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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. 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