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

Four-week Nordic hamstring exercise intervention for individuals with ACL reconstruction via hamstrings tendon autograft: feasibility of a pilot randomized controlled trial

BACKGROUND

The Nordic hamstring exercise (NHE) has been widely used among uninjured, athletic populations to mitigate the risk of hamstring injury, yet little is known about its utility as an intervention for individuals who undergo ACL reconstruction with hamstring tendon autograft (ACLR-HT). Understanding the feasibility of NHE as a means of enhancing hamstring function may aid in the development of evidence-based recommendations to guide hamstring recovery. Our aim was to determine the feasibility of conducting a pilot NHE trial among individuals with ACLR-HT.

METHODS

We used a single-blind randomized controlled trial with parallel arms to investigate individuals 18-35 years with primary, unilateral ACLR-HT. Twenty-three participants were randomized to a standardized, 4-week (10 session) progressive NHE intervention (n = 17) or usual care control (n = 6) group at a 3:1 ratio. Those randomized to the control group were eligible to open-enroll in the intervention group at the completion of the original study period. Primary feasibility outcomes included recruitment uptake, protocol adherence, dose goal attainment, and retention. Exercise perceptions and safety were also assessed. Summary statistics were used to descriptively report all findings.

RESULTS

Two control participants were open-enrolled in the intervention group after completing their original study period (n = 19). All participants (88.5% recruitment uptake) adhered to the exercise protocol (100%) and 18 participants (94.7%) attained the total exercise dosage goal. A 100% retention rate was observed, as all participants (intervention 17 randomized, 2 open-enrolled; control 6) returned for their follow-up assessment.

CONCLUSIONS

A standardized, 4-week progressive NHE protocol is feasible for individuals with ACLR-HT. Positive perceptions of exercise, minimal exercise-related discomfort, and no reported adverse events further support the acceptability of this protocol and the likelihood of successful implementation in future efficacy trials.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05738200. Registered 2 November 2022-retrospectively registered, https://clinicaltrials.gov/study/NCT05738200 .

Eccentric training effects on hamstring muscles in oral contraceptive users and naturally menstruating women

PURPOSE

This study evaluated the effects of eccentric resistance training on hamstring muscles properties in women using oral contraceptives (OC) and naturally menstruating women.

METHODS

Before and after the training intervention, we measured maximal isometric and eccentric moment of the knee flexor muscles, thickness and shear wave velocity (SWV) of the biceps femoris long head (BFlh), semitendinosus (ST) and semimembranosus (SM) muscles, and BFlh fascicle length using ultrasonography and dynamometry.

RESULTS

The 12-week training intervention resulted in a modest but statistically significant increase in resting BFlh fascicle length (~2% on average, p = 0.005) across both groups, with no observed effect of OC use on any variable. The muscle strength and thickness increased comparably in both groups, with an average increase of ~20% in isometric knee flexor moment and 14% in eccentric knee flexor moment (p < 0.001 for both tests). ST muscle thickness increased by ~4% on average (p = 0.016), while no main effect of training was observed for SM and BFlh thickness. The shear modulus of the SM muscle decreased by 9% (p = 0.021) for the combined groups. However, it remained unchanged in the BFlh and ST muscles, and OC use did not influence these measurements either.

CONCLUSION

These findings suggest that eccentric training induces similar adaptations in women regardless of OC use. Furthermore, fascicle lengthening was not attributable to changes in muscle shear modulus under the present conditions.

Less pain, same gain? A randomized controlled trial comparing assisted- versus non-assisted Nordic Hamstring exercise training in elite youth football players

INTRODUCTION

The Nordic Hamstring exercise (NHE) increases hamstring strength, but muscle soreness and excessive fatigue may hinder adoption. The assisted NHE (A-NHE), with an elastic band around the chest lowering the force in the eccentric lowering phase, may be a less demanding alternative. We investigated the effectiveness of A-NHE versus NHE on hamstring strength, muscle soreness, and perceived exertion.

METHODS

We randomized 31 youth elite football players (under-14 and -15) from a single professional football academy to either NHE or A-NHE, who performed the same supervised 8-week program. The A-NHE was performed with an elastic band, progressing from heavy to light assistance. A blinded tester assessed Nordic hamstring strength, while hamstring muscle soreness and perceived exertion were assessed during each session.

RESULTS

Intention-to-treat analysis showed no group by time interaction (p = 0.61) for Nordic hamstring strength. Both groups improved significantly (A-NHE mean difference: 3.7 kg, 95% CI [2.1; 5.3]; NHE mean difference: 3.2 kg, 95% CI [1.2; 5.2]) corresponding to approximately 20%. The NHE group reported significantly higher hamstring muscle soreness (beta = 1.77, p < 0.01) and perceived exertion (beta = 1.54, p < 0.01).

CONCLUSION

Eight weeks of assisted-versus regular Nordic Hamstring training led to similar strength gains, but with lower hamstring muscle soreness and perceived exertion.

A new field-test for assessing the medial and lateral hamstring strength at long-muscle length

This research investigates the influence of tibial rotations with knee flexion (KF) on the electromyographic (EMG) activities of hamstring muscles (HM) groups and the strength ratio between the medial and lateral rotation of the tibia. A cross-sectional design was employed to assess muscle activity, isometric strength and reliability. The research was conducted in a controlled laboratory environment. Thirty-six amateur male athletes were recruited as volunteers. The measures included peak muscle activity of the semitendinosus and biceps femoris long head, the knee flexors' isometric strength ratio and reliability. The isometric strength ratios of medial (MR) to lateral (LR) tibial rotations were 0.94 ± 0.17 at 90°, and 0.93 ± 0.10 at both 60° and 30° of KF angulation. Tibial position significantly influenced knee flexion strength as well as HM activity, irrespective of KF angulation. Specifically, biceps femoris activity increased by 33.6% in LR compared to MR, while semitendinosus activity increased by 22.6% in MR compared to LR. The Knee-Rotation test (KR-test) can be a valuable tool for evaluating both HM groups (ICC >0.87), and identifying the primary target for strengthening purposes during the injury prevention process. It provides insights for effective rehabilitation and training interventions.

