Preventing Hamstring Injuries

This is a brief post predominently about the Nordic Hamstring Exercise, which can be used as part of a preventative programme for hamstring injuries.  It should not be used in isolation and as in all preventative programmes the sport involved, level of participation and physiological/psychosocial requirements must be accounted for.

Hamstring injuries can be a significant problem in sports involving rapid changes in pace/direction, with between 12-16% occurrence in English and Australia professional football (Peterson and Holmich, 2005). Recurrence rates are also high (12-63%), with the first month after return to play (RTP) being the highest risk period (Brukner et al., 2014).

So not only is the rehabilitation of hamstring injuries important, but the prevention of further hamstring injuries at RTP, especially in the first month. To understand how to prevent injury we need to understand the risk factors for that injury. Peterson and Holmich (2005) nicely distinguish between the different risk factors by sub-grouping them in to non-modifiable and modifiable. The main risk factors for hamstring injury are:

Non-Modifiable:

– Age – older individuals are at greater risk.

– Black or aboriginal ethnic origin.

Modifiable:

– Muscular imbalance – low hamstring:quadriceps strength ratio.

– Muscle fatigue.

– Hamstring tightness.

– Insufficient warm-up.

– Previous injury.

In terms of preventing hamstring injuries, eccentric exercises (muscle is working as it is lengthening) have received a lot of attention over the last few years (Mjølsnes et al., 2004; Small et al.; 2009 and Brooks et al., 2006) and more recently the Nordic Hamstring Exercise. Mjølsnes et al. (2004) compared Nordic hamstrings with a concentric leg curl strengthening programme and found that greater gains were achieved with the Nordic hamstrings and also a greater improvement in the hamstrings:quadriceps strength ratio compared to the hamstring curl exercise. Subjects in this group were healthy individuals with either no history of hamstring injury or “fully recovered” from previous injury.

Nordic Hamstring Exercise

The Nordic Hamstring Exercise is performed by anchoring the lower legs and slowly leaning forward from a tall kneeling position. The individual tries to control their lean until they reach a “tipping point” when they use their arms (not face!) to break their fall. See the video below for a demonstration:

Nordic Hamstring Video:

The training protocol used in the Mjølsnes et al. study was over a 10 week period and is reproduced below:

Training protocol for Nordic hamstring exercise

Reproduced from Mjølsnes et al. (2004)

Points To Note

– The subjects in this study had no current injuries.

– The Nordic hamstring exercise is a high effort level exercise to perform.

– It can be great as part of a rehabilitation programme, but should only be used as advised by a suitably experienced and qualified therapist/trainer.

– A suitable warm-up should be performed prior to performing the exercise.

– The Nordic hamstring exercise should be used as part of a comprehensive rehabilitation/preventative programme and not in isolation.

Thanks for reading, get in touch if you have any questions.

Ed

References:

Brooks, J.H.M., Fuller, C.W., Kemp, S.P.T. and Reddin, D.B. (2006) Incidence, Risk, and Prevention of Hamstring Muscle Injuries in Professional Rugby Union. American Journal of Sports Medicine, 34:8, 1297-1306.

Brukner, P., Nealon, A., Morgan, C., Burgess, D. and Dunn, A. (2014) Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme. British journal of Sports Medicine 48:11 929-938.

Mjølsnes, R., Arnason, A., Østhagen, T., Roasted, T. and Baar, R. (2004) A 10-week randomised trial comparing eccentric vs concentric hamstring strength training in well trained soccer players. Scandinavian Journal of Sports Medicine, 14:, 311-317.

Petersen, J. and Holmich, P. (2005) Evidence based prevention of hamstring injuries in sport. British Journal of Sports Medicine, 39:6, 319-323.

Small, K; McNaughton, L; Greig, M and Lovell, R. (2009) Effect of timing of eccentric hamstring strengthening exercises during soccer training: implications for muscle fatiguability. Journal of Strength and Conditioning Research, 23:4, 1077-1083.

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