Rehabilitation of Biceps Femoris Tendinopathy

The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any rehabilitation.

Aims of Rehabilitation:

Whether the injury is inflammation of the tendon, or a strain or partial rupture the basic aims remain the same, although timescales may be longer for more severe injuries:

• Decrease pain and inflammation.
• Stretch and the muscles and restore mobility and flexibility.
• Strengthen the knee.
• Gradual return to full fitness.

Decreasing Pain and Inflammation

• Rest from aggravating exercises. Avoid any form of exercise that may make the injury worse. If you are on your feet allot at work then this will not help. You should rest until the acute stage has passed. This is usually 48 hours if you look after it. If you continue to use the tendon then it may remain acute for longer. If you can contract the hamstring muscles (bend the knee) without pain then the acute stage may have passed.
• Apply ice / cold therapy. At least 3 times a day for 15 minutes.
• NSAID (Non Steroidal Anti-inflammatory Drugs) e.g. Ibuprofen may help reduce inflammation in the early stages. Always consult your Doctor before taking medication. Ibuprofen should not be taken if you have asthma.
• Wear a knee support or heat retainer. Heat may be applied after the acute stage but up until then, apply cold therapy.

Stretching and Restoring Flexibility

• Hamstring stretches can be done from day one so long as they are not painful. If stretching produces pain then rest until stretching can be done without pain.
• Hold stretches for 30 seconds and repeat the stretch 5 times.
• Stretch every day (if it is pain free).
• Stretching exercises should be done with the leg rotated inwards and again with the leg rotated outwards....more.
• Sports massage can play an important part in restoring flexibility and enhancing the healing process. Massage can begin after the initial acute stage - usually after the first 48 hours. If bending the knee is painful then avoid massage therapy until it is not.

Strengthening Exercises

• Strengthening exercises should be done to prevent the injury recurring.
• Strengthening exercises can begin as soon as they can be done without pain. This may be after the first 48 hours or it may be up to a week before strengthening can begin.
• There should be a gradual progression. Once you can cope with the easy exercises without pain during, after or the following day then move onto a more difficult exercise....more.
• Strengthening exercises should continue long after you feel the injury has recovered.

Return to Fitness

• As soon as you are confident of pain free stretching and strengthening exercises it may be possible to begin more sports specific training. This may be within a few days or up to a couple of weeks or longer depending on severity.
• This should be a gradual process. Start with a gentle jogging programme as shown below:

• Continue this gradual progression until you can confidently run and resume normal training.
• Gradually increase the duration of your runs. No more than 10 % per week is usually recommended. If your sport demands sprinting then gradually increase the speed each training session so long as there are no adverse effects. Start at 50% of maximum speed and increase about 10% per session.
• Continue with specific strengthening and stretching exercises.
• Each session should begin with a warm up and stretch and end with a cool down and stretch.

Prevention

• Always ensure you follow a correct warm up before training or competition.
• Stretch the hamstring muscles both before and after training. Stretch every day, regardless of whether you are training or not.
• Strengthen the muscles to cope with the demands placed on them.
• Have regular sports massage to keep the muscles and tendons in good condition.
• Avoid doing too many accelerating / decelerating runs or hill work