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Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes
  1. Nicol van Dyk1,
  2. Fearghal P Behan2,
  3. Rod Whiteley3
  1. 1 Aspetar Injury and Illness Prevention Program (ASPREV), Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 Research Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  3. 3 Department of Rehabilitation, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  1. Correspondence to Dr Nicol van Dyk, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; nicol.vanDyk{at}


Research question Does the Nordic hamstring exercise (NHE) prevent hamstring injuries when included as part of an injury prevention intervention?

Design Systematic review and meta-analysis.

Eligibility criteria for selecting studies We considered the population to be any athletes participating in any sporting activity, the intervention to be the NHE, the comparison to be usual training or other prevention programmes, which did not include the NHE, and the outcome to be the incidence or rate of hamstring injuries.

Analysis The effect of including the NHE in injury prevention programmes compared with controls on hamstring injuries was assessed in 15 studies that reported the incidence across different sports and age groups in both women and men.

Data sources MEDLINE via PubMed, CINAHL via Ebsco, and OpenGrey.

Results There is a reduction in the overall injury risk ratio of 0.49 (95% CI 0.32 to 0.74, p=0.0008) in favour of programmes including the NHE. Secondary analyses when pooling the eight randomised control studies demonstrated a small increase in the overall injury risk ratio 0.52 (95% CI 0.32 to 0.85, p=0.0008), still in favour of the NHE. Additionally, when studies with a high risk of bias were removed (n=8), there is an increase of 0.06 in the risk ratio to 0.55 (95% CI 0.34 to 0.89, p=0.006).

Conclusions Programmes that include the NHE reduce hamstring injuries by up to 51%. The NHE essentially halves the rate of hamstring injuries across multiple sports in different athletes.

Trial registration number PROSPERO CRD42018106150.

  • hamstrings
  • injury prevention
  • intervention
  • sports and exercise medicine
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  • Contributors NvD and RW: concept, design and analysis, writing and editing of the manuscript. FPB: analysis, writing and editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Full dataset and/or statistical code are available from the corresponding author.

  • Patient consent for publication Not required.

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