The proximal biceps femoris tendon (long head) shares its ischial tuberosity origin with the semitendinosus as the conjoint tendon. High-speed running tears predominantly occur at the proximal myotendinous junction of the long head. Complete proximal avulsion tears in water skiers and gymnasts from forceful hip flexion with the knee extended produce palpable and visible posterior thigh deformity.
| Muscle |
|
|---|---|
| Attachment | Ischial tuberosity. The conjoint tendon attaches to the medial part of the upper tuberosity, separate from the semimembranosus laterally |
Hip extension and knee flexion force transmission from the ischium
Biceps femoris long head strains are most common at the proximal myotendinous junction. MRI grading (I-III) guides return-to-sport timelines. Complete proximal avulsion, caused by sudden hip flexion with the knee extended, needs early surgical repair with suture anchors, ideally within 3-4 weeks; chronic retracted avulsions leave weakness, sitting pain and sciatic nerve irritation from scar. High-speed sprint-specific rehabilitation (Nordic hamstring curl, high-speed running) is the evidence-based return-to-sport protocol.
High-speed running hamstring injury at the proximal myotendinous junction managed with rehabilitation or surgical repair for complete proximal avulsion.
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