Still poorly adopted in male professional football: but teams that used the Nordic Hamstring Exercise in team training had fewer hamstring injuries – a retrospective survey of 17 teams of the UEFA Elite Club Injury Study during the 2020–2021 season

Ekstrand, Jan; Bengtsson, Håkan; Waldén, Markus; Davison, Michael; Hägglund, Martin

doi:10.1136/bmjsem-2022-001368

Cited by 32 publications

(47 citation statements)

References 30 publications

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“…The Nordic Hamstring Exercise programme has been promoted for injury prevention,24 and may reduce hamstring injuries by 65–70% 25 26. However, the programme has not been widely adopted in men’s professional football in Europe 24 27. Challenges to implementing the programme include:…”

Section: Discussionmentioning

confidence: 99%

“…It is also considered unlikely that a single exercise would be the whole solution to a multifactorial injury problem. 27 …”

Section: Discussionmentioning

confidence: 99%

“…It is also considered unlikely that a single exercise would be the whole solution to a multifactorial injury problem. 27 Can we explain why structural injuries were reported to be more common than functional injuries during the recent eight seasons?…”

Section: Original Researchmentioning

confidence: 99%

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Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men’s professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22

et al. 2022

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ObjectivesTo: (1) describe hamstring injury incidence and burden in male professional football players over 21 seasons (2001/02 to 2021/22); (2) analyse the time-trends of hamstring muscle injuries over the most recent eight seasons (2014/15 to 2021/22); and (3) describe hamstring injury location, mechanism and recurrence rate.Methods3909 players from 54 teams (in 20 European countries) from 2001/02 to 2021/22 (21 consecutive seasons) were included. Team medical staff recorded individual player exposure and time-loss injuries. Time-trend analyses were performed with Poisson regression using generalised linear models.Results2636 hamstring injuries represented 19% of all reported injuries, with the proportion of all injuries increasing from 12% during the first season to 24% in the most recent season. During that same period, the percentage of all injury absence days caused by hamstring injuries increased from 10% to 20%. Between 2014/15 and 2021/22, training hamstring injury incidence increased (6.7% annually, 95% CI 1.7% to 12.5%) as did burden (9.0% annually, 95% CI 1.2% to 18.3%). During those years, the match hamstring injury incidence also increased (3.9% annually, 95% CI 0.1% to 7.9%) and with the same trend (not statistically significant) for match hamstring injury burden (6.2% annually, 95% CI −0.5% to 15.0%).ConclusionsHamstring injury proportions—in number of injuries and total absence days—doubled during the 21-year period of study. During the last eight seasons, hamstring injury rates have increased both in training and match play.

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Section: Discussionmentioning

confidence: 99%

“…It is also considered unlikely that a single exercise would be the whole solution to a multifactorial injury problem. 27 …”

Section: Discussionmentioning

confidence: 99%

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Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men’s professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22

et al. 2022

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“…Our basic hypothesis is that the coaches are the most important persons for the injury situation in an elite club, medical staff can only realise suggestions for preventative training implementation across the whole team if the coach and coaching staffs are positive about the suggestions 6 23 24…”

Section: Discussionmentioning

confidence: 99%

Risk factors for hamstring muscle injury in male elite football: medical expert experience and conclusions from 15 European Champions League clubs

Ekstrand

Ueblacker²,

Zoest³

et al. 2023

BMJ Open Sport Exerc Med

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ObjectivesTo describe the perceived importance of suggested hamstring injury risk factors according to chief medical officers (CMOs) of European male professional football clubs. A secondary objective was to compare if these perceptions differed between teams with a lower-than-average hamstring injury burden and teams with a higher than average hamstring injury burden.MethodsFirst, CMOs of 15 European professional male football clubs were asked to suggest risk factors for hamstring injury in their club. The perceived importance of the suggested risk factors was then rated by all participants on a 5-graded Likert scale. Participating teams were divided in two groups depending on their hamstring injury burden during the 2019/2020 and 2020/2021 seasons. The LOW group consisted of seven teams that had a lower than average hamstring injury burden. The HIGH group consisted of eight teams that had a higher-than-average hamstring injury burden.ResultsTwenty-one risk factors were suggested. The majority were extrinsic in nature, associated with coaching staff, team or club rather than players themselves. ‘Lack of communication between medical staff and coaching staff’ had the highest average importance (weighted average=3.7) followed by ‘Lack of regular exposure to high-speed football during training sessions’ (weighted average=3.6). The HIGH group perceived the player factors fatigue and wellness as more important than the LOW group.ConclusionAccording to CMOs recruited in this study, most risk factors for hamstring injuries are extrinsic and associated with the club and coaching staff, and not the players themselves.