The Effect of the Nordic Hamstring Exercise on Hamstring Muscle Activity Distribution During High-Speed Running Estimated Using Multichannel Electromyography: A Pragmatic Randomized Controlled Trial

OBJECTIVE

To evaluate the effect of the Nordic hamstring exercise on normalized muscle activity and relative contribution of the biceps femoris long head, semitendinosus, and semimembranosus through multichannel electromyography in the late-swing phase of high-speed running.

DESIGN

A pragmatic, 2-arm, single-center randomized controlled trial. Participants were randomly assigned to a Nordic group or control group.

SETTING

Dutch male basketball.

PARTICIPANTS

Twenty injury-free players (mean age 18 ± 3 years).

INTERVENTION

A 12-week Nordic hamstring exercise intervention.

MAIN OUTCOME MEASURES

Level of normalized muscle activity (percentage maximal voluntary isometric contraction [%MVIC]) and relative contribution (%con) of hamstring muscles for 12 weeks.

RESULTS

The Nordic hamstring exercise intervention did not result in significant changes for 12 weeks. For normalized muscle activity, between-group differences (compared with the control group) for 12 weeks were 11.4 %MVIC (95% confidence interval [95% CI]: -11.0, 33.8) for the biceps femoris long head, -9.4 %MVIC (95% CI: -23.3, 5.2) for the semitendinosus, and -2.7 %MVIC (95% CI: -15.8, 10.3) for the semimembranosus, P = 0.151. For relative contribution, between-group differences for 12 weeks were -6.1 %con (95% CI: -2.4, 14.6) for the biceps femoris long head, -7.0 %con (95% CI: -13.6, -0.4) for the semitendinosus, and 0.9 %con (95% CI: -9.2, 11.0) for the semimembranosus P = 0.187. Positive values are in favor of the Nordic group.

CONCLUSIONS

A 12-week Nordic hamstring exercise intervention did not affect the level of muscle activity and relative contribution of hamstring muscles in the late-swing phase of high-speed running. Because of the low amount of data sets, results should be interpreted cautiously.

The Structure, Function, and Adaptation of Lower-Limb Aponeuroses: Implications for Myo-Aponeurotic Injury

The aponeurosis is a large fibrous connective tissue structure within and surrounding skeletal muscle and is a critical component of the muscle-tendon unit (MTU). Due to the lack of consensus on terminology and the heterogeneous nature of the aponeurosis between MTUs, there are several questions that remain unanswered. For example, the aponeurosis is often conflated with the free tendon rather than being considered an independent structure. This has subsequent implications when interpreting data regarding the structure, function, and adaptation of the aponeuroses from these studies. In recent years, a body of work has emerged to suggest that acute injury to the myo-aponeurotic complex may have an impact on return-to-sport timeframes and reinjury rates. Therefore, the purpose of this review is to provide a more detailed understanding of the morphology and mechanical behaviour common to all aponeuroses, as well as the unique characteristics of specific lower-limb aponeuroses that are commonly injured. This review provides the practitioner with a current understanding of the mechanical, material, and adaptive properties of lower limb aponeuroses and suggests directions for future research related to the myo-aponeurotic complex.

The Effects of Reverse Nordic Exercise Training on Measures of Physical Fitness in Youth Karate Athletes

Background: In karate, the ability to execute high-velocity movements, particularly kicks and punches, is heavily dependent on the strength and power of the lower limb muscles, especially the knee extensors. As such, this study aimed to evaluate the effects of an 8-week eccentric training program utilizing the reverse Nordic exercise (RNE) integrated into karate training compared with regular karate training only on measures of physical fitness in youth karate athletes. Methods: Twenty-seven youth karatekas were recruited and allocated to either RNE group (n = 13; age = 15.35 ± 1.66 years; 7 males and 6 females) or an active control group ([CG]; n = 14; 7 males and 7 females; age = 15.30 ± 1.06 years). To track the changes in measures of physical fitness before and after training, tests to assess linear sprint speed (i.e., 10 m), change of direction (CoD) speed (i.e., modified 505 CoD), vertical jumping (i.e., countermovement jump [CMJ] height) and horizontal jumping distance (i.e., standing long jump [SLJ]), and lower-limb asymmetry score (i.e., the difference between SLJ-dominant and non-dominant legs) were carried out. Results: The results indicated significant group-by-time interactions in all measures of physical fitness (effect size [ES] = 1.03 to 2.89). Post-hoc analyses revealed significant changes in the RNE group across all performance measures (effect size [ES] = 0.33 to 1.63). Additionally, the asymmetry score exhibited a moderate decrease from pre to posttest (∆46.96%, ES = 0.64). In contrast, no significant changes were observed in the CG across all fitness measures. Moreover, the individual response analysis indicated that more karatekas from the RNE group consistently achieved improvements beyond the smallest worthwhile change threshold across all fitness measures. Conclusions: In summary, RNE training is an effective approach to enhance various physical fitness measures besides lower-limb asymmetry scores in youth karatekas and is easy to incorporate into regular karate training. Practitioners are therefore encouraged to consistently integrate RNE training to enhance essential physical fitness components in young karatekas.

Relationship between individual hip extensor muscle size and sprint running performance: sprint phase dependence

The muscle size of the hip extensors has been suggested to be important in sprint running performance; however, reported findings are partly inconsistent. Here, we hypothesised that the association between hip extensor size and sprint performance may vary by sprint phase (early-acceleration, maximal-velocity and deceleration phases). To test this hypothesis, we measured the volumes of individual hip extensors of 26 male sprinters via magnetic resonance imaging and their sprint velocities for each 10-m interval during a maximal-effort 100-m sprint. Based on the sprint velocities, the maximal-velocity phase was determined for each sprinter. At the individual muscle level, the semimembranosus volume relative to body mass was positively correlated with sprint velocity only in the early-acceleration phase (0-10 m, r = 0.592, corrected p = 0.003). On the other hand, the semitendinosus volume relative to body mass was positively correlated with sprint velocities in the maximal-velocity (r = 0.483, corrected p = 0.020) and deceleration (90-100 m, r = 0.605, corrected p = 0.003) phases. These results show that the association between hip extensor size and sprint performance is not constant but changes through the sprint phases.

Can Eccentric-Only Resistance Training Decrease Passive Muscle Stiffness While Increasing Size and Strength of Hamstrings?

