Impact of the Nordic hamstring and hip extension exercises on hamstring architecture and morphology: implications for injury prevention

Changes in rectus femoris architecture induced by the reverse nordic hamstring exercises

BACKGROUND

Injuries and mechanical stimuli alter the muscle architecture and, therefore, its function. The changes in the architecture of the rectus femoris (RF) induced by an eccentric training protocol with reverse nordic hamstring exercises (RNHE) have never been studied. Therefore, the aim of the present study was to determine the architectural adaptations of the RF after an eccentric training with RNHE, followed by a subsequent detraining period.

METHODS

Twenty-six subjects performed a first week of control, 8 weeks of eccentric training, concluding with a 4-week period of detraining. The architectural characteristics of the RF were evaluated using 2D ultrasound at rest (pretest: week 1), after the training (post-test: week 9), and at the end of the detraining period (retest: week 13).

RESULTS

At the end of the training period, a significant increase in the muscle fascicle length (FL) (t=-8.96, d=2.22, P<0.001), muscle thickness (MT) (t=-8.76, d=2.219, P<0.001), pennation angle (PA) (t=-9.83, d=2.49, P<0.05) and cross-sectional area (CSA) (t=-13.06, d=3.06, P<0.001) was observed. After the detraining period FL, MT, PA and CSA showed a significant decrease.

CONCLUSIONS

The eccentric training with RNHE may cause changes in the architectural conditions of RF, which, in addition, are also reversible after a 4-week detraining period. The adaptations produced by RNHE may have practical implications for injury prevention and rehabilitation programs, which include the changes in muscle architecture variables.

Four Weeks of Nordic Hamstring Exercise Reduce Muscle Injury Risk Factors in Young Adults

Ribeiro-Alvares, JB, Marques, VB, Vaz, MA, and Baroni, BM. Four weeks of Nordic hamstring exercise reduce muscle injury risk factors in young adults. J Strength Cond Res 32(5): 1254-1262, 2018-The Nordic hamstring exercise (NHE) is a field-based exercise designed for knee-flexor eccentric strengthening, aimed at prevention of muscle strains. However, possible effects of NHE programs on other hamstring injury risk factors remain unclear. The purpose of this study was to investigate the effects of a NHE training program on multiple hamstring injury risk factors. Twenty physically active young adults were allocated into 2 equal-sized groups: control group (CG) and training group (TG). The TG was engaged in a 4-week NHE program, twice a week, 3 sets of 6-10 repetitions; while CG received no exercise intervention. The knee flexor and extensor strength were assessed through isokinetic dynamometry, the biceps femoris long head muscle architecture through ultrasound images, and the hamstring flexibility through sit-and-reach test. The results showed that CG subjects had no significant change in any outcome. TG presented higher percent changes than CG for hamstring isometric peak torque (9%; effect size [ES] = 0.27), eccentric peak torque (13%; ES = 0.60), eccentric work (18%; ES = 0.86), and functional hamstring-to-quadriceps torque ratio (13%; ES = 0.80). The NHE program led also to increased fascicle length (22%; ES = 2.77) and reduced pennation angle (-17%; ES = 1.27) in biceps femoris long head of the TG, without significant changes on muscle thickness. In conclusion, a short-term NHE training program (4 weeks; 8 training sessions) counteracts multiple hamstring injury risk factors in physically active young adults.

Jumping Performance is Preserved but Not Muscle Thickness in Collegiate Volleyball Players After a Taper

Bazyler, CD, Mizuguchi, S, Sole, CJ, Suchomel, TJ, Sato, K, Kavanaugh, AA, DeWeese, BH, and Stone, MH. Jumping performance is preserved but not muscle thickness in collegiate volleyball players after a taper. J Strength Cond Res 32(4): 1020-1028, 2018-The purpose of this study was to examine changes in muscle architecture and jumping performance in NCAA division I women's volleyball players throughout a competitive season and in preparation for conference championships. Ten women volleyball players were tested at preseason (T1), pretaper (T2), and post-taper (T3) on measures of vastus lateralis muscle thickness (MT), pennation angle (PA) and fascicle length (FL) using ultrasonography, and unloaded and loaded squat jump height (SJH) and peak power allometrically scaled to body mass (SJPPa) on a force platform. Rating of perceived exertion training load and strength training volume load were monitored weekly. Player's MT (p < 0.001, Glass's Δ = 2.8) and PA increased (p = 0.02, Δ = 3.9) after in-season training. However, MT decreased after the taper (p = 0.01, Δ = 0.6) but remained elevated above preseason values (p < 0.001, Δ = 1.7). There were no statistical changes in FL, SJH, or SJPPa. Large-to-very large negative relationships (r = -0.51 to -0.81) were observed between preseason relative maximal strength and changes in SJH and SJPPa with various loads over the season. These findings demonstrate that relatively low volumes of strength training and concurrent sport training during a tapering period are capable of preserving jumping performance, but not MT in women's volleyball players; however, jumping performance changes seem to be related to the player's strength level. Stronger players may benefit from an overreaching microcycle before the taper to preserve previously accrued muscular adaptations and jumping performance.

