A 24-year-old professional soccer player sustained a rare distal biceps femoris avulsion injury during a training session, characterized by a near-complete tear at the musculotendinous junction approximately 5 cm proximal to the fibular head, without tendon detachment or significant retraction. Given the unusual nature of this injury and the absence of tendon retraction or involvement of lateral stabilizing structures, a conservative, nonoperative treatment approach was adopted. The patient underwent a carefully structured, four-phase rehabilitation protocol spanning 12 weeks, focusing sequentially on pain control and protection, gradual introduction of eccentric strengthening, neuromuscular re-education, and finally sport-specific functional training. Serial imaging, including MRI at six weeks, confirmed progressive tendon healing and resolution of intramuscular edema, validating safe progression through rehabilitation phases.

Despite the general inclination towards surgical intervention in distal biceps femoris avulsion injuries, especially in elite athletes, this case highlights successful full functional recovery and return to competitive play without surgery. The rehabilitation program emphasized tailored progression based on clinical milestones, strength assessments, and imaging findings. Key elements included initial isometric strengthening, controlled eccentric loading, and prevention strategies targeting flexibility, core stability, and load management to mitigate recurrence risk. Moreover, the patient's history of a prior contralateral hamstring injury led to genetic evaluation, which was unremarkable, underscoring the importance of individualized assessment.

This case contributes valuable evidence supporting the viability of nonoperative management in select distal biceps femoris avulsion injuries, particularly when surgical indications such as greater than 2 cm tendon retraction or multi-ligamentous instability are absent. The detailed four-phase rehabilitation protocol outlined here offers a practical framework for clinicians managing similar presentations, balancing tissue healing with progressive functional demands. Ultimately, individualized treatment decisions incorporating clinical, imaging, and patient-specific factors are paramount to optimizing outcomes in this rare but challenging injury.

Muscle and joint injuries, Occupational medicine, Trauma and rehabilitation