The pain in the back of your thigh is getting worse. It has not responded to rest and physical therapy. At times getting up from sitting is nearly impossible. Your doctor thinks it is a hamstring injury. What is the Biceps Femoris? What is tendonitis? What is Biceps Femoris Tendonitis? What causes this condition? What are the symptoms of Biceps Femoris Tendonitis? What are the risk factors? What are the traditional treatment options? What are the regenerative treatment options? Is there a Biceps Femoris Tendonitis stem cell treatment? What are Biceps Femoris Tendonitis stem cell treatment options? Let’s dig in.
Your hamstrings are the thick muscles in the back of your thigh that are responsible for the movement of your hip, thigh, and knee. The hamstrings are made of three distinct muscles:
- Biceps Femoris
The Biceps Femoris, like other muscles, starts and stops at specific points in the body. The Biceps Femoris starts from the Sitz bone AKA ischial tuberosity and travels down the backside of the thigh where attaches to the outer shin bone (the fibula).
The Biceps Femoris muscle enables you to bend (flex) your knee and straighten (extend) your hip (1),
What is Tendonitis? (Tendon Inflammation)
A tendon is a thick piece of connective tissue that connects muscle to bone. Tendonitis is a medical condition where the tendon has become inflamed or irritated creating pain.
Tendonitis needs to be distinguished from the term tendinosis. Both conditions affect tendons but have significant differences. Tendonitis is inflammation of the tendon whereas Tendinosis is a chronic condition that involves degeneration and injury to the actual tendon (2). Both Tendonitis and Tendinosis can be caused by repetitive overuse or injury.
It is inflammation of the Biceps Femoris Tendon. Hamstring injuries are the most common injury in sports (3). They are the most frequently reported injury in soccer, accounting for 37% of the muscular injuries (4). Other sports that involve sudden bursts of use or abrupt changes in speed or direction are also at risk for this condition. Common examples include runners, football players, field and track, and waterskiers.
What Are the Causes of Biceps Femoris Tendonitis?
Multiple factors play a role in the development of Biceps Femoris Tendonitis. The most common include
- Increasing volume or intensity too quickly during training (5)
- Prolonged sitting (6)
- Increase in body weight
- Metabolic conditions such as Diabetes and elevated lipids
- Fluoroquinolone antibiotics (7)
- Compression or irritation of low back nerves
- Sacroiliac Joint dysfunction (8)
What Are the Symptoms of Biceps Femoris Tendonitis?
Symptoms vary depending on the severity of the injury. The most common symptoms of Biceps Femoris Tendonitis include
- Localized pain oftentimes sharp and burning
- Muscle tightness/banding
- Swelling and inflammation
- Muscle and joint stiffness
- Restricted range of motion
There are multiple studies that have examined the risk factors. The major risk factors for Hamstring Tendonitis are:
- Muscle imbalance: Is your opposite side hamstring stronger or weaker?
- More common during competition than training.
- Shorter pre-seasons
- Previous hamstring injury (9)
Treatment Options for Biceps Femoris Tendonitis?
When appropriate conservative care should always be the first-line treatment. The goal is to reduce pain, minimize intramuscular bleeding, and control the inflammatory response. Options include rest, physical therapy, chiropractic care, gentle stretching, dry needling, and ultrasound.
Steroid injections are often recommended for patients who do not respond to conservative treatment. Steroids have many different brands and names which include dexamethasone, methylprednisolone, betamethasone, and cortisone. Steroids are powerful anti-inflammatory agents that have a significant number of side effects. These include injury to cartilage, tendons, and ligaments. To learn more about the harmful effects of steroids please click here.
Regenerative Treatment Options (PRP & Biceps Femoris Tendonitis Stem Cell Treatment)
Two principle Regenerative options exist for the treatment of Biceps Femoris Tendonitis
PRP is rich in growth factors that can increase blood flow and promote healing. PRP has been demonstrated to be superior to steroids for the treatment of hamstring injuries (10)
Biceps Femoris Tendonitis Stem Cell Treatment
Stem cells are your body’s own powerhouses for healing. Biceps Femoris Tendonitis stem cell treatment options at the Centeno-Schultz Clinic are as follows.
Indications for Stem Cell Treatments
Stem cell treatments are appropriate for patients who have failed to receive significant healing from PRP injections or those who have Biceps Femoris Tendonitis and partial thickness tearing of the tendon.
Who Performs the Injections?
Board-certified, fellowship-trained physicians perform all injections in the clinic. All the physicians are experts in Orthopedic injuries and the successful treatment using PRP and stem cells.
What Is Injected?
There are many different types of stem cells which include bone marrow-derived, adipose-derived, culture-expanded, and “birth tissue products”. Birth tissue products have been demonstrated to have no living stem cells are should be avoided. To learn more please click here.
At the Centeno-Schultz Clinic, bone marrow-derived stem cells are used. This is a same-day procedure where the bone marrow is aspirated in the morning and the processed stem cells are re-injected in the afternoon. A special technique is used to maximize the number of stem cells obtained. The higher the number of stem cells, the better the results.
Where Are the Stem Cells Injected?
The cells are injected through a needle into the area of tendonitis using ultrasound guidance. This guidance is critical to ensure the proper placement of the cells into the area of injury. Blind injections are beneath the standard of care as there is no assurance that the cells are injected into the targeted tissue
How to Prepare?