Effects of preconditioning hamstring resistance exercises on repeated sprinting-induced muscle damage in female soccer players

To examine whether adding preconditioning hamstring resistance exercises to a regular warm-up prior to a repeated sprinting exercise provides protection against the sprinting-induced muscle damage. Ten female soccer players (mean ± SD age: 21.3 ± 4.5yrs; height: 171.34 ± 8.29 cm; weight: 68.53 ± 11.27 kg) participated in this study. After the familiarization visit, the subjects completed three separate randomly sequenced experimental visits, during which three different warm-up interventions were performed before the muscle-damaging protocol (12 sets of 30-m maximal repeated sprints): 1. Regular running and static stretching (Control); 2. Control with hyperextensions (HE); 3. Control with single leg Romanian deadlift (SLRD). Before (Pre), immediately (Post0), 24 hours (24hr), and 48 hours after (48hr) the sprints, hamstring muscle thickness, muscle stiffness, knee flexion eccentric peak torque, knee extension concentric peak torque, and functional hamstring to quadriceps ratios were measured. Repeated sprints have induced muscle damage (e.g., an average of 42% knee flexion eccentric strength reduction) in all three conditions. After the SLRD, hamstring muscle thickness decreased from 24hr to 48hr (p < 0.001). Additionally, muscle stiffness and eccentric strength for the SLRD showed no difference from baseline at 24hr and 48hr, respectively. When compared with the SLRD at 48hr, the muscle stiffness and the eccentric strength were greater and lower, respectively, in other protocols. The SLRD protocol had protective effect on sprinting-induced muscle damage markers than other protocols. Athletes whose competitions/training are densely scheduled may take advantage of this strategy to facilitate muscle recovery.

Hamstring Muscle Use in Women During Hip Extension and the Nordic Hamstring Exercise: A Functional Magnetic Resonance Imaging Study

Background Understanding hamstring muscle activation patterns in resistance training exercises may have implications for the design of strength training and injury prevention programs. Unfortunately, surface electromyography studies have reported conflicting results regarding hamstring muscle activation patterns in women. Objectives To determine the spatial patterns of hamstring muscle activity during the 45° hip extension and Nordic hamstring exercises in women using functional magnetic resonance imaging (fMRI). Methods This was a cross-sectional study in which 6 recreationally active women with no history of lower-limb injury underwent fMRI on both thighs before and immediately after 5 sets of 6 bilateral eccentric contractions of the 45° hip extension exercise or the Nordic exercise. Using fMRI, the transverse (T2) relaxation times were measured from pre-exercise and postexercise scans, and the percentage increase in T2 was used as an index of muscle activation. Results The fMRI revealed a significantly higher biceps femoris long head-to-semitendinosus ratio during the 45° hip extension exercise than in the Nordic exercise (P = .028). The T2 increase after the 45° hip extension exercise was greater for the biceps femoris long head (P<.001), semitendinosus, and semimembranosus (P≤.001) than that for the biceps femoris short head. During the Nordic exercise, the T2 increase of the semitendinosus was greater than that of the biceps femoris short head (P<.001) and biceps femoris long head (P = .001). Conclusion While both exercises involve high levels of semitendinosus activation in women, the Nordic exercise preferentially recruits that muscle, while the hip extension exercise more evenly activates all the biarticular hamstrings. J Orthop Sports Phys Ther 2018;48(8):607-612. Epub 23 Apr 2018. doi:10.2519/jospt.2018.7748.

Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis

BACKGROUND

Change of direction and kicking have been described as the main actions resulting in adductor longus injury. Video descriptions of inciting events are lacking.

OBJECTIVE

Perform a standardised visual video analysis of a series of acute adductor longus injuries in football.

STUDY DESIGN

Cross-sectional.

