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(Last Updated On: May 6, 2019)

Biceps Femoris Pain: Differences Between Trigger Point Pain and Muscle Strain Pain

Where Is The Biceps Femoris Muscle?

The biceps femoris is located in the back of the thigh. The muscle has two heads, the long head, and the short head.

The long head of the muscle attaches to the pelvis (ischial tuberosity) and extends down the leg to connect to the head of the small bone in the lower leg (fibula).

The short head attaches to the thigh bone (linea aspera of the femur) and also connects to the head of the fibula. The biceps femoris is one of 3 hamstring muscles.


What Movements Does The Biceps Femoris Muscle Control?

  • Bends the knee (flexion)
  • Twists the leg outward (external rotation)
  • Straightens the thigh at the hip (extension)

Looking for detailed muscle anatomy? Go to the Biceps Femoris O,I,A page. Agonist and antagonist are listed for each muscle action.

Biceps Femoris Muscle Pain

Biceps femoris pain is felt in the back of the thigh. Pain can occur at any point in the muscle from the bottom of the buttock to the outside of the knee. The pain ranges from aching and persistent to sharp and debilitating.

Pain caused by trigger points occurs in the back of the knee and may extend up into the lower thigh and down into the top of the calf. The pain concentrates toward the outside of the knee, thigh, and calf. Trigger point pain tends to be aching and persistent, easing at times, but seldom completely gone.

Pain caused by a muscle strain happens when the fibers of the muscle tear. Strains can occur anywhere along the length of the biceps femoris but are most frequent at the top of the muscle and thigh. The moment a strain occurs you feel it. There will be a tugging or pulling sensation if the strain is mild. If the strain is more severe the pain is sharp and immediate.

Biceps Femoris pain pattern

Biceps Femoris Pain Pattern: Pain in the back of the knee going up the outside of the back of the thigh that worsens when walking.

What Are The Signs and Symptoms of Biceps Femoris Trigger Points?

Biceps femoris trigger point pain remains localized, it does not radiate to other areas of the body. The pain is usually more noticeable on the outside of the lower knee.

Signs and symptoms:

  • Dull aching pain toward the outside of the back of the knee
  • Pain can extend into the lower thigh or descend into the top of the calf
  • Standing from a sitting position brings awareness of tightness in the back of the thigh and pain in the knee
  • Walking increases pain
  • Sharp pain can occur with a twisting motion of the thigh or knee

What Causes Trigger Points To Develop In The Biceps Femoris Muscle?

  • Sitting for prolonged periods of time
  • Seats with hard edges that put pressure on the back of the thigh
  • Sitting with your legs dangling when your feet cannot reach the floor
  • Activities that require frequent bending and straightening of the knee ie. squats, gardening
  • Football, soccer, and basketball players are prone to trigger points in the muscle
  • Activities that require fast acceleration and quick turns and pivots contribute to the development of trigger points
  • Trigger points often develop while recovering from a muscle strain

How To Avoid Development of Trigger Points In The Biceps Femoris Muscle

  • Don't sit for hours at a time without getting up. Stand up, walk around and do some simple stretches for a few minutes each hour. If you work at a desk consider investing in a standing desk.
  • Don't sit on hard surfaces or seating that has a hard edge that pushes into the back of your thigh. Use a seat cushion or roll a towel and place it between your thighs and the hard edge.
  • Don't allow your legs to dangle unsupported when sitting. Rest feet on the rungs of a high chair/bar stool or use a footstool for other types of seating.
  • Always take time to warm up and do a few stretches before exercise and competitions.
  • If your legs start feeling weak and fatigued stop and rest. Don't try to push through.

Biceps Femoris Trigger Point Treatment

Massage therapists, physical therapists, and chiropractors who have trigger point therapy or neuromuscular training can show you the location of specific trigger points and show you how to do self-treatment. Not all have the specific training so be sure to ask before making an appointment.

If you would like to learn how to treat trigger points The Trigger Point Therapy Workbook is an excellent book to learn the skill. The book has diagrams that show you the location of trigger points in various muscles and how to treat TrPs throughout your body. It takes time and patience to learn how to find trigger points but once you learn you have a skill that will help you locate and treat muscle pain throughout your body.

TWD Suggestions For Biceps Femoris Trigger Points

Sombra Warm Therapy Pain Relieving Gel is highly recommended for trigger point and chronic pain relief. It relaxes the muscles without the burning heat of other creams. (not sold in stores)

The Trigger Point Therapy Workbook is the best resource to learn how to treat and manage your TrP muscle pain. Learn the methods and have the knowledge to relieve muscle pain throughout the body.

If you are buying the Trigger Point Workbook to self-treat the biceps femoris you will need a hardball for treatment. The Kieba Massage Lacrosse Balls are a good choice to use on the thighs and other areas of the body.

The Tiger Tail Foam Roller Stick is recommended for sore tight leg muscles. You can roll the muscle in multiple directions, up, down and even diagonally to relieve pain and stiffness. Easy to use and does not require upper body strength like other foam rollers.

How Long Before I Feel A Reduction In Pain?

If the cause of your pain is trigger points, a reduction of pain and tightness is noticeable after a few treatments. To fully treat trigger points treatment should be done several times a day until the trigger point is gone. Treatment consistency is important as well as continuing treatment until the trigger point(s) are gone.

Other muscles that should be considered and examined in conjunction with the biceps femoris muscle:

Satellite trigger points associated with the biceps femoris muscle:

If you find trigger points in the biceps femoris it is likely you will find trigger points in some or all of these muscles:

Interesting facts about the biceps femoris muscle:

  • Like the biceps in the arm, the biceps femoris splits into two heads, the short head, and the long head. The short head of the muscle is absent in some people.
  • A braking action of the biceps femoris along the other hamstring muscles help keep the body from falling forward when standing or moving. It also helps with precision movement when bending, squatting then straightening or standing up.