PURPOSE

Resistance training may be empirically believed to increase passive muscle stiffness. Meanwhile, a recent study showed that the passive stiffness of a specific hamstring muscle acutely decreased after eccentric-only resistance exercise at long muscle lengths with a long contraction duration (LL). To extend this finding, the present study investigated the chronic effects of eccentric-only resistance training with LL at different weekly frequencies on the passive stiffness of the biarticular hamstring muscles.

METHODS

Thirty-six healthy young males were assigned into two training groups with two and three weekly sessions (W2 and W3; n = 12, respectively) and a control group (CON; n = 12). The participants in both training groups performed eccentric-only stiff-leg deadlift at 50%-100% of exercise range of motion (0% = upright position) with 5 s per repetition for 10 wk. Before and after the intervention period, the shear moduli of the biarticular hamstring muscles, maximal voluntary isometric torque of knee flexion, and volumes of the individual hamstring muscles were measured.

RESULTS

In W3, the shear modulus of the semimembranosus (-11.4%) significantly decreased, whereas those of the other biarticular muscles did not change. There were no significant changes in the shear moduli of the biarticular hamstring muscles in W2 or CON. The isometric torque (20.3% and 26.2%, respectively) and semimembranosus volume (5.7% and 7.4%, respectively) were significantly increased in W2 and W3.

CONCLUSIONS

Passive stiffness of a specific muscle could be chronically decreased when eccentric-only resistance training with LL is performed at a relatively high weekly frequency with a high total training volume. Our training modality may be a promising strategy for decreasing passive muscle stiffness while increasing muscular strength and size.

Effects of ankle position during the Nordic Hamstring exercise on range of motion, heel contact force and hamstring muscle activation

One of the main benefits of the Nordic Hamstring Exercise (NHE) is that it can be performed without the need of any extra material. However, numerous technical execution variables such as the ankle and pelvis position can influence the performance. The primary aims of this study were to investigate the effects of ankle position (i.e., plantar or dorsal flexion) on Nordic Hamstring Break Point (NHBP), repetition time and heel contact force. A secondary aim was to investigate differences in biceps femoris long head and semitendinosus muscle activation. Male professional field hockey players (n = 12) volunteered for the study. Paired t-tests were used to analyse the effect of ankle position on muscle NHBP, eccentric peak torque and repetition time. Ankle dorsal flexion resulted in a higher NHBP (p = 0.002, effect size [ES] = 1.48 [0.57 to 2.38]), repetition time (p = 0.004, ES = 0.98 [0.24 to 1.72]) and both absolute and relative heel contact force (p = 0.028, ES = 0.67 [0.01 to 1.34], p = 0.017, ES = 0.76 [0.07 to 1.44], respectively) compared to plantar flexion. Muscle activation was not significant different. This study showed a higher NHBP, absolute and relative heel contact force and repetition time with a dorsal flexed ankle vs. a plantar flexed ankle in the NHE, without changes in hamstrings muscle activation.

Strength effects of the Copenhagen adduction exercise vs an adductor squeeze exercise in male football players - A randomized controlled trial

To examine the effect of assigning male football players to an 8-week Copenhagen Adduction (CA) and Adductor Squeeze (SQ) Pragmatic randomized controlled trial, 57 participants (16.7 ± 0.9 years, 175.9 ± 7.3 height and 66 ± 8.4 weight) were individually randomized to an 8-week progressive dynamic training protocol with the CA or an isometric training protocol with the SQ twice per week. Maximal eccentric (EHAD) and isometric (IHAD) hip adductor torque was tested with a handheld dynamometer. Perceived exertion and delayed onset muscle soreness (DOMS) were recorded throughout the intervention period. In the intention-to-treat analysis, no significant between-group difference was observed for EHAD (p = 0.478-0.833) nor IHAD (p = 0.084-0.118). There was a significant difference in DOMS between groups in the third to sixteenth exercise session, with the CA group reporting higher values (median varying between 0-3 vs 0-1, p = 0.000-0.009). Perceived exertion was greater for the CA group only in the fifteenth exercise session of the protocol (median of 4 vs 3, p = 0.031). No other significant differences between the groups were observed for DOMS nor perceived exertion. An 8-week adductor training program with either the Copenhagen Adduction or Adductor Squeeze exercise performed with two sets twice a week and adjusted for total volume did not result in significant differences in eccentric nor isometric adduction torque between the groups.

Muscle Hypertrophy and Strength Adaptations to Systematically Varying Resistance Exercises

We compared the effects of varied and constant resistance exercises on muscular adaptations in young women. Seventy young women (21.8 ± 3.4 yrs, 62.0 ± 12.3 kg, 162.3 ± 5.7 cm) were randomly divided into two groups: constant resistance exercises (CON-RE, n = 38) or varied resistance exercises (VAR-RE, n = 32). The resistance training (RT) was performed thrice a week over 10 weeks. CON-RE performed a 45º leg press and stiff-leg deadlift in every training session, while VAR-RE performed 45º leg press and stiff-leg deadlift in the first training session of the week, hack squat and prone leg curl in the second, and Smith machine squat and seated-leg curl in the third. Both groups performed two sets of 10-15 repetitions maximum per resistance exercise. We measured the muscle thickness of the thigh's anterior, lateral, and posterior aspects by ultrasonography at different muscle sites (proximo-distal). Muscular strength was analyzed from the one-repetition maximum (1RM) tests in the 45° leg press and leg extension (non-trained exercise). The muscle thickness increased similarly in both groups for all muscles and sites (CON-RE: +7.8-17.7% vs. VAR-RE: +7.5-19.3%, p > .05). The 1RM increased similarly in both groups (CON-RE: +24.4-32.1% vs. VAR-RE: +29.0-30.1%, p > .05). Both RT routines resulted in virtually similar muscular strength gains and hypertrophy. Therefore, both strategies should be considered for the improvement of strength and muscle growth.

Hamstrings Hypertrophy Is Specific to the Training Exercise: Nordic Hamstring versus Lengthened State Eccentric Training

INTRODUCTION

The hamstring muscles play a crucial role in sprint running but are also highly susceptible to strain injuries, particularly within the biceps femoris long head (BFlh). This study compared the adaptations in muscle size and strength of the knee flexors, as well as BFlh muscle and aponeurosis size, after two eccentrically focused knee flexion training regimes: Nordic hamstring training (NHT) vs lengthened state eccentric training (LSET, isoinertial weight stack resistance in an accentuated hip-flexed position) vs habitual activity (no training controls: CON).

