The Current Implementation of an Evidence-Based Hamstring Injury Prevention Exercise (Nordic Hamstring Exercise) among Athletes Globally

Keywords: hamstring muscles, muscle injury, athletes, surveys, questionnaires


Purpose. The Nordic hamstring exercise (NHE) has been shown to be successful in reducing hamstring muscle injury (HMI), which is one of the most common non-contact injuries of the lower limbs. This is especially pertinent in sports that require acceleration, maximal sprints, and sudden changes in the direction of running and sprinting, such as soccer and rugby. This study aimed to evaluate the awareness, implementation, and opinions of athletes worldwide regarding the effectiveness of NHE in preventing hamstring injury.

Materials and methods. A self-administered questionnaire was distributed to 1500 athletes from different sports. The survey consisted of six questions covering country, gender, type of sport, awareness, implementation, and opinions of athletes worldwide regarding the effectiveness of NHE in preventing hamstring injury. The survey was available in ten different languages.

Results. A total of 1142 male and female athletes from different sports participated in the survey. More than half of the athletes 641 (56%) were aware of NHE, and only 519 (45.4 %) were implementing NHE in their current training routines. Athletes who implemented NHE reported a positive opinion regarding the program’s effectiveness with a score of 8.4 ± 1 out of 10.

Conclusions. Many athletes were aware of NHE and implemented it in their training routine since they found it to be effective in decreasing hamstring injury rates. However, additional work must be done to educate athletes about the importance of implementing this exercise and its effectiveness in preventing hamstring injury.


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Author Biography

Wesam Saleh A. Al Attar, Umm Al Qura University; The University of Sydney; University of Basel

Department of Physical Therapy, Faculty of Applied Medical Sciences,
PO Box: 715, Makkah, 21955, Saudi Arabia


Reurink, G., Tol, J. L., & de Vos, R-J. (2014). Acute hamstring injuries in athletes [in Dutch]. Ned Tijdschr Geneeskd, 159, A8152

Ueblacker, P., Müller-Wohlfahrt, H. W., & Ekstrand, J. (2015). Epidemiological and clinical outcome comparison of indirect (“strain”) versus direct (“contusion”) anterior and posterior thigh muscle injuries in male elite football players: UEFA Elite League study of 2287 thigh injuries (2001-2013). Br J Sports Med., 49(22), 1461-1465.

Ekstrand, J., Healy, J. C., Waldén, M., Lee, J. C., English, B., & Hägglund, M. (2012). Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Br J Sports Med., 46(2), 112-117.

De Vos, R. J., Reurink, G., Goudswaard, G. J., Moen, M. H., Weir, A., & Tol, J. L. (2014). Clinical findings just after return to play predict hamstring re-injury, but baseline MRI findings do not. Br J Sports Med., 48(18), 1377-1384.

Chumanov, E. S., Heiderscheit, B. C., & Thelen, D. G. (2011). Hamstring musculotendon dynamics during stance and swing phases of high-speed running. Med Sci Sports Exerc., 43(3), 525–532.

Ropiak, C. R., & Bosco, J. A. (2012). Hamstring injuries. Bull NYU Hosp Jt Dis, 70(1), 41-48.

Hägglund, M., Waldén, M., Bengtsson, H., & Ekstrand, J. (2018) Re-injuries in Professional Football: The UEFA Elite Club Injury Study. In: Musahl V., Karlsson J., Krutsch W., Mandelbaum B., Espregueira-Mendes J., d’Hooghe P. (eds) Return to Play in Football. Springer, Berlin, Heidelberg.

Dadebo, B., White, J., & George, K. P. (2004). A survey of flexibility training protocols and hamstring strains in professional football clubs in England. Br J Sports Med., 38(4), 388-394.

Yeung, S. S., Suen, A. M. Y., & Yeung, E. W. (2009). A prospective cohort study of hamstring injuries in competitive sprinters: preseason muscle imbalance as a possible risk factor. Br J Sports Med., 43(8), 589-594.

Ekstrand, J., Waldén, M., & Hägglund, M. (2016). Hamstring injuries have increased by 4% annually in men’s professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med., 50(12), 731-737.

Delahunt, E., McGroarty, M., De Vito G., & Ditroilo M. (2016). Nordic hamstring exercise training alters knee joint kinematics and hamstring activation patterns in young men. Eur J Appl Physiol., 116(4), 663-672.

Seymore, K. D., Domire, Z. J., DeVita, P., Rider, P. M., & Kulas, A. S. (2017). The effect of Nordic hamstring strength training on muscle architecture, stiffness, and strength. Eur J Appl Physiol., 117(5), 943-953.