Patients must have discontinued nonsteroidal anti-inflammatory agents, steroids, statin medications, and blood thinners. This is important for optimal clinical outcomes as steroids, statin medications and NSAIDs can poison your stem cells.
Biceps Femoris Tendinosis and other hamstring injuries can be debilitating. Often times there is significant downtime. For example, after a hamstring injury, runners need 16 weeks, on average, to return to sport without restrictions, while dancers can take up to 50 weeks. In professional soccer, the athlete remains, on average, 14 days away from competitive activities.
Hamstring injuries also have one of the highest recurrence rates, which is estimated to range between 12% and 33% (11). Why is this important? If not properly treated the injury can reoccur causing additional pain and downtime.
A Biceps Femoris Tendonitis or any other hamstring injury is a warning signal that you have a fundamental problem that needs attention. If ignored the potential consequences include:
- Tendonitis can progress to a tendon tear
- Tendon tears can extend ripping the tendon off the boney attachment (avulsion injury)
- Negatively impact knee function. To learn how Dr. Centeno’s hamstring injury compromised his knee function please click here
- The Biceps Femoris is one of three muscles that make up your hamstring.
- The Biceps Femoris is a thick muscle in the back of your thigh that is responsible for the movement of your hip, thigh, and knee.
- Tendonitis is inflammation of the tendon
- Biceps Femoris Tendonitis is inflammation of the Biceps Femoris tendon which is a common sports injury.
- There are multiple causes for Biceps Femoris Tendinosis which include training too quickly, prolonged sitting, increase body weight, injury of low back nerves, and SI joint dysfunction.
- Pain, muscle tightness, swelling, and restricted range of motion are the most common symptoms.
- Treatment options include conservative care and steroids. The latter should be avoided as they are toxic and can damage tendons and joint cartilage.
- Regenerative treatment options include PRP and stem cells
- Biceps Femoris Tendonitis stem cell treatment options at the Centeno-Schultz Clinic involve the use of bone marrow derives stem cells that are accurately injected into the area of tendonitis.
- Biceps Femoris Tendonitis stem cell treatment options are best suited for those patients that have failed to receive significant benefit from PRP or that have partial thickness tears in the tendon.
- The Centeno-Schultz Clinic are experts in the treatment of hamstring injuries. All procedures are performed by board-certified, fellowship-trained physicians.
- Biceps Femoris Tendonitis is a warning signal that requires your attention. If untreated, tendonitis can progress to a tendon tear or being ripping off the bone (avulsion).
1.Danielsson, A., Horvath, A., Senorski, C. et al. The mechanism of hamstring injuries – a systematic review. BMC Musculoskelet Disord 21, 641 (2020). https://doi.org/10.1186/s12891-020-03658-8
2.Bass E. Tendinopathy: why the difference between tendinitis and tendinosis matters. Int J Ther Massage Bodywork. 2012;5(1):14-17. doi:10.3822/ijtmb.v5i1.153
3.Ernlund L, Vieira LA. Hamstring injuries: update article. Rev Bras Ortop. 2017;52(4):373-382. Published 2017 Aug 1. doi:10.1016/j.rboe.2017.05.005
4.Askling CM, Koulouris G, Saartok T, Werner S, Best TM. Total proximal hamstring ruptures: clinical and MRI aspects including guidelines for postoperative rehabilitation. Knee Surg Sports Traumatol Arthrosc. 2013 Mar;21(3):515-33. doi: 10.1007/s00167-012-2311-0. Epub 2012 Dec 11. PMID: 23229384.
5.Goom TS, Malliaras P, Reiman MP, Purdam CR. Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management. J Orthop Sports Phys Ther. 2016 Jun;46(6):483-93. doi: 10.2519/jospt.2016.5986. Epub 2016 Apr 15. PMID: 27084841.
6.Lempainen L, , Sarimo J, , Mattila K, , Orava S. and Proximal hamstring tendinopathy—overview of the problem with emphasis on the surgical treatment. Oper Tech Sports Med. 2009; 17: 225– 228. http://dx.doi.org/10.1053/j.otsm.2009.12.016
7. Lewis T, , Cook J. and Fluoroquinolones and tendinopathy: a guide for athletes and sports clinicians and a systematic review of the literature. J Athl Train. 2014; 49: 422– 427. http://dx.doi.org/10.4085/1062-6050-49.2.09
8.Massoud Arab A, Reza Nourbakhsh M, Mohammadifar A. The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction. J Man Manip Ther. 2011;19(1):5-10. doi:10.1179/106698110X12804993426848
9.van Beijsterveldt AM, van de Port IG, Vereijken AJ, Backx FJ. Risk factors for hamstring injuries in male soccer players: a systematic review of prospective studies. Scand J Med Sci Sports. 2013 Jun;23(3):253-62. doi: 10.1111/j.1600-0838.2012.01487.x. Epub 2012 Jun 21. PMID: 22724435.
10.Park PYS, Cai C, Bawa P, Kumaravel M. Platelet-rich plasma vs. steroid injections for hamstring injury-is there really a choice? Skeletal Radiol. 2019 Apr;48(4):577-582. doi: 10.1007/s00256-018-3063-9. Epub 2018 Sep 17. PMID: 30225608.