Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes

Abstract

Research questionDoes the Nordic hamstring exercise (NHE) prevent hamstring injuries when included as part of an injury prevention intervention?DesignSystematic review and meta-analysis.Eligibility criteria for selecting studiesWe considered the population to be any athletes participating in any sporting activity, the intervention to be the NHE, the comparison to be usual training or other prevention programmes, which did not include the NHE, and the outcome to be the incidence or rate of hamstring injuries.AnalysisThe effect of including the NHE in injury prevention programmes compared with controls on hamstring injuries was assessed in 15 studies that reported the incidence across different sports and age groups in both women and men.Data sourcesMEDLINE via PubMed, CINAHL via Ebsco, and OpenGrey.ResultsThere is a reduction in the overall injury risk ratio of 0.49 (95% CI 0.32 to 0.74, p=0.0008) in favour of programmes including the NHE. Secondary analyses when pooling the eight randomised control studies demonstrated a small increase in the overall injury risk ratio 0.52 (95% CI 0.32 to 0.85, p=0.0008), still in favour of the NHE. Additionally, when studies with a high risk of bias were removed (n=8), there is an increase of 0.06 in the risk ratio to 0.55 (95% CI 0.34 to 0.89, p=0.006).ConclusionsProgrammes that include the NHE reduce hamstring injuries by up to 51%. The NHE essentially halves the rate of hamstring injuries across multiple sports in different athletes.Trial registration numberPROSPERO CRD42018106150.

Effects of eccentric training at long‐muscle length on architectural and functional characteristics of the hamstrings

“…One such training strategy is eccentric training, with a typical representative exercise being the Nordic hamstring exercise (NHE). 5 Indeed, programs that include the NHE induce favorable changes in established modifiable HSI risk factors (eg, eccentric knee flexor strength, BFlh fascicle length 6 ) and reduce HSIs by up to 51%. 5 However, it should be noted that the NHE is a knee-dominant movement performed with neutral hip position (0° hip flexion) and with limited knee joint range of motion due to participants' lack of eccentric knee flexor strength.…”

“…5 Indeed, programs that include the NHE induce favorable changes in established modifiable HSI risk factors (eg, eccentric knee flexor strength, BFlh fascicle length 6 ) and reduce HSIs by up to 51%. 5 However, it should be noted that the NHE is a knee-dominant movement performed with neutral hip position (0° hip flexion) and with limited knee joint range of motion due to participants' lack of eccentric knee flexor strength. As a result, NHE (a) does not enable eccentric strengthening at hamstring lengths that are similar to the lengths achieved in the late swing phase of the sprinting and (b) has limited potential in eliciting high strains and high negative work in biarticular hamstring MTUs.…”

Can we improve coaches’ injury prevention views and implementation practices in the community female Gaelic sport of camogie?

“…Hamstring strains frequently occur in camogie 1 and in a recent systematic review, programs that include Nordic hamstring curls have been found to half the amount of hamstring strains sustained. 26 However, four out of five elite European soccer teams did not complete the Nordic hamstring curl exercises, despite 88% of clubs being familiar with the Nordic hamstring curl exercise programme. 27 Some coaches reported that it was not easy to get players to complete the programme and that it causes muscle soreness in players.…”

Effect of slope angle on muscle activity during variations of the Nordic exercise

“…Clinical literature has suggested several strengthening exercises for the hamstring and gluteal muscle groups, including the hamstring curl, single-leg extension, Roman chair exercise, and Nordic exercise (McAllister et al, 2014;Park and Yoo, 2014;van Dyk et al, 2017). Recent findings have demonstrated the biomechanical effectiveness and practical benefits of the Nordic exercise (van Dyk et al, 2019;Whyte et al, 2019). This exercise (also called the "Russian hamstring exercise") can be performed with a partner without any substantial equipment (Ebben, 2009).…”

“…This exercise (also called the "Russian hamstring exercise") can be performed with a partner without any substantial equipment (Ebben, 2009). Although previous studies have noted several advantages of the Nordic exercise (Ebben, 2009;McAllister et al, 2014;van Dyk et al, 2019;Whyte et al, 2019), few reports have investigated variations of this exercise.…”