Biceps femoris tendinopathy: exercises and recovery tips

Despite the name, your biceps femoris isn’t in your arm. It’s a muscle in your leg that helps you bend your knee and extend your hip. When the biceps femoris muscle or its tendon is irritated, everyday activities like walking, running, climbing stairs, or getting in and out of a car can feel more challenging or uncomfortable.

“Biceps femoris tendinopathy is a type of tendon irritation behind the knee that can take time to heal, often longer than a typical muscle injury,” says Tyler Boyd, PT, DPT, a physical therapist at Hinge Health. “Starting physical therapy early and doing targeted exercises consistently can make a big difference in your long-term recovery.” 

Read on to learn what can contribute to biceps femoris tendinopathy and how to relieve it, especially with hamstring-strengthening exercises recommended by Hinge Health physical therapists.

What is biceps femoris tendinopathy?

The biceps femoris is one of three hamstring muscles located at the back of your thigh, running along the outside of your leg from your pelvis, down past your knee, to your lower leg. Of the three hamstring muscles, the biceps femoris is the most likely to become irritated or injured. Its tendons are more susceptible to injury as well.

Tendinopathy is an umbrella term for tendon issues. Tendons are the tough fibers that connect your muscles to your bones. When tendons become irritated — often from doing more activity than they’re used to — you might notice discomfort or stiffness around the area.

With biceps femoris tendinopathy, people often feel discomfort near the back of the knee, where the tendon attaches to the fibula (the thinner lower leg bone). Sometimes, symptoms can also show up near the hip or glutes (butt muscles) if the upper end of the biceps femoris tendon is affected.

Symptoms of biceps femoris tendinopathy

Symptoms of biceps femoris tendinopathy can include knee, hip, or glute pain that can be sharp and shooting or a dull ache. Here are other common symptoms:

• Pain or tenderness at the back of the thigh near your glute or the behind your knee

• Swelling or inflammation around the tendon

• Stiffness or limited range of motion in the knee or hip

• Pain or stiffness may ease with activity, especially initially, but returns after

• Pain with activity may occur as the injury worsens

Causes of biceps femoris tendinopathy

Pain in the biceps femoris tendon often develops from doing more activity than your body is used to — especially repetitive movements like running, jumping, or extended periods of walking. Other factors, such as muscle imbalances and injury history can also play a role. Learn about the common causes of biceps femoris tendinopathy below.

• Progressing too quickly. “Any sudden increase in activity can put added stress on the tendon,” says Dr. Boyd. For example, this can look like ramping up your mileage too quickly while training for a race, or playing more rounds of golf than usual over the weekend. Whether returning from a break or injury or taking your workout to the next level, diving in too quickly can aggravate the tendon. 

• Repetitive motions and overuse. Doing the same movement over and over — like running, jumping, or even walking more than usual — can sometimes lead to irritation in the biceps femoris tendon, especially if your body hasn’t had time to adapt to those motions. “Activities like swinging a golf club rely on your biceps femoris to help extend your hip,” Dr. Boyd says.

• Muscle imbalances. When some muscles are stronger or tighter than others — like between your hip muscles or between your hamstrings and quadriceps — it can sometimes add extra stress to the biceps femoris tendon. Balancing strength and flexibility throughout your lower body can help support comfortable movement and prevent injuries like tendinopathy.

• Inadequate warm-up. Skipping a dynamic warm-up can leave your muscles and tendons stiff.. Taking a few minutes to warm up helps your body transition into exercise and may lower the risk of sudden injury — especially in activities with lots of quick, directional changes, like soccer or pickleball.

• Acute injury. Activities with lots of quick starts and stops — like basketball or tennis — or even chasing kids or grandkids around the house can sometimes put extra strain on the tendon, leading to irritation or discomfort.

• Previous injury. If you’ve had a hamstring or tendon injury before, experiencing bicep femoris tendinopathy may be more likely. 

How physical therapy can help biceps femoris tendinopathy

Physical therapy focuses on gentle movement and targeted exercises, which are key for supporting tendon healing and regaining strength and flexibility. Staying active with the right exercises boosts blood flow and helps your tendon recover.

Physical therapists (PTs) can also guide you on how to modify activities and progress your training safely to avoid setbacks. “A PT can help you move at the right pace and break the cycle of pain and rest, so you can build strength and return to the activities you enjoy,” says Dr. Boyd.

Doing targeted exercises, like the ones below, can support your recovery so you can get back to doing what you love.

All of these exercises help build strength and flexibility in your lower body. They support the muscles around your hamstrings and hips, which can ease discomfort and promote healing. “These movements provide targeted resistance to your hamstring, which can encourage your tendon to remodel and adapt over time,” says Dr. Boyd. Practicing these exercises regularly can help you move more comfortably.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for biceps femoris tendinopathy

Tendon injuries can take time to improve, since tendons naturally receive less blood flow than muscles, which delays healing. Still, most cases of biceps femoris tendinopathy respond well to simple treatments. Physical therapy and targeted exercises are key, along with general movement and pain-relief strategies like heat, ice, medication, or electrical stimulation. Here’s what can help support your recovery.