METHODS

Video footage was reviewed by players, and assessed independently by five sports medicine professionals. Inciting events were described and categorised using standardised scoring, including playing situation, player/opponent behaviour, movement and body positions.

RESULTS

Videos of acute adductor longus injuries in 17 professional male football players were analysed. Most injuries occurred in non-contact situations (71%), following a quick reaction to a change in play (53%). Injury actions were: change of direction (35%), kicking (29%), reaching (24%) and jumping (12%). Change of direction and reaching injuries were categorised as closed chain movements (59%), characterised by hip extension and abduction with external rotation. Kicking and jumping injuries were categorised as open chain (41%), characterised by a change from hip extension to hip flexion, and hip abduction to adduction, with external rotation.

CONCLUSION

Acute adductor longus injuries in football occur in a variety of situations. Player actions can be categorised into closed (change of direction and reaching) and open (kicking and jumping) chain movements involving triplanar hip motion. A rapid muscle activation during a rapid muscle lengthening appears to be the fundamental injury mechanism for acute adductor longus injuries.

Interseason variability in isokinetic strength and poor correlation with Nordic hamstring eccentric strength in football players

In elite sport, the use of strength testing to establish muscle function and performance is common. Traditionally, isokinetic strength tests have been used, measuring torque during concentric and eccentric muscle action. A device that measures eccentric hamstring muscle strength while performing the Nordic hamstring exercise is now also frequently used. The study aimed to investigate the variability of isokinetic muscle strength over time, for example, between seasons, and the relationship between isokinetic testing and the new Nordic hamstring exercise device. All teams (n = 18) eligible to compete in the premier football league in Qatar underwent a comprehensive strength assessment during their periodic health evaluation at Aspetar Orthopaedic and Sports Medicine Hospital in Qatar. Isokinetic strength was investigated for measurement error, and correlated to Nordic hamstring exercise strength. Of the 529 players included, 288 players had repeated tests with 1/2 seasons between test occasions. Variability (measurement error) between test occasions was substantial, as demonstrated by the measurement error (approximately 25 Nm, 15%), whether separated by 1 or 2 seasons. Considering hamstring injuries, the same pattern was observed among injured (n = 60) and uninjured (n = 228) players. A poor correlation (r = .35) was observed between peak isokinetic hamstring eccentric torque and Nordic hamstring exercise peak force. The strength imbalance between limbs calculated for both test modes was not correlated (r = .037). There is substantial intraindividual variability in all isokinetic test measures, whether separated by 1 or 2 seasons, irrespective of injury. Also, eccentric hamstring strength and limb-to-limb imbalance were poorly correlated between the isokinetic and Nordic hamstring exercise tests.

The effect of Nordic hamstring exercise training volume on biceps femoris long head architectural adaptation

The aim of this study was to determine the time course of architectural adaptations in the biceps femoris long head (BF_LH ) following high or low volume eccentric training. Twenty recreationally active males completed a two week standardized period of eccentric Nordic hamstring exercise (NHE) training, followed by four weeks of high (n = 10) or low volume (n = 10) training. Eccentric strength was assessed pre- and post intervention and following detraining. Architecture was assessed weekly during training and after two and four weeks of detraining. After six weeks of training, BF_LH fascicles increased significantly in the high (23% ± 7%, P < .001, d = 2.87) and low volume (24% ± 4%, P < .001, d = 3.46) groups, but reversed following two weeks of detraining (high volume: -17% ± 5%, P < .001, d = -2.04; low volume: -15% ± 3%, P < .001, d = -2.56) after completing the intervention. Both groups increased eccentric strength after six weeks of training (high volume: 28% ± 20%, P = .009, d = 1.55; low volume: 34% ± 14%, P < .001, d = 2.09) and saw no change in strength following a four week period of detraining (high volume: -7% ± 7%, P = .97, d = -0.31; low volume: -2% ± 5%, P = .99, d = -0.20). Both low and high volume NHE training stimulate increases in BF_LH fascicle length and eccentric knee flexor strength. Architectural adaptations reverted to baseline levels within two weeks after ceasing training, but eccentric strength was maintained for at least four weeks. These observations provide novel insight into the effects of training volume and detraining on BF_LH architecture and may provide guidance for the implementation of NHE programs.