Biceps femoris muscle pain and symptoms can be similar to, contribute to, and be affected by these medical diagnoses:

  • L5 radiculopathy
  • Bruised ischial tuberosity
  • Cauda equina syndrome
  • Deep vascular thrombosis (DVT)


Biceps Femoris Muscle Strain Pain

Biceps femoris strain pain is felt in the back of the thigh and is sharp and sudden. Mild strains may be sharp when the tear happens but is usually a tugging or pulling sensation. You may be able to resume whatever activity you were engaged in at the time of injury though there will likely be discomfort. Mild strains rarely affect daily activities.

Moderate strains are usually a stabbing pain with a tearing or popping sensation when the injury occurs. The pain will make you stop what you are doing. Daily activities may be affected because of pain and limping.

Severe strains cause extremely sharp pain with a ripping or hard pop sensation and are debilitating. It will be painful to put weight on the leg and straightening the thigh at the hip will be very painful.

Some of the signs of a biceps femoris strain are:

  • Sudden and intense pain in the back of the thigh
  • A tearing or popping sensation is often felt
  • Pain when putting weight on the leg.
  • If the strain is severe standing on the leg may be impossible due to pain
  • Pain in the lower buttock, down the back of the thigh that may continue into the knee when straightening the thigh at the hip
  • Bending the knee will usually increase pain
  • Pain and stiffness when bending over to touch the toes
  • Swelling and bruising occur with most moderate and severe strains

Running, jumping, and sudden turns and pivots can cause a biceps femoris strain.

TWD Suggestions For Biceps Femoris Strains

Biofreeze Pain Relieving Gel cools the area much like ice discouraging inflammation. Provides excellent pain relief between cold treatments. Recommended by medical professionals and trainers.

The Simple Spectra Clay Hot/Cold Wrap can be placed and secured high on the thigh, providing hot or cold treatment as well as compression which is important for recovery. The wrap can also be used on other areas of the body.

If you are an athlete or exercise aficionado who uses cold treatments a lot, the Freeze Sleeve provides excellent cold compression treatments for thigh and knees. Great to have on hand for fast easy treatments.

What Causes A Biceps Femoris Strain?

Jumping, quick sudden turns or rapid acceleration when running are the most common cause of biceps femoris strains. Other contributors are:

  • Not taking time for a proper warm-up
  • Poor conditioning
  • Muscle fatigue
  • Over-extension of stride when walking, jogging or running
  • Sudden acceleration or deceleration when walking or running
  • Planting a foot then doing a hard pivot or quick turn
  • Repetitive jumping in sports like basketball or volleyball
  • Taking a misstep and twisting the thigh at the hip or knee

Sports and activities that contribute to strains:

  • Runners especially sprinters
  • Hurdlers
  • Cyclists
  • Gymnasts
  • Basketball
  • Volleyball
  • Soccer
  • Football
  • Hockey
  • Swimmers

Biceps Femoris Strain Treatment

Most mild and moderate strains do not require medical help and can be treated at home using the P.R.I.C.E. protocol. The protocol should be started as soon as possible and followed the first 24-72 hours after injury to reduce pain and inflammation.

  • Protect - Protect and stabilize thigh. Limit movement and putting weight on the leg.
  • Rest  -  Stay off the leg. Get your sleep, take extra naps.  Rest is important for the healing process.
  • Ice -  Apply ice or cold packs every 1- 2 hours for 20 minutes per treatment the first 24-48 hours after injury. Longer cold treatment times can cause soft tissue damage.
  • Compression -  Applying pressure using an Ace bandage or Velcro wrap will reduce swelling and provide support.
  • Elevate: Use pillows to elevate the leg.

Once the swelling, heat, and initial bruising begin to subside it is time to alternate cold and warm treatments. Start with cold treatment for 20 minutes then 1-2 hours later apply a warm treatment. Alternate treatments throughout the day.

When to see a doctor:

  • Unbearable pain level
  • Excessive swelling and bruising
  • Inability to move leg without extreme pain
  • Unable to put weight on the leg
  • Pain, swelling, redness, and heat have not decreased in 24 hours

How Long Does It Take A Biceps Femoris Strain To Heal?

A mild strain (Grade I) can heal in 2-4 weeks.

A moderate (Grade II) will usually heal in 4-8 weeks.

A severe (Grade III) may take several months to a year to fully heal depending on the severity of the muscle and tendon fiber tears.

Note: Grade II strains with a lot of swelling and pain and all Grade III strains should be monitored by a medical professional.

The Sparthos Thigh Compression Sleeves provides compression as well as support. It stays in place, it does not slide down, the top doesn't roll down and the bottom does not roll up during movement.

The Thigh Brace by Vive provides support and compression to injured hamstring muscles. The two Velcro straps are easily adjusted for compression.

The CW-X Endurance Pro Tights were made specifically for the hamstrings. They provide support and compression. Highly recommended for athletes.

The Odofit Support Brace has 3 straps that allow you to adjust the compression to your needs.  The waistband holds the brace in place. One of the best for moderate and severe thigh and groin pain and injury.

Tips To Avoid Biceps Femoris Strains

  • Warm up before sports, exercise and strenuous activities. A few minutes of preparation can help prevent injuries!
  • Do not push past your conditioning and fitness, this is when most injuries occur.
  • Do not stretch past muscle capacity.
  • Wear proper footwear when participating in sports or exercise.
  • If muscle soreness sets in or you experience an injury, take the needed time off to recover.


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