METHODS

Forty-two healthy young males completed 34 sessions of NHT or LSET over 12 wk or served as CON ( n = 14/group). Magnetic resonance imaging-measured muscle volume of seven individual knee flexors and BFlh aponeurosis area, and maximum knee flexion torque during eccentric, concentric, and isometric contractions were assessed pre- and post-training.

RESULTS

LSET induced greater increases in hamstrings (+18% vs +11%) and BFlh (+19% vs +5%) muscle volumes and BFlh aponeurosis area (+9% vs +3%) than NHT (all P ≤ 0.001), with no changes after CON. There were distinctly different patterns of hypertrophy between the two training regimes, largely due to the functional role of the muscles; LSET was more effective for increasing the size of knee flexors that also extend the hip (2.2-fold vs NHT), whereas NHT increased the size of knee flexors that do not extend the hip (1.9-fold vs LSET; both P ≤ 0.001). Changes in maximum eccentric torque differed only between LSET and CON (+17% vs +4%; P = 0.009), with NHT (+11%) inbetween.

CONCLUSIONS

These results suggest that LSET is superior to NHT in inducing overall hamstrings and BFlh hypertrophy, potentially contributing to better sprint performance improvements and protection against hamstring strain injuries than NHT.

Relationship between Peak Eccentric Force during the Nordic Hamstring Exercise and One Repetition Maximum Deadlift Performance

Background

The Nordic hamstring exercise (NHE) is useful for preventing hamstring strain injuries. However, its adoption rates in the sports field are currently low, necessitating a safe and efficient introduction.

Hypothesis/Purpose

The purpose was to examine the relationship between the eccentric force during the NHE and the one repetition maximum of deadlift. It was hypothesized that the eccentric force during the NHE would be correlated with the one repetition maximum (1RM) of the deadlift.

Study design

Cross-sectional study.

Methods

Healthy student rugby players with no history of hamstring tears were recruited to participate. The peak eccentric forces during the NHE, which is the vertical peak force on the part holding the leg, were measured in both legs, while gradually leaning forward to a prone position over three seconds. The 1RM of deadlift was calculated from the weight that could be raised three times during a deadlift (x kg) using the estimated formula (x kg / 0.93). The correlation between the left and right peak eccentric forces during the NHE, the total left and right forces, and the 1RM of the deadlift was examined using Spearman's rank correlation coefficient, with all values corrected for body mass.

Results

During the NHE, the peak eccentric force of the right and left legs and the total peak eccentric force of both legs were 3.8 ± 1.1 N/BM, 3.8 ± 1.2 N/BM, and 7.6 ± 2.1 N/BM, respectively. The 1RM of deadlift was 1.9 ± 0.3 kg/BM. Weak correlations (r = 0.34-0.37) were found between the 1RM of the deadlift and the peak eccentric force in the right and left legs and the total peak eccentric force of both legs.

Conclusion

The present study revealed a weak correlation between the peak eccentric force during the NHE and 1RM of deadlift.

Level of Evidence

2c.

Comparing activity of the gluteus maximus and hamstring muscles in fatigue conditions between hamstring injury-experienced and inexperienced individuals

INTRODUCTION

Muscle fatigue is considered a risk factor for hamstring injury (HSI), which occurs during high-speed running. To decrease this risk, higher gluteal muscle activity may have a role to play. This study aimed to compare the muscle activities of the gluteus maximus (GMax) and hamstring (HS) muscles between HSI-experienced and inexperienced people in pre- and post-fatigue conditions during the swing and stance phases of running.

METHODS

Participants were asked to run 13 sets of 20 km/h on the treadmill. GMax and HS muscle activities of the (i) injured and (ii) uninjured legs in the HSI-experienced group and (iii) dominant leg (healthy leg) in the inexperienced group were collected using the first run as pre-fatigue data, and the last (13th) run as post-fatigue data.

RESULTS

GMax activity of the injured legs was higher than in the healthy leg during the stance phase in pre-fatigue condition (p < 0.05). The activity of the GMax and semitendinosus were higher in the uninjured legs than in the healthy legs during the swing phase in pre-fatigue condition (p < 0.05). However, no differences in muscle activities between pre- and post-fatigue or the injured and uninjured legs were found.

CONCLUSION

The GMax may prevent HSI recurrence during the stance phase of running. The GMax and semitendinosus of the uninjured leg may act as stabilizers of the body while the injured leg is placed on the ground.

Hamstring Muscle-Tendon Geometric Adaptations to Resistance Training Using the Hip Extension and Nordic Hamstring Exercises

Targeted resistance training stimulates hamstring muscle hypertrophy, but its effect on tendon-aponeurosis geometry is unknown. This study examined changes in hamstring muscle, free tendon, and aponeurosis geometry following a 10 week Nordic or hip extension exercise intervention. Thirty recreationally active males were randomly allocated (n = 10 per group) to a Nordic, hip extension, or control group. Magnetic resonance imaging of both thighs was acquired pre- and post-intervention. Changes in free tendon and aponeurosis volume for each hamstring muscle, biceps femoris long head (BFlh) aponeurosis interface area and muscle volume-to-interface area ratio were compared between groups. Regional changes in muscle CSA were examined via statistical parametric mapping. The change in semimembranosus free tendon volume was greater for the Nordic than control group (mean difference = 0.06 cm3, 95% CI = 0.02-0.11 cm3). No significant between-group differences existed for other hamstring free tendons or aponeuroses. There were no between-group differences in change in BFlh interface area. Change in BFlh muscle volume-to-interface area ratio was greater in the hip extension than Nordic (mean difference = 0.10, 95% CI = 0.007-0.19, p = 0.03) and control (mean difference = 0.12, 95% CI = 0.03-0.22, p = 0.009) groups. Change in muscle CSA following training was greatest in the mid-portion of semitendinosus for both intervention groups, and the mid-portion of BFlh for the hip extension group. There was limited evidence for tendon-aponeurosis hypertrophy after 10 weeks of training with the Nordic or hip extension exercises. For the BFlh, neither intervention altered the interface area although hip extension training stimulated an increase in the muscle volume-to-interface area ratio, which may have implications for localized tissue strains. Alternative muscle-tendon loading strategies appear necessary to stimulate hamstring tendon adaptations.