Alonso‐Fernandez, D., Docampo‐Blanco, P., & Martinez‐Fernandez, J. (2018) Changes in muscle architecture of biceps femoris induced by eccentric strength training with Nordic hamstring exercise. Scand J Med Sci Sports., 28(1), 88-94.

Lovell, R., Knox, M., Weston, M., Siegler, J. C., Brennan, S., & Marshall, P. W. M. (2018). Hamstring injury prevention in soccer: before or after training? Scand J Med Sci Sports., 28(2), 658-666.

Brughelli, M., Mendiguchia, J., Nosaka, K., Idoate, F., Arcos, A. L., & Cronin J. (2010). Effects of eccentric exercise on optimum length of the knee flexors and extensors during the preseason in professional soccer players. Phys Ther Sport., 11(2), 50-55.

Aktuğ, Z. B., Yılmaz, A. K., İbiş, S., Aka, H., Akarçeşme, C., & Sökmen, T. (2018). The effect of 8-week Nordic hamstring exercise on hamstring quadriceps ratio and hamstring muscle strength. World J Educ., 8(3), 162-169.

Rey, E., Paz-Domínguez, Á., Porcel-Almendral, D., Paredes-Hernández, V., Barcala-Furelos, R., & Abelairas-Gómez, C. (2017). Effects of a 10-week Nordic hamstring exercise and Russian belt training on posterior lower-limb muscle strength in elite junior soccer players. J Strength Cond Res., 31(5), 1198-1205.

Ribeiro-Alvares, J. B., Marques, V. B., Vaz, M. A, & Baroni, B. M. (2018). Four weeks of Nordic hamstring exercise reduce muscle injury risk factors in young adults. J Strength Cond Res., 32(5), 1254-1262.

Al Attar, W. S. A., Soomro, N., Sinclair, P. J., Pappas, E., & Sanders, R. H. (2017). Effect of injury prevention programs that include the Nordic hamstring exercise on hamstring injury rates in soccer players: a systematic review and meta-analysis. Sports Med., 47(5), 907-916.

Van der Horst, N., Smits, D. W., Petersen, J., Goedhart, E. A., & Backx, F. J. (2015). The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players: a randomized controlled trial. Am J Sports Med., 43(6), 1316-1323.

Dunlop, G., Ardern, C. L., Andersen, T. E., Lewin, C., Dupont, G., & Ashworth, B. et al. (2020). Return-to-play practices following hamstring injury: a worldwide survey of 131 premier league football teams. Sports Med., 50(4), 829-840.

Al Attar, W. S. A., & Alshehri, M. A. (2019). A meta‐analysis of meta‐analyses of the effectiveness of FIFA injury prevention programs in soccer. Scand J Med Sci Sports., 29(12), 1846-1855.

Bahr, R., Thorborg, K., & Ekstrand, J. (2015). Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey. Br J Sports Med., 49(22), 1466-1471.

Potier, T. G., Alexander, C. M., & Seynnes, O. R. (2009). Effects of eccentric strength training on biceps femoris muscle architecture and knee joint range of movement. Eur J Appl Physiol., 105(6), 939-944.

Van der Horst, N. (2018). Preventing hamstring injuries in football through enhanced exercise and RTP strategies. Br J Sports Med., 52(10), 684-685.

Ekstrand, J., Gillquist, J. (1982). The frequency of muscle tightness and injuries in soccer players. Am J Sports Med., 10(2), 75-78.

Al Attar, W. S. A, Soomro, N., Pappas, E., Sinclair, P. J., & Sanders, R. H. (2016). How effective are F-MARC injury prevention programs for soccer players? A systematic review and meta-analysis. Sports Med., 46(2), 205-217.

Al Attar, W. S. A., Soomro, N., Sinclair, P. J., Pappas, E., Muaidi, Q. I., & Sanders, R. H. (2018). Implementation of an evidence-based injury prevention program in professional and semi-professional soccer. Int J Sports Sci Coaching, 13(1), 113-121.

Al Attar, W. S. A., Komir, R., Alzubeadi, A., Bukhari, I., & Ghulam, H. (2021). Limited implementation of the Nordic hamstring exercise in professional and semi-professional soccer. Journal of Orthopaedics, Trauma and Rehabilitation, 28, 1-7.
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Al Attar, W. S. A. (2021). The Current Implementation of an Evidence-Based Hamstring Injury Prevention Exercise (Nordic Hamstring Exercise) among Athletes Globally. Teorìâ Ta Metodika Fìzičnogo Vihovannâ, 21(3), 273-280.
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