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“…However, as the NHE was still superiorly effective in comparison to sprinting and the lower limb training programme alone, it maybe preferential to incorporate the NHE to reduce the risk of HSIs. Further investigation is however warranted on the application of other supramaximal eccentric modalities other than the NHE due to the low levels of compliance reported in sport [ 9 , 66 ]. However, sprinting could offer a viable alternative to supramaximal eccentric modalities at time points of the season, as long as acute sprint training loads do not compromise athlete readiness, potentially increasing risk of injury [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of additional Nordic hamstring exercise or sprint training on the modifiable risk factors of hamstring strain injuries and performance

et al. 2023

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The Nordic hamstring exercise (NHE) has commonly been investigated in isolation, however, within practice multiple modalities are commonly incorporated. However, the NHE has a low level of compliance within sport, with sprinting being potentially being preferred. The present study aimed to observe the effect of a lower-limb program with either additional NHE or sprinting on the modifiable risk factors hamstring strain injury (HSI) and athletic performance. 38 collegiate athletes were randomly assigned into three groups: control standardised lower-limb training program (n = 10 (2 female, 8 male), age = 23.50 ± 2.95 years, height = 1.75 ± 0.09 m, mass 77.66 ± 11.82 kg), additional NHE (n = 15 (7 female, 8 male), age = 21.40 ± 2.64 years, height = 1.74 ± 0.04 m, mass 76.95 ± 14.20 kg) and additional sprinting (n = 13 (4 female, 9 male), age = 22.15 ± 2.54 years, height = 1.74 ± 0.05 m, mass 70.55 ± 7.84 kg). All participants performed a standardised lower-limb training program twice per week for seven weeks, including Olympic lifting derivatives, squatting movements, and the Romanian deadlift, with experimental groups performing with either additional sprinting or NHE. Bicep femoris architecture, eccentric hamstring strength, jump performance, lower-limb maximal strength and sprint ability were measured pre and post. All training groups demonstrated significant (p < 0.001), small-moderate increases in Bicep femoris architecture (g = 0.60–1.22), with significant (p < 0.001), small-large increases in absolute and relative eccentric peak force (g = 0.60–1.84). Significant and small increases were observed in take-off velocity and mean propulsion force (p < 0.02, g = 0.47–0.64), with non-significant and small increases for both the sprint and control training groups for mean propulsion force (p > 0.05, g = 0.42–0.50). Nordic and sprint training groups had significant and small increases in peak absolute and relative net force (p < 0.001, g = 0.44–0.60). The control group had a non-significant trivial increase in absolute peak net force (p > 0.05, g = 0.22), with a significant and small increase in relative peak relative net force (p = 0.034, g = 0.48). Significant and small decreases for the NHE and sprinting training groups was observed for 0–10 m, 0–20 m, and 10–20 m sprint time (p < 0.010, g = 0.47–0.71). Performing multiple modalities, with either additional NHE or sprinting, as part of a complete resistance training program was superiorly effective for measures of modifiable risk factors HSI, with similar increases observed in measures of athletic performance derived from the standardised lower-limb training program.

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Still poorly adopted in male professional football: but teams that used the Nordic Hamstring Exercise in team training had fewer hamstring injuries – a retrospective survey of 17 teams of the UEFA Elite Club Injury Study during the 2020–2021 season

Cited by 32 publications

References 30 publications

Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men’s professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22

Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men’s professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22

Risk factors for hamstring muscle injury in male elite football: medical expert experience and conclusions from 15 European Champions League clubs

Effect of additional Nordic hamstring exercise or sprint training on the modifiable risk factors of hamstring strain injuries and performance

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