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Nordic Hamstring Exercises as a Preventative Measure in Soccer
By: Jennifer Cuchna, MBA, MEd., LAT, ATC
Hamstring muscle injuries are one of the most prevalent injuries in soccer, accounting for 12-37%
of all soccer muscle injuries. The incidence rate has been reported to vary from 20.4 to 36.9 for
every 1000 match hours participated. The consensus statement for injury definition by the
Federation Internationale de Football Association (FIFA) defines a hamstring injury as any physical
complaint affecting the posterior aspect of the upper thigh sustained during a soccer match or
training, irrespective of the need for medical attention or time loss from soccer activities.
Hamstring injuries can produce significant time lost from practice and competition and often
present with lingering symptoms upon return to sport. Despite the high prevalence of hamstring
injuries, and the cascading consequences of the injury, controversy exists as to the underlying
factors that predispose one to injury. Intrinsic factors such as lack of proper warm-up, age, previous
injury history, poor hamstring flexibility and muscle strength deficiencies and imbalances have
been proposed as possible risk factors for initial hamstring injury as well as subsequent re-injury.
With strength deficiencies and imbalances being recognized as a modifiable risk factor, several
studies have proposed the use of strength training specific to the hamstring muscle group as a
preventative measure to reduce the incidence of such injuries in sport. Nordic hamstring (NH)
exercises, in particular, utilize eccentric hamstring contraction and have been proposed as a means
to decrease overall hamstring injury rates. The NH exercise is a partner exercise in which the
participant starts in a kneeling position with a partner securely holding his feet and lower legs to
the ground. The participant slowly lowers his upper body toward the ground, while resisting the
fall using his hamstring muscles. Once the chest reaches the ground the individual utilizes a chest
press maneuver to return the body back to the upright position.
As a clinician and consumer of
healthcare, you may want to
know the evidence supporting
the use of NH exercises for
reducing hamstring injury.
Several studies have found a
significantly lower incidence of
hamstring injuries in
experimental groups (those
performing NH exercises)
compared to control group (those
continuing with normal practices
and warm-ups). The findings
from these studies indicate
moderate evidence to support the
use of NH exercises in reducing
hamstring injury in competitive
male soccer players. Differences
exist in the specifications of each program’s administration, which relate to the timing of inclusion
of the NH exercises in each training session. All evidence supports the implementation of the NH
exercises following some period of normalized activity in hopes of decreasing the effects that can be
experienced with eccentric loading. Even though program progression and length varied, all studies
noted a significant reduction in hamstring injury incidence rates in the intervention groups. These
findings further support the concept that the inclusion of progressive NH exercises at some point
throughout the season and at any time during the training session decrease hamstring injury
incidence rates, but that the exact specifications of the program may vary.
All of the studies utilized only the NH exercise previously described. The simplicity and ease of this
single NH exercise ensures it can easily be incorporated into an existing warm-up, or at the
beginning of a cool-down routine, in an effort to prevent the incidence of hamstring injuries
throughout a competitive season. Due to the relative ease and simplicity of the exercise,
compliance, when reported, was high suggesting that inclusion of such an exercise in a prevention
program would be feasible. However, factors reported to affect compliance with the
implementation of this intervention included the desire of coaching staff to participate, the
potential for delayed-onset muscle soreness (DOMs) within the beginning of the implementation,
and the individual desire of players to complete the exercises. With only a short time period for
DOMs to occur combined with the relative ease of including a single exercise within the warm-up or
training session, the issues related to compliance are considered minimal when compared to the
outcome of reduced hamstring injury incidence over the course of a season.
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