Nordic hamstring exercise halves hamstring injury

Physiotherapy journal editor Michele Harms and Caroline White report on latest physio research

Physio findings: Nordic hamstring exercises halves hamstring injury (photo: Alamy)

Including the Nordic hamstring exercise in training programmes halves the hamstring injury rate, irrespective of sport, gender, age, or competition level, finds a pooled analysis of the available data.

The evidence for using this exercise to ward off injury is now compelling, conclude the researchers, even if it still isn’t clear exactly how it works. 

They base their findings on data from 15 international studies, two of which included only women, which compared the Nordic hamstring exercise with other types of strength or warm up exercises on injury rate. 

The studies involved 8,459 athletes aged 18 to 40, at all levels of competition in a range of ball sports.

Pooled analysis of the data showed that overall injury risk fell by 51 per cent in those training programmes incorporating the Nordic hamstring exercise.

Despite the evidence stacking up in favour of its use to prevent the most common muscle injury across a wide range of sports, the Nordic hamstring exercise is still not a regular feature of injury prevention programmes, note the researchers.

It’s still not clear exactly how it exerts its protective effects. It may ‘increase fascicle length, leading to morphological changes that may protect the hamstring muscle from injury,’ or it may simply boost eccentric strength, which may in turn curb injury risk, say the researchers.

But what is clear, is that it works, and has repeatedly been shown to do so. 

‘Perhaps a key component to ensuring greater success in our implementation efforts is understanding the context in which the intervention is being introduced,’ they write. ‘This would require the involvement of key stakeholders in the process of injury prevention, including the medical team, the coach and the player.’ 

Van Dyk N et al. Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8,459 athletes. British Journal of Sports Medicine 2019 

Physiotherapy Journal March 2019

Physiotherapy journal editor Michele Harms highlights some ‘in press’ papers and as a CSP member you can access the journal free.

Erectile dysfunction and premature ejaculation 

From Australia comes this systematic review in a little researched area in physiotherapy. The authors discuss the likelihood that these problems are linked to an underlying musculoskeletal abnormality but acknowledge psychological and cardiovascular risk factors. They find evidence to suggest that the incidence of ED and PE in the general male population could be as high as 52 per cent and 30 per cent respectively. They challenge the current focus on pharmaceutical prescription and instead investigate the efficacy of pelvic floor muscle training in these conditions. In this systematic review, they found little standardisation or consistency in approach in the included studies, when therapist contact, concurrent interventions, intervention length, training frequency and intensity were considered. Of the ten trials that were included in the review, all trials showed comparative improvement and cure rates in response to treatment in ED; and the majority showed comparative improvement rates, with a greater range in overall cure rates in response to treatment in PE. As is often the case, the authors flag lack of heterogeneity and limitations in the methodological quality of available studies. They do however conclude that there is some evidence that pelvic floor muscle training is effective in managing ED and PE, but no optimal training protocol has been identified. Pelvic floor muscle training improves erectile dysfunction and premature ejaculation: a systematic review Myers C, Smith M. Download the PDF and full text.  

Group exercise and stroke

A systematic review undertaken by researchers at the University of Sheffield examined the efficacy of group exercise when conducted following post-stroke rehabilitation. They argue that group exercise has the potential to continue the improvement in cardiovascular fitness, activity levels, balance, gait, movement efficiency, and strengthening. Their review focused on activity and participation in stroke survivors. They were able to include 14 RCTs with a total of 624 chronic stroke survivors. Participants were on average 67 years old, 32 with left and 39 with right hemisphere lesions. The authors found that although intervention and control groups showed signs of improvement, there were no significant differences between groups. They also comment that most improvements were short term, with little improvement after six months.
The effectiveness of group exercise for improving activity and participation in adult stroke survivors: a systematic review Church G, Parker J, Powell L. Mawson S. Download the PDF and full text.

Long-term effects of McKenzie’s 

This paper reports on the long-term follow-up of an RCT conducted to compare the effects of the McKenzie method and motor control exercises on trunk muscle thickness in people with chronic low back pain (LBP) and a directional preference. The study involved 70 adults (58 at one year follow-up) with greater than three-month history of LBP and a directional preference. The two arms of this RCT were 12 treatments of either the McKenzie method or motor control exercises conducted over eight weeks. However, the research group found no significant between group differences for changes in trunk muscle thickness (transversus abdominis, obliquus internus, and obliquus externus measured from ultrasound images); or for function, perceived recovery, and pain. A randomized clinical trial comparing the McKenzie method and motor control exercises in people with chronic low back pain and a directional preference: 1-year follow-up Halliday MH, Pappas E, Hancock MJ, Clare HA, Pinto RZ, Robertons G, Ferreira PH. Download the PDF and full text.

Comments and conclusions

  • It’s not how old you are, but how old you feel, suggests a study of 126,356 patients whose exercise stress test performance was used to calculate a formula (A-BEST) of physiological age. Within eight years, 9,929 (eight per cent) had died. A-BEST, which was based on exercise capacity, the heart’s response to exercise and its recovery time, was a better predictor of survival than chronological age, even after adjustment. European Journal of Preventive Cardiology 2019 
  • An analysis of 230,732 women shows that those who gave up smoking 30 or more years earlier had a 37 per cent lower risk of developing the more severe form of rheumatoid arthritis (seropositive) than women who had only recently quit. Arthritis Care & Research 2019 
  • A study of 1,104 physically active firefighters found that those who managed more than 40 push-ups during a timed test were 96 per cent less likely to have cardiovascular health issues over the next decade than those who could do no more than 10. JAMA Network Open 2019 


Number of subscribers: 1

Log in to comment and read comments that have been added