Region-dependent hamstrings activity in Nordic hamstring exercise and stiff-leg deadlift defined with high-density electromyography

Recent studies suggest region-specific metabolic activity in hamstring muscles during injury prevention exercises, but the neural representation of this phenomenon is unknown. The aim of this study was to examine whether regional differences are evident in the activity of biceps femoris long head (BFlh) and semitendinosus (ST) muscles during two common injury prevention exercises. Twelve male participants without a history of hamstring injury performed the Nordic hamstring exercise (NHE) and stiff-leg deadlift (SDL) while BFlh and ST activities were recorded with high-density electromyography (HD-EMG). Normalized activity was calculated from the distal, middle, and proximal regions in the eccentric phase of each exercise. In NHE, ST overall activity was substantially higher than in BFlh (d = 1.06 ± 0.45), compared to trivial differences between muscles in SDL (d = 0.19 ± 0.34). Regional differences were found in NHE for both muscles, with different proximal-distal patterns: The distal region showed the lowest activity level in ST (regional differences, d range = 0.55-1.41) but the highest activity level in BFlh (regional differences, d range = 0.38-1.25). In SDL, regional differences were smaller in both muscles (d range = 0.29-0.67 and 0.16-0.63 in ST and BFlh, respectively) than in NHE. The use of HD-EMG in hamstrings revealed heterogeneous hamstrings activity during typical injury prevention exercises. High-density EMG might be useful in future studies to provide a comprehensive overview of hamstring muscle activity in other exercises and high-injury risk tasks.

Effects of the Nordic Hamstring exercise on sprint capacity in male football players: a randomized controlled trial

This assessor-blinded, randomized controlled superiority trial investigated the efficacy of the 10-week Nordic Hamstring exercise (NHE) protocol on sprint performance in football players. Thirty-five amateur male players (age: 17-26 years) were randomized to a do-as-usual control group (CG; n = 17) or to 10-weeks of supervised strength training using the NHE in-season (IG; n = 18). A repeated-sprint test, consisting of 4 × 6 10 m sprints, with 15 s recovery period between sprints and 180 s between sets, was conducted to evaluate total sprint time as the primary outcome. Secondary outcomes were best 10 m sprint time (10mST) and sprint time during the last sprint (L10mST). Additionally, peak eccentric hamstring strength (ECC-P_HS) and eccentric hamstring strength capacity (ECC-CAP_HS) were measured during the NHE. Ten players were lost to follow-up, thus 25 players were analyzed (CG n = 14; IG n = 11). Between-group differences in mean changes were observed in favor of the IG for sprint performance outcomes; TST (-0.649 s, p = 0.056, d = 0.38), 10mST (-0.047 s, p = 0.005, d = 0.64) and L10mST (-0.052 s, p = 0.094, d = 0.59), and for strength outcomes; ECC-P_HS (62.3 N, p = 0.006, d = 0.92), and ECC-CAP_HS (951 N, p = 0.005, d = 0.95). In conclusion, the NHE showed small-to-medium improvements in sprint performance and large increases in peak eccentric hamstring strength and capacity.

TRIAL REGISTRATION NUMBER

NCT02674919.

M. biceps femoris - A wolf in sheep's clothing: The downside of a lower limb injury prevention training

Both, hamstring and ACL injuries are among the most typical injuries, particularly in change of direction and high speed running sports. They're also difficult to treat. Therefore, in the past few years, sports medicine practitioners and exercise scientists have mainly been focusing on the development and implementation of preventive programs in order to reduce the number of lower limb injuries, mainly by improving knee alignment. A number of studies have been able to prove the success of these training interventions, which are mainly addressing sensorimotor abilities and plyometric activities. The number of non-contact hamstring injuries has nevertheless been on the rise, particularly in sports like soccer and football. Therefore, the purpose of the following article is to introduce the hypothesis that the above-mentioned training interventions have a massive influence on the activation patterns on the targeted muscle group, and on the M. biceps femoris in particular. Muscle function and the resulting internal load are directly related to muscle architecture at the insertion. Training induced adaptations in hamstring activation patterns can thus lead to an increased injury susceptibility. In this case, a simulation model that directly relates to an acute deceleration maneuver provides valuable insights into the function of the biceps femoris muscle, especially when the rate of activity and the muscle geometry at the insertion area are taken into consideration. We conclude that there needs to be a greater individualization of prevention programs, especially in regards to anatomical requirements, in order to further reduce injury rates in elite sports. Moreover, it would also seem reasonable to apply a similar approach to aspects of chronic pain such as chronic non-specific low back pain.

