Bicep Femoris Tendinitis

Biceps Femoris Tendinitis ;- Its a Painful condition at the posterior aspects of the knee joint ,mainly sports persons are affected but bicep femoris tendinitis injury can be happen to any one above the age of 50 yrs

1. Bicep femoris tendinitis
BY
Dr S.ZAFAR
PROFESSOR
DEPT OF PHYSIOTHERAPY
SMAS
GALGOTIAS UNIVERSITY

2. Biceps femoris tendinitis
•Bicepsfemoristendinopathyisanoveruseinjuryto
thebicepsfemoristendon(mainhamstringmuscle)
alongthebackofthethigh.Asthebicepsfemoris
hastwoheads,andoneinsertionalpoint,paincan
occuratoneoftwoplaces:justunderthebuttock,
orthebackandoutsideofthekneejoint.These
locationsarewherethemuscleisconnectedto
yourpelvisandyourshinbone(fibula).Repeated
injuriesthatinvolvethemusclecancauseachronic
inflammationofthetendonsandtheir
sheath.Tendinopathyisoftenassociatedwith
inflammationofthetendonandrepeatedmicro
tearingofthesurroundingsheath.

3. Biceps femoris tendinitis
Bicepfemoristendinitis:-itisainflammationofbiceps
musclestendonofthefemurbone.Themusclesofthe
bicepsfemorisarehamstringmuscles.ithastwomuscle
iesemimembranous&semitendinosus'.Hamstring
tendinitisisinflammationofoneofthehamstring
tendonsatthepointwhereitattachestothebackof
theknee.Mostcommonlyitisthebicepsfemoris
tendonontheoutside.Hereweexplainthe
symptoms,causesandtreatmentofhamstring
tendonitis&tendinopathy.Themajorityofdistal
bicepsrupturesareassociatedwithacombined
hyperextensionandexternalrotationinjurymechanism.
TheLCLandPLCcomplexusuallyshareloadingduring
combinedhyperextensionexternalrotationforces

4. Biceps femoris tendinopathy
•When the load on the muscles tendon increases than there is amicro
tear in the tendons

5. Anatomy of the bicep femoris tendons
•Therearetwoheadsoforigininthejoint.One,whichis
thelonghead,arisesoutoftheinnerandlower
impressionsalongthebackpartoftheleg.Theother,the
shorthead,arisesoutofthelaterallipofthelegand
extendsuptothebuttocks.Fibersofthelongheadform
thefusionbelly,whichpassesdownwardandlaterally
acrossthesciaticnerveendinginaponeurosisandcovering
theposteriorofthemuscle.Fibersreceivedfromtheshort
headbecomecontractedwiththetendon,whichisinserted
withthelateralsideofthefibulahead(thetopofthe
fibulabone)andasmallslipofthetibia(shinbone).

6. Biceps tendon
Tendons are basically just like
springs
Tendon

7. Bicepefemoris tendon
Normal tendon
Disorganized collagen
Atendonor sinew is a tough band of fibrous connective tissue that
connects muscle to bone and is capable of withstanding
tension.Tendonsare similar to ligaments; both are made of
collagen.

8. Symptoms of biceps femoris tendinopathy
•Tenderness and swelling where the tendon inserts into your tibia
bone at the outside back of the knee.
•Pain is likely to have come on gradually. You may have had a
‘niggle’, or restriction that you have put up with for some time.
•You may feel stiffness at the back of the knee, which is often
worse in the mornings, or after sitting for long periods.
•Often, when your tendon warms up pain eases off, only to return
later.

9. Assessment tests
Physiotherapist will do a number of assessment tests
and take a full case history to understand your injury.
In particular, ‘resisted knee flexion’ (trying to bend
your knee against resistance) may reproduce
symptoms at the back of your knee. You may also
show signs oftight hamstring muscles.

10. Causes & Anatomy
The hamstring muscles
Thehamstringmusclesgroupconsistsofthe
biceps femoris, semitendinosus and
semimembranosusmuscles.Thesemusclesare
usedtostronglybendtheknee,andextendthe
hipbackward.Agreatdealofforceisputthrough
thehamstringmusclesatspeedwhensprinting
andjumping.Inparticularatthepointjustbefore
yourfoottouchesdownwhensprinting.Thisis
becausethemusclesworkeccentrically
(contractingwhilstalsolengthening)toslowthe
forwardmovementofyourlowerleg.

11. Mechanism of injury
•Sportspersonwhoplayfastgameslikefootball,lawntennis,cricket,
Hockeyetc.Thepredominanthamstringinjurymechanisminfootball
occursduringhigh-speedrunningoraccelerationefforts.
•BiomechanicalandkinematicstudieshavedemonstratedthattheBFis
subjecttothehighestlevelsofmuscle–tendonunitstretchthroughoutthe
crucialterminalswingphasein(highspeed)running.

12. Mechanism of injury
•Boththesemitendinosus(ST)andtheBFengageinmaximal
eccentricactivationthroughouttheswingphaseofrunning
(middleswingtoinitialstancephase).Thesesynergistswork
alternatinglyincomplexneuromuscularcoordinationpatterns,
wheretheBFispredominantlyactivatedduringthemiddle(to
late)swingphaseandtheSTistheleadingplayerintheterminal
swingphase.Thisstressestheimportanceofsufficient
neuromuscularandintramuscularcoordinationbetweenthosetwo
musclebellies.Alteredmuscleactivationpatternshavebeen
associatedwithpriorhamstringinjuriesandanincreasedriskof
re-injury.

13. Clinical feature
•Acute pain on tendon part .
•Patients unable to flex the knee joint.
•Tenderness at the biceps femoris long head tendon
•Difficulty in walking.
•Limping gait.
•Swelling at the hamstring muscles.

14. Investigation
•MRI
•Ultrasound scan

15. MRI Imagine of Biceps Femoris Tendinitis
Coronalmagneticresonanceimagingscanshowing
ruptureoftheleftleg’sdistalbicepsfemoristendon
fromthefibularheadwithretraction.

16. Treatment
•Conservative
•Drug therapy
•Physiotherapy
•Surgical
•Conservative management.
•Drug therapy :-analgesic Tab combiflam,muscles relaxant
Neucoxia MR ,Mobizox. 1B.D
•Antacid :-Tab zintac150 Mg ,Tab acilock 150 mg, Tab digene 1 B.D
•Analgesic spray/analgesic gel application on the hamstring
muscles.

17. Physiotherapy treatment
•PRICE
•PROTECT USE OF BRACE ,SPLINT (IMMOBILZE,SPLINT , CREEPE
BANDAGES) WITH FLEXED KNEE FOR 4-6 WEEKS
•REST
•ICE PACKS
•ELEVATION
•TENS
•IFT
•QUADRICEEPS EXERISE
•Avoid squat

18. Physiotherapy treatment
•Ultrasound therapy with 1Mhz for5-7 minutes for 7-10 days
•Shock wave Therapy at tender spot
•Laser therapy class 3B laser with intensity 904 , 2-3 joule of
energy for 5 minute at tender spot.
•Massage with analgesic oil (Bestogesic oil)
•Weight training exercise with weight cuff of 2.5-5 pound :-10-15
repetition.

19. Exercise for strengthening of hamstring
muscles (biceps femoris tendinitis)
•Basic hamstringing exercise

20. Exercise for strengthening the biceps femoris
tendinitis
•Exercise with medicine ball
Advance hip flexion
exercise with weight in
hand

21. Different type of strengthening exercise for
bicep femoris tendinitis.
Thyraband exercise
Gait training with
Sqaut
Forward bend and than
hip flex

22. THANK YOU