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.
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 is a surgical emergency requiring repair within 3-4 weeks. High-speed sprint-specific rehabilitation (Nordic hamstring curl, high-speed treadmill 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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