Relationship Between Force-Velocity Characteristics and Sprint Performance in Elite Sprinters: A Pilot Study

BACKGROUND

Sprinting is a type of running that consists of producing a short and intense effort in order to perform maximal speed in a short period of time. Sprinting is widely investigated because of the multiple and complex mechanisms involved. Sprint studies are now focusing on how to improve performance by focusing their analyses on the mechanic variables. The hamstrings are part of the most important muscle groups during sprinting because of their role of stabilization and propulsion, but they must be able to produce the maximum strength during a short moment, this ability is characterized by rate of torque development (RTD). The main of this study was to investigate the association between hamstring RTD (Nm.s-1.kg-1) and mechanical variables composed of maximal power output (Pmax) (W.kg-1), maximal theoretical velocity (V0) (m.s-1), and maximal horizontal force production (F0) (N.kg-1) on short sprints in elite sprinters.

METHODS

For this clinical trial, we used a research method based on data collection. A single group composed of four male and one female elite sprinters (age: 17.2 ± 1.79 years) has been included in this study. The sprinters performed a hamstring strength test, which included five trials of four seconds for each leg. This test required a portable dynamometer, the Kforce®, to collect 100 and 200 milliseconds RTD. Then the subjects were submitted to a sprint test. My Sprint® application has been used to collect the sprint mechanical variables. The sprint test included two trials; a starting block has been used for this test. A linear regression analysis was used between the rates of torque development and mechanical variables composed of maximal power output (Pmax) (W.kg-1), maximal theoretical velocity (V0) (m. s-1), and maximal horizontal force production (F0) (N.kg-1).

RESULTS

No significant correlation was observed between 100 and 200 ms hamstring RTD and sprint biomechanical variables: maximal power output (Pmax) (W.kg-1), maximal theoretical velocity (V0) (m. s-1), and horizontal force production (F0) (N.kg-1). However, 100 and 200 ms RTD collected on the dominant leg tends to be more correlated with maximal theoretical velocity (spearman's rho = 0.80; p-value = 0.13) and Pmax output (spearman's rho = 0.70; p-value = 0.23) while for non-dominant leg, RTD tends to be more correlated with maximal power output (spearman's rho = 0.60; p-value = 0.35) and horizontal force production (spearman's rho = 0.70; p-value = 0.23).

CONCLUSIONS

Hamstring RTD is not correlated with sprint biomechanical variables in elite sprinters. Further investigations must be made to study the observed trends in this study.

The impact of a 10-week Nordic hamstring exercise programme on hamstring muscle stiffness, a randomised controlled trial using shear wave elastography

Hamstring strain injuries (HSIs) remain a burden with high prevalence rates. The Nordic Hamstring exercise (NHE) has been found to be effective in preventing HSIs. However, the preventive mechanisms are not fully understood. Changes in stiffness are postulated as a possible protective mechanism. Surprisingly, the effect of the NHE on the stiffness of different hamstring muscles has never been investigated before. Therefore, the aim of this Randomised controlled trial was to investigate the impact of a 10-week NHE programme on the eccentric strength and the shear wave velocity (proxy of stiffness) of the hamstrings. Thirty-six soccer players were randomly assigned to either the control or the experimental group. The experimental protocol consisted of the incorporation of a 10-week NHE programme within the normal training routine. The hamstring stiffness and eccentric strength were assessed before and after. Within-group analyses showed a significant increase in strength, only for the experimental group. However, no significant effect of the NHE was found on the stiffness of each hamstring muscle. A 10-week NHE programme does not affect hamstring stiffness, despite an increase in eccentric strength, indicating that the preventive mechanism of the NHE is probably not (co-)explained by alterations in hamstring muscle stiffness.

The Effects of Nordic Hamstring Exercise on Performance and Injury in the Lower Extremities: An Umbrella Review

Due to their potential positive outcomes, hamstring eccentric exercises are becoming increasingly popular in training regimens. Among the various exercises, the Nordic Hamstring Exercise (NHE) is the most common. Despite its popularity, there are still some doubts about its benefits and risks. So, the aim of this umbrella review was to summarize the effects of NHE on performance and injury prevention. Following the PRISMA guidelines, a comprehensive literature search was conducted across multiple e-databases, according to the P (injured and non-injured athletes or recreationally active or healthy individuals) I (NHE) C (no intervention, placebo, or other interventions) O (performance or injury) S (systematic reviews) model. The quality of the studies was accessed with the AMSTAR-2. From the 916 systematic reviews found, only 10 could be included. They encompassed 125 studies, enrolling 17,260 subjects. The results from the studies indicate that NHE interventions demonstrated positive effects on sprint performance, muscle activation, eccentric strength, and muscle architecture (fascicle length, muscle thickness, and pennation angle). Furthermore, NHE is effective in preventing hamstring injuries (up to 51%). In conclusion, NHE should be integrated in training (especially, in the warm-up phase) for both enhancing athletic performance and preventing hamstring injuries. For achieving more positive results, it is recommended that high-volume is followed by low-volume maintenance, targeting 48 reps/week.

Semitendinosus and biceps femoris long head activity during the single leg bridge test in healthy individuals

INTRODUCTION

The single leg bridge test (SLBT) has been suggested as a clinical test to examine function, screen injury risk, and monitor the effectiveness of rehabilitation programes targeting the hamstring. This study aimed to determine the inter-day reliability and repeatability of both SLBT performance, semitendinosus (ST), and biceps femoris long head (BFlh) surface electromyography (sEMG) responses and characterise the BFlh and ST electrical activity during the SLBT performed until exhaustion in healthy individuals.

METHODS

Twelve physically active young men without previous hamstring injury were tested for the number of repetitions attained, and sEMG signal median frequency and amplitude in both ST and BFlh of each lower limb, randomly in two sessions, with a seven-day interval between sessions.

RESULTS

High reliability [ICC = 0.85] was found for the number of SLBT repetitions attained. Reliability of sEMG outcomes showed better results for ST (ICC = 0.62-0.91) than for BFlh (ICC = 0.39-0.81), and a high to very-high repeatability was found for both ST (ICC = 0.91-0.84) and BFlh (ICC = 0.91-0.85). sEMG median frequency decreased and amplitude increased for both BFlh (p ≤ 0.001) and ST (p ≤ 0.039) at the end of SLBT, suggesting localised fatigue.

