking / hiking but no cycling or running), I carefully resumed running again. Starting with 15 minutes, then 20 minutes, etc., until I could run for an hour without feeling any pain afterwards.
The next five months running was no problem anymore and I was super-happy, thinking I would permanently be released from my injury. I did not do any cycling again, as I have always been more of a runner.
At the end of January 2021 however, I used a bike (the same bike that caused the injury) to go to the supermarket. This is just a 5 minute ride, so I did not see any harm in this.
Until I came home and felt the - too familiar - pain again!
Feeling frustrated and angry at myself, I did not want to stop running and hoped this time the pain would go away faster. But it did not. After two weeks I consulted a physiotherapist.
He was convinced he could help me, but after a few sessions I got the impression that he was unable to locate the specific cause of the problem.
For me it was not hard to diagnose myself with biceps femoris tendinopathy, as all symptoms matched the descriptions on the internet. Just like in your case it is definitely not high hamstring tendinopathy, so all the physio’s exercises to treat that kind of injury were useless.
The physio also said I could safely continue running, as I would not worsen the injury by doing that.
Now I strongly disagree with that view, as my complaints did get worse by running, and to some extent also by the physio’s exercises.
After 7 sessions the physiotherapist suggested I would do an ultrasound, as he admitted that he was unable to help me.
The ultrasound did not show any problem, so the GP wanted to send me to the physiotherapist again (!) I gradually lost courage, as no one seemed to be able to come up with the right diagnosis or cure.
My husband arranged an appointment for me to see a good sports doctor. He took his time for a thorough analysis of the problem and was able to locate the sore spot on my leg quite fast. He recommended an MRI-scan to be sure, and – again – physiotherapy sessions to strengthen the thigh muscles and increase pelvis stability.
I am scheduled for my MRI next week, but do not expect any magic from that.
However, being fed up with advice that did not work, I got quite ‘lazy’ the past six weeks and did not do any exercises or stretching anymore. I sat on a chair most of the day for work and took short walks to the supermarket. Miraculously enough, 4 weeks of rest took away all pain, and when I tried to resume running after these 4 weeks, I did not experience any pain afterwards, even though I ran for 50 minutes. Thrilled with this result, I ran a second time and a third. After the third run however, the pain did come back. So I guess I was a bit overconfident.
Now, 10 days later, I still feel pain, so I suppose I will have to rest for at least 4 to 6 weeks and then carefully resume running, i.e. just 15 minutes to start with.
All this to state that after a year my problem is not solved either, so you’re definitely not the only one.
But I believe there is hope.
I hold onto the thought that I have been free from complaints for 5 months last year, and was probably on my way to the same positive situation in the past month. Thanks to resting, foamrolling and walking (or even going on long hikes).
Have you tried complete rest (so no running or cycling) for a longer period?
It seems too easy, and people who are fond of sports find this the hardest thing to do - I know - but it might just do the trick.
Because my experience is that running and cycling do make things worse, and I even have the impression that my complaints are now more persisting than they were last year, because I continued running for several weeks despite the pain (because the physiotherapist said it was okay).
I don’t know if this is helpful to you, but as for me, I am quite fed up with all sorts of therapists and exercises that did not do help me. They consumed a lot of time, money and mental energy.
Allthough I miss running a lot and it felt great to be able to do it again, taking rest eventually brought peace of mind as well, as I could use my exercise time for other things, with the (careful) promise of healing and the ability to resume running (and maybe even cycling, but on another bike…) again.
So don’t loose courage. Perhaps focusing on the problem (even under the form of therapy) sometimes worsens it, and letting go may cure it ‘automatically’.
Don’t lose courage, and try to enjoy your Sunday,
Katrien
Mihel,
Did you actually do all the rehab exercises and take a short break from running while doing them?
I spent about 2 years getting dry needled etc from various physios and nothing worked until I finally went through the exercises to strengthen my glutes and calves - everything -around- the hamstring. Then after a few weeks of strictly doing those and not running, when pain subsided, I started doing super light hamstring curls, like no weight on a cable machine, and built up slowly from there while adding in some slow short runs on the treadmill.
As for overall cause, after seeing a good sports doc and having MRI’s, I was diagnosed with CAM/FAI in that hip, and they could visually see that my glute on that side was smaller than the other side, which possibly caused the hamstring to be overloaded over time. Thus strengthening the glute being part of rehab.
Good luck!
Hello Katrien, if I refer to the earliest era of pain - that is from February to April 2020 when the symptoms were the clearest (after that it also became a phsycologic issue for me, so the symptoms cannot really be trusted fully) I can say that yes, I have rested 2 full months - february and march with zero pain and then when I started running in April, in the first run I could run 7 km without really feeling the posterior thigh that much (only in the final km I think) but then it gradually got worse during the next 3 weeks of running and then I stopped because I had enough it. After that I never really got back to running, only perhaps 3,4 easy kilometers every now and then. I don’t really push off the left leg anymore so I can say I can complete these 3-4 kms with no big issues. The big issuse for me has now become the bicycle, I was really negatively suprised yday, it was really ucomfortable on the bike.
To answer to SBRcanuck. No I didnt’ really do any specific exercises, why? because I haven’t been prescribed any because nobody knows what’s my issue and if you don’t know the issue you can’t rehab it. I’ve been doing various exercises I’ve found on the web by myself tho during these 15 months, lately due to time shortage I’ve been doing 5 minutes of classic and side planks to activate the core followed by lateral band walks or clamshells. Can’t say that helped much. What I have noticed during these 15 months is that when I was doing lying pigeon stretch, supine piriformis stretch the issue got worse. But I don’t know what to do with this info so if anyone does, I am here.
And regarding the CAM/FAI - i actually have that aswell lol, but to my bad luck it’s bilaterally, my symptoms are strictly on the left so I can’t help with it, this isn’t the cause of my problems…nobody measured and compared my glutes tho…
Do you perhaps have these rehab exercises in some kind of digital form, if so could you send them to me? Or if you could post them here, I would be extremely grateful. I would be more than willing to try them for a weeks to see if they work for me…
The exercises were honestly pretty ‘generic’.
So:
Just to be clear, I am not a physio. The above is what worked for me to get rid of the high hamstring tendinopathy. All the fancy ‘treatments’, like dry needle, shockwave, ultrasound, etc did absolutely nothing for me.