• Try physical therapy and targeted exercises. Targeted exercises — like the ones above — can strengthen your biceps femoris muscle and reduce strain on the tendon, making movement feel easier and more comfortable. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active. If the back of your knee hurts, it’s natural to want to rest. But gentle movement usually helps more than completely stopping, says Dr. Boyd. Being inactive can make your muscles get weaker and stiffer, which can delay healing and make the pain hang around longer. Try to stay active within your movement sweet spot — a level that feels okay to help you recover without stirring up your symptoms.

• Apply heat or ice. Heat and ice can both help ease discomfort in irritated tendons and muscles. Ice can numb pain and soothe swelling, especially after a new injury. Heat, on the other hand, helps relax stiff muscles and tendons and encourages blood flow to support healing. Use whichever feels best for you — or alternate between the two. 

• Try over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have biceps femoris pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take. 

• Consider complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for biceps femoris tendinopathy relief, such as massage, acupuncture, or dry needling.

• Try TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce pain associated with conditions like biceps femoris tendinopathy. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.

How to prevent biceps femoris tendinopathy

You can keep your biceps femoris tendon healthy and reduce your risk of an injury with a comprehensive exercise plan that includes warm-ups and recovery time. Here are ways to prevent biceps femoris tendinopathy.

• Start with a warm-up. Doing dynamic stretches for your hamstrings, quads, hips, and glutes can boost blood flow and prepare your muscles and joints for activity. This reduces stiffness and lowers your risk of discomfort or injury.

• Strengthen surrounding muscles. Building strength in the above muscle groups can help support your biceps femoris tendon and can protect it from irritation during everyday activities. Consider working with a physical therapist or a personal trainer to help target these lower body muscles. 

• Ease into physical activity. Starting slowly and building up gradually allows your body to adapt, helping you avoid unnecessary discomfort or setbacks. Give yourself time to progress at a pace that feels good for you.

• Stretch regularly. Keeping the muscles around your hamstrings flexible can help reduce stress on the biceps femoris tendon and support more comfortable movement during exercise and sports.

• Schedule recovery time. Giving your body breaks between intense or repetitive activities helps your biceps femoris tendon recover. Recovery days are a great time to try gentle strength movements, mobility exercises, or even a light activity like yoga instead of doing no movement.

• Listen to your body. If you notice discomfort or pain, treat it as a signal to slow down or modify your activity. “Adjusting your routine can help you recover and prevent further irritation,” says Dr. Boyd.

When to see a doctor

Biceps femoris tendinopathy often improves with at-home treatments like exercise therapy. However, if your pain is severe, worsening, or causing difficulty with daily activities, like walking or getting out of a chair, consult a healthcare provider. It’s also a good idea to get care if you have:

• Numbness or tingling down the legs

• Weakness in the legs

• Pain that disrupts your sleep

• Changes in how you’re walking

• Inability to bear weight on the affected side

• Balance issues

PT tip: Stay consistent and give it time 

“Tendon injuries heal more slowly than muscle injuries, so don’t get discouraged if you aren’t seeing immediate results,” says Dr. Boyd. “You’ll likely notice some improvement in the first six to eight weeks, but full recovery can take three months or more. Stick with it.”

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Dolman, B., Verrall, G., & Reid, I. (2014). Physical principles demonstrate that the biceps femoris muscle relative to the other hamstring muscles exerts the most force: implications for hamstring muscle strain injuries. Muscles, Ligaments and Tendons Journal, 4(3), 371. https://pmc.ncbi.nlm.nih.gov/articles/PMC4241430/

2. Bass, E. (2012). Tendinopathy: Why the Difference between Tendinitis and Tendinosis Matters. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice, 5(1). doi:10.3822/ijtmb.v5i1.153

3. Heiderscheit, B. C., Sherry, M. A., Silder, A., Chumanov, E. S., & Thelen, D. G. (2010). Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 67–81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2867336/

4. Physiopedia. (2014). Biceps Femoris. Physiopedia. https://www.physio-pedia.com/Biceps_Femoris

5. M. Garzón, M. Balasch-Bernat, Cook, C., Y. Ezzatvar, Ó. Álvarez-Lliso, L. Dueñas, & Lluch, E. (2024). How long does tendinopathy last if left untreated? Natural history of the main tendinopathies affecting the upper and lower limb: A systematic review and meta-analysis of randomized controlled trials. Musculoskeletal Science and Practice, 72, 103103–103103. doi:10.1016/j.msksp.2024.103103