CONCLUSIONS

The SLBT performed by healthy individuals until exhaustion proved to be reliable and to induce fatigue in both BFlh and ST, where the sEMG median frequency and amplitude can be measured on different days with acceptable reliability and high repeatability, suggesting its potential future use in both practical and clinical settings.

Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction

Rehabilitation after an anterior cruciate ligament (ACL) reconstruction requires patience, devotion, and discipline. Rehabilitation should be individualized to each patient's specific need and sport. Return to sport is a continuum throughout the rehabilitation, and patients should not return to performance before passing a battery of muscle function tests and patient-reported outcomes, as well as change of direction-specific tests. Return to full participation should be an agreement between the patient, physical therapist, surgeon, and coach. For minimal risk for second ACL injury, patients should continue with maintenance and prevention training even after returning to sport.

Advanced MRI Approaches for Evaluating Common Lower Extremity Injuries in Basketball Players: Current and Emerging Techniques

Magnetic resonance imaging (MRI) can provide accurate and non-invasive diagnoses of lower extremity injuries in athletes. Sport-related injuries commonly occur in and around the knee and can affect the articular cartilage, patellar tendon, hamstring muscles, and bone. Sports medicine physicians utilize MRI to evaluate and diagnose injury, track recovery, estimate return to sport timelines, and assess the risk of recurrent injury. This article reviews the current literature and describes novel developments of quantitative MRI tools that can further advance our understanding of sports injury diagnosis, prevention, and treatment while minimizing injury risk and rehabilitation time. Innovative approaches for enhancing the early diagnosis and treatment of musculoskeletal injuries in basketball players span a spectrum of techniques. These encompass the utilization of T2, T1ρ, and T2* quantitative MRI, along with dGEMRIC and Na-MRI to assess articular cartilage injuries, 3D-Ultrashort echo time MRI for patellar tendon injuries, diffusion tensor imaging for acute myotendinous injuries, and sagittal short tau inversion recovery and axial long-axis T1-weighted, and 3D Cube sequences for bone stress imaging. Future studies should further refine and validate these MR-based quantitative techniques while exploring the lifelong cumulative impact of basketball on players' knees. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.

Do athletes with hamstring strain injury have shorter muscle fascicles in the injured limb?

INTRODUCTION

Previous studies have suggested that a reduced length of the biceps femoris long head (BFlh) fascicles may increase the risk of hamstring strain injury (HSI). However, it remains unclear whether the BFlh fascicles of the injured limb are shorter than those of the contralateral limb in athletes with an acute HSI.

OBJECTIVE

To investigate the between-limb asymmetry of BFlh fascicle length in amateur athletes with an acute HSI.

METHODS

Male amateur athletes were evaluated using ultrasound scans within five days following an HSI. The BFlh fascicle length was estimated using a validated equation.

RESULTS

Eighteen injured athletes participated in this study. There was no significant difference (p = 0.27) in the length of BFlh fascicles between the injured limb (9.53 ± 2.55 cm; 95%CI 8.26 to 10.80 cm) and the uninjured limb (10.54 ± 2.87 cm; 95%CI 9.11 to 11.97 cm). Individual analysis revealed high heterogeneity, with between-limb asymmetries (percentage difference of the injured limb compared to the uninjured limb) ranging from -42% to 25%. Nine out of the 18 athletes had a fascicle length that was more than 10% shorter in the injured limb compared to the uninjured limb, five athletes had a difference of less than 10%, and four athletes had a fascicle length that was more than 10% longer in the injured limb compared to the uninjured limb.

CONCLUSION

The architecture characteristics of injured and uninjured muscles is not consistent among athletes with HSI. Therefore, rehabilitation programs focused on fascicle lengthening should be evaluated on a case-by-case basis.

Biceps femoris long head muscle and aponeurosis geometry in males with and without a history of hamstring strain injury

OBJECTIVES

Hamstring strain injuries (HSIs) commonly affect the proximal biceps femoris long head (BFlh) musculotendinous junction. Biomechanical modeling suggests narrow proximal BFlh aponeuroses and large muscle-to-aponeurosis width ratios increase localized tissue strains and presumably risk of HSI. This study aimed to determine if BFlh muscle and proximal aponeurosis geometry differed between limbs with and without a history of HSI.

METHODS

Twenty-six recreationally active males with (n = 13) and without (n = 13) a history of unilateral HSI in the last 24 months underwent magnetic resonance imaging of both thighs. BFlh muscle and proximal aponeurosis cross-sectional areas, length, volume, and interface area between muscle and aponeurosis were extracted. Previously injured limbs were compared to uninjured contralateral and control limbs for discrete variables and ratios, and along the relative length of tissues using statistical parametric mapping.

RESULTS

Previously injured limbs displayed significantly smaller muscle-to-aponeurosis volume ratios (p = 0.029, Wilcoxon effect size (ES) = 0.43) and larger proximal BFlh aponeurosis volumes (p = 0.019, ES = 0.46) than control limbs with no history of HSI. No significant differences were found between previously injured and uninjured contralateral limbs for any outcome measure (p = 0.216-1.000, ES = 0.01-0.36).

CONCLUSIONS

Aponeurosis geometry differed between limbs with and without a history of HSI. The significantly larger BFlh proximal aponeuroses and smaller muscle-to-aponeurosis volume ratios in previously injured limbs could alter the strain experienced in muscle adjacent to the musculotendinous junction during active lengthening. Future research is required to determine if geometric differences influence the risk of re-injury and whether they can be altered via targeted training.

Force Production and Electromyographic Activity during Different Flywheel Deadlift Exercises

This study aimed to characterize and compare force production and muscle activity during four flywheel deadlift exercises (bilateral [Bi] vs. unilateral [Uni]) with different loading conditions (vertical [Ver] vs. horizontal [Hor]). Twenty-three team-sport athletes underwent assessments for exercise kinetics (hand-grip force), along with surface electromyography (sEMG) of the proximal (BFProx) and medial biceps femoris (BFMed), semitendinosus (ST), and gluteus medius (GM). Mean and peak force were highest (p < 0.001) in Bi + Ver compared with Bi + Hor, Uni + Ver, and Uni + Hor. Although no significant differences were observed between Bi + Hor and Uni + Ver, both variants showed higher (p < 0.001) average force and peak eccentric force when compared with Uni + Hor. The presence of eccentric overload was only observed in the vertically loaded variants. Bi + Ver and Uni + Ver showed higher (p < 0.05) sEMG levels in BFProx and BFMed compared with the Uni + Hor variant. In addition, Uni + Ver registered the largest GM and ST sEMG values. In conclusion, the vertical variants of the flywheel deadlift exercise led to higher muscle force production and sEMG compared with their horizontal counterparts. Both Bi + Ver and Uni + Ver may be effective in promoting an increase in hamstring muscles activity and muscle force at long muscle length, while the Uni + Ver variant may be more effective in promoting GM and ST involvement.