Addition of Glute-Ham-Gastroc Raise to a Resistance Training Program: Effect on Jump Propulsion and Landing

Chiu LZF, Yaremko A, and vonGaza GL. Addition of glute-ham-gastroc raise to a resistance training program: effect on jump propulsion and landing. J Strength Cond Res 31(9): 2562-2571, 2017-Exercises such as squats and cleans are commonly used in resistance training programs to enhance athletic performance. However, these exercises may not effectively train the gastrocnemius, an important muscle for energy generation and absorption. The purpose of this research was to examine the effects of adding glute-ham-gastroc raise exercise to target the gastrocnemius to a traditional resistance training program involving squats and cleans. Vertical jump height, weight-bearing ankle dorsiflexion, and jump propulsion and landing mechanics were examined before and after an 8-week training intervention in female youth volleyball players. Approach (with: [INCREMENT] = 2.6 ± 1.7 cm; 90% confidence interval [CI] [1.8-3.6 cm] vs. without: [INCREMENT] = 1.8 ± 1.9 cm; 90% CI [0.8-2.8 cm]) and standing (with: [INCREMENT] = 2.7 ± 1.7 cm; 90% CI [1.7-3.6 cm] vs. without: [INCREMENT] = 1.6 ± 1.5 cm; 90% CI [0.8-2.4 cm]) vertical jump height increased more in the group performing glute-ham-gastroc raise. Weight-bearing ankle dorsiflexion increased when glute-ham-gastroc raise was included (left: [INCREMENT] = 4.1 ± 4.1°; 90% CI [1.9-6.4°] and right: [INCREMENT] = 4.1 ± 3.9°; 90% CI [1.9-6.2°]) but did not appear to change with resistance training only (left: [INCREMENT] = 1.4 ± 4.5°; 90% CI [-1.0 to 3.9°] and right: [INCREMENT] = 2.5 ± 4.4°; [-0.3 to 4.5°]). No discernible differences were observed for changes in jump propulsion and landing mechanics between groups. Glute-ham-gastroc raise may have a beneficial effect with young athletes when added to squat- and clean-based resistance training programs.

Rehabilitation and Prevention of Proximal Hamstring Tendinopathy

Proximal hamstring tendinopathy (PHT) comprises a small but significant portion of hamstring injuries in athletes, especially runners. PHT is a chronic condition that is clinically diagnosed but can be supported with imaging. The main presenting complaint is pain in the lower gluteal or ischial region that may or may not radiate along the hamstrings in the posterior thigh. There is little scientific evidence on which to base the rehabilitation management of PHT. Treatment is almost always conservative, with a focus on activity modification, addressing contributing biomechanical deficiencies, effective tendon loading including eccentric training, and ultrasound-guided interventional procedures which may facilitate rehabilitation. Surgery is limited to recalcitrant cases or those involving concomitant high-grade musculotendinous pathology. The keys to PHT management include early and accurate diagnosis, optimal rehabilitation to allow for a safe return to preinjury activity level, and preventative strategies to reduce risk of reinjury.

The effect of Nordic hamstring strength training on muscle architecture, stiffness, and strength

PURPOSE

Hamstring strain injury is a frequent and serious injury in competitive and recreational sports. While Nordic hamstring (NH) eccentric strength training is an effective hamstring injury-prevention method, the protective mechanism of this exercise is not understood. Strength training increases muscle strength, but also alters muscle architecture and stiffness; all three factors may be associated with reducing muscle injuries. The purpose of this study was to examine the effects of NH eccentric strength training on hamstring muscle architecture, stiffness, and strength.

METHODS

Twenty healthy participants were randomly assigned to an eccentric training group or control group. Control participants performed static stretching, while experimental participants performed static stretching and NH training for 6 weeks. Pre- and post-intervention measurements included: hamstring muscle architecture and stiffness using ultrasound imaging and elastography, and maximal hamstring strength measured on a dynamometer.

RESULTS

The experimental group, but not the control group, increased volume (131.5 vs. 145.2 cm³, p < 0.001) and physiological cross-sectional area (16.1 vs. 18.1 cm², p = 0.032). There were no significant changes to muscle fascicle length, stiffness, or eccentric hamstring strength.

CONCLUSIONS

The NH intervention was an effective training method for muscle hypertrophy, but, contrary to common literature findings for other modes of eccentric training, did not increase fascicle length. The data suggest that the mechanism behind NH eccentric strength training mitigating hamstring injury risk could be increasing volume rather than increasing muscle length. Future research is, therefore, warranted to determine if muscle hypertrophy induced by NH training lowers future hamstring strain injury risk.