Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes
Across 15 studies in 8459 athletes of different sports, ages and both sexes, injury prevention programmes that included the Nordic hamstring exercise (NHE) had about half the hamstring injury risk of usual training or programmes without it (risk ratio 0.49). The result held when only the eight randomised studies were pooled (0.52) and when studies at high risk of bias were removed (0.55).
Participants
n=8459 athletes in 15 studies that reported how often hamstring injuries occurred, spanning a range of sports and age groups and including both women and men.
Protocol
Research question: does the NHE prevent hamstring injuries when included in an injury prevention intervention?
Population: athletes in any sporting activity. Intervention: the NHE. Comparison: usual training or other prevention programmes without the NHE. Outcome: incidence or rate of hamstring injuries.
Sources: MEDLINE via PubMed, CINAHL via Ebsco, OpenGrey. Registered on PROSPERO (CRD42018106150).
Key Results
| Analysis | Injury risk ratio (NHE vs control) | 95% CI | p |
|---|---|---|---|
| All studies | 0.49 | 0.32 to 0.74 | 0.0008 |
| Eight randomised control studies | 0.52 | 0.32 to 0.85 | 0.0008 |
| High-risk-of-bias studies removed (n=8 as given in the abstract) | 0.55 | 0.34 to 0.89 | 0.006 |
Authors' conclusion: programmes containing the NHE cut hamstring injuries by up to 51%; in effect, the NHE halves hamstring injury rates across multiple sports.
The abstract reports the same p = 0.0008 for the overall and the randomised-only analyses.
Practical Application
"Does the Nordic hamstring exercise actually prevent hamstring injuries?" — yes: in a meta-analysis of 15 studies (8459 athletes, women and men, several sports and ages), prevention programmes that included the NHE had about half the hamstring injury rate of those without it (risk ratio 0.49, 95% CI 0.32 to 0.74), and the effect held in the randomised trials alone (0.52) and without the high-risk-of-bias studies (0.55).
For anyone whose training includes maximal sprinting (track sprint blocks, strides, team sport), put the NHE into the regular prevention routine rather than treating it as optional.
The abstract gives no sets, reps, weekly frequency or programme length; take the dose from the individual trials or a clinician, not from this entry.
Inference, not tested here: the NHE is a hard eccentric exercise and hamstrings can stay stiff for days after heavy hamstring work (REF-322, a different exercise), so place it away from the key sprint session of the week.
Limitations
The effect is of programmes that include the NHE, compared with usual training or programmes without it; the NHE's own share of the effect cannot be separated in every study.
No dose, compliance or sport-specific breakdown in the abstract.
The "n=8" in the risk-of-bias analysis is ambiguous in the abstract (studies removed or studies remaining).
Written from the abstract and record metadata only (full text not read).
How this entry was checked and changed
Why this level
meta-analysis of 15 controlled studies (8 randomised), n=8459; the effect held in the randomised and low-risk-of-bias subsets