The Effect of Variations in Knee and Hip Angles on Electromyographic Activity of the Hamstrings and Related Muscles During the Nordic Hamstring Exercise

Background

The benefit of performing the Nordic Hamstring Exercise (NHE) on an inclined board has been described, however, isometric hamstring activation in different knee and hip angles has not yet been thoroughly explored.

Purpose

This study investigated the effect of variations in knee and hip angles during the isometric performance of the NHE on electromyographic activity of the hamstring muscles.

Study design

Crossover study.

Methods

Thirteen male volunteers performed isometric contractions during the NHE with the knee (30°, 50°, 60°) and the hip (0°, 30°, and 45°) in various angles of flexion on a leg support platform which was inclined at 30°. An electrical goniometer was used to monitor the knee and hip joint angles during 5-s isometric contractions. A multivariate analysis of variance with repeated measures was used to compare normalized electromyographic values of each muscle across different knee and hip angles, followed by pairwise comparisons.

Results

The electromyographic activity of the biceps femoris, semitendinosus, and semimembranosus at a knee angle of 30° and hip angle of 0° were significantly higher than those observed with a knee angle of 50° and hip angle of 0°, or a knee angle of 60° and hip angle of 0° (p<0.05). The electromyographic activity of the semimembranosus at a knee angle of 60° and hip angle of 45° was significantly higher than values obtained with knee and hip angles of 60° and 0°, respectively (p<0.05).

Conclusions

The results indicate that using a knee flexion of 30° and a hip flexion of 0°, while isometrically performing the NHE on a platform inclined at 30°, may optimize electromyographic activity of the hamstrings.

Level of Evidence

3.

Hip adduction and abduction strength profiles in elite and sub-elite female soccer players according to players level and leg limb-dominance

BACKGROUND

Understanding the hip adduction and abduction strength in female soccer players is crucial for performance enhancement and injury prevention. This study compares the strength profiles in these muscle groups between elite and sub-elite female soccer players and assesses the impact of leg limb-dominance.

METHODS

A descriptive-comparative study was employed. Eighty-two female soccer players were evaluated. Isometric hip-adduction and abduction strength were measured using a handheld dynamometer.

RESULTS

Female elite and sub-elite soccer players displayed a mean and standard deviation (SD) on isometric hip-adductor strength for dominant (3.19 Nm/kg ± 0.69 vs. 2.40 Nm/kg ± 0.67) and non-dominant leg (3.32 Nm/kg ± 0.76 versus 2.42 Nm/kg ± 0.70), respectively. For isometric hip-abductor strength in elite and sub-elite players, a mean and SD of dominant (2.86 Nm/kg ± 0.56 vs. 2.07 Nm/kg ± 0.50) and non-dominant (2.80 Nm/kg ± 0.59 vs. 2.04 Nm/kg ± 0.43). In essence, elite players were stronger than sub-elite players on isometric hip-adduction (mean difference [MD] = 0.82 Nm/kg, CI95% = 0.42-1.12) and abduction (MD = 0.83 Nm/kg, CI95% = 0.54- 1.12) both in dominant and non-dominant, leg, whereas no differences existed for hip adduction:abduction ratios between groups and legs.

CONCLUSIONS

Elite female athletes exhibited greater strength than sub-elite female players in both hip adduction and abduction, whereas adduction:abduction ratio values did not differ between the two groups or between different legs.

A musculoskeletal multifactorial individualised programme for hamstring muscle injury risk reduction in professional football: results of a prospective cohort study

Objective

To test whether a musculoskeletal multifactorial and individualised hamstring muscle injury (HMI) risk reduction programme could reduce HMI risk in professional football.

Methods

We conducted a prospective cohort study in Finnish premier football league teams, with the 2019 season used as a control and an intervention conducted in the 2021 season. Screening was conducted to provide individualised programmes and monitor progress. Cox regression with hazard ratio (HR) was used with HMI as outcome and season as explanatory variable, including all players for primary analysis and those who performed the two seasons for secondary analysis.

Results

90 players were included in the control and 87 in the intervention seasons; 31 players performed in the 2 seasons. Twenty HMIs were recorded during the control and 16 during the intervention seasons. Cox regression analyses revealed that HMI risk at any given time was not significantly different between control and intervention seasons (for all players: HR 0.77 (95% CI 0.39 to 1.51), p=0.444; for the 31 players: HR 0.32 (95% CI 0.01 to 1.29), p=0.110)). For the 31 players, the HMI burden was significantly reduced in the intervention compared with the control season (RR 0.67 (95% CI 0.53 to 0.85)). Higher compliance with knee strength training, maximal velocity exposure and lower performance reductions in maximal theoretical horizontal force and knee flexor force were associated with lower HMI incidence.

Conclusions

Although the primary analysis did not reveal any significant effect of the intervention to reduce HMI risk in professional football, the programme was feasible, and additional secondary analyses showed a significant association between the intervention and lower HMI burden, incidence and risk.

Implementing hamstring injury prevention programmes remotely: a randomised proof of concept trial

Objectives

This study aimed to (1) compare the effectiveness of a Nordic hamstring exercise (NHE) versus single-leg Romanian deadlift (SLRDL) exercise programme on a hamstring injury risk surrogate; (2) compare the muscle soreness experienced by both exercise programmes; and (3) assess compliance to remote injury prevention exercise protocols through video software.

Methods

Twenty participants (10 women and 10 men: 21.45±1.6 years; 176±23 cm; 70±10 kg) were randomised into an NHE or SLRDL programme for 6 weeks. Single-leg hamstring bridge (SLHB), a hamstring injury surrogate, was the primary outcome for exercise efficacy. Muscle soreness and exercise adherence were also assessed. Significance was set at p<0.05.

Results

Both exercises increased SLHB performance resulting in an overall effect (p=0.013) with no effect for group (p=0.470) and no interaction effect (p=0.709), indicating both groups improved but there was no difference in improvement between interventions. There was no difference in muscle soreness between groups (p=0.087). Finally, both groups had 100% adherence to the programme.

Conclusions

Both the NHE and SLRDL are equally effective in increasing SLHB performance and demonstrate a similar level of muscle soreness. This suggests that SLRDL may be a viable option as a preventative exercise to mitigate the risk of hamstring injury. Finally, implementing injury prevention programmes remotely has the potential to enhance adherence.

Six Weeks of Unilateral Flywheel Hip-Extension and Leg-Curl Training Improves Flywheel Eccentric Peak Power but Does Not Enhance Hamstring Isokinetic or Isometric Strength

PURPOSE

This preregistered trial investigated how 6 weeks of unilateral flywheel leg-curl and hip-extension training impact isokinetic, isometric, and flywheel strength and power outcomes.

METHODS

The study involved 11 male university athletes (age 22 [2] y; body mass 77.2 [11.3] kg; height 1.74 [0.09] m) with one leg randomly allocated to flywheel training and one leg to control. Unilateral eccentric and isometric knee-flexion torque and flywheel unilateral leg-curl and hip-extension peak power were tested. Training intensity and volume (3-4 sets of 6 + 2 repetitions) were progressively increased.

RESULTS

The intervention enhanced hip-extension concentric (P < .01, d = 1.76, large) and eccentric (P < .01, d = 1.33, large) peak power more than the control (significant interaction effect). Similarly, eccentric (P = .023, d = 1.05, moderate) peak power was enhanced for the leg curl. No statistically significant differences between conditions were found for isokinetic eccentric (P = .086, d = 0.77, moderate) and isometric (P = .431, d = 0.36, small) knee-flexor strength or leg-curl concentric peak power (P = .339, d = 0.52, small). Statistical parametric mapping analysis of torque-angle curves also revealed no significant (P > .05) time-limb interaction effect at any joint angle.

CONCLUSION

Unilateral flywheel hamstring training improved knee-flexor eccentric peak power during unilateral flywheel exercise but not flywheel concentric, isokinetic eccentric, or isometric (long-lever) knee-flexor strength.

Effectiveness of cryo plus ultrasound therapy versus diathermy in combination with high-intensity laser therapy for pain relief in footballers with muscle injuries: A prospective study

BACKGROUND

Muscle injuries are common traumatic events in the clinical practice of the rehabilitation field. There is still a gap in the scientific literature on the effectiveness of physical agent modalities in the management of muscle injuries in athletes.

OBJECTIVE

The aim of this study was to assess the effectiveness of cryo plus ultrasound therapy com-pared to diathermy in combination with high-intensity laser therapy (HILT) for pain relief in professional footballers with muscle injuries.

METHODS

A case-control study was conducted on 31 professional footballers with a muscle injury of the lower limbs. Of these, 17 patients, assigned to a Group A (AG), were treated with HILT and cryoultrasound therapy; the remaining 14 patients, assigned to a Group B (BG), underwent HILT and diathermy. We assessed the extent of the pain, the size of the muscle injury, frequency of recurrence and number of days to recovery, at the time of recruitment, at the end of the rehabilitation and 3 months after the injury.

RESULTS

Group A athletes had a greater benefit on pain (4.65 ± 0.61 vs 3.24 ± 0.63; p< 0.05) and muscle injury recurrence. The return to play in the athletes of group A took place 4.73 days earlier.

CONCLUSION

HILT and cryo plus ultrasound therapy, in combination with therapeutic exercise, rep-resent a valid strategy in the treatment of muscle injuries in professional footballers.

The influence of isokinetic dynamometer configuration on eccentric hamstring strength metrics: implications for testing and training

Isokinetic dynamometry is the clinical gold standard for strength assessment but testing protocols and outcome metrics can lack functional relevance. To quantify the influence of dynamometer configuration on eccentric hamstring strength metrics, 23 trained participants completed isokinetic eccentric knee flexor trials at 180°·s-1 in a seated and extended hip position. The extended position elicited a greater peak torque (P = 0.04) which was achieved at a significantly (P < 0.001) greater degree of knee flexion. Isokinetic range and functional range (defined as 85% of peak torque) were consistent at ~44° and ~21°, respectively, across trials, but were achieved with a more flexed knee in the extended hip configuration. Therefore, whilst the extended hip configuration might better reflect the biarticular nature of the hamstring musculature and the mechanism of hamstring strain injury, the sensitivity of strength metrics to configuration has implications for clinical assessment and training adaptations.

Relationship Between Nordic Hamstring Strength and Single Leg Bridge Test in University Soccer Players

CONTEXT

Nordic hamstring strength (NH strength) and single leg bridge test (SLBT) scores are used to predict the risk of hamstring strain injury. Although NH strength and SLBT scores may be related, the relationship between NH strength and SLBT score remains unknown.

OBJECTIVES

This study investigated the relationship between NH strength and SLBT scores in university soccer players.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

PARTICIPANTS

38 male university soccer players.

MAIN OUTCOME MEASURES

NH strength and SLBT scores.

INTERVENTIONS

A participant was instructed to lean forward gradually at the slowest possible speed from a kneeling posture with the knee joint flexed 90° for the NH strength measurement. Participants in the SLBT crossed their arms over their chests, pushed down from their heels, and lifted their hips off the ground as many times as they could until they failed. We investigated the relationship between NH strength and SLBT scores in the left and right sides using Spearman rank correlation coefficient. Additionally, we calculated the percentage of left-right asymmetry in NH strength and SLBT scores and investigated the relationship between these variables using Pearson correlation coefficient.

RESULTS

There were no significant correlations between NH strength and SLBT scores in the right (rs = .239, P = .16) and left (rs = .311, P = .065) legs. Furthermore, there was no significant relationship between NH strength and SLBT between-limb asymmetry (r = .073, P = .671).

CONCLUSIONS

NH strength and SLBT scores could be different indexes, indicating either maximal muscle strength or muscle endurance. Thus, the findings suggested that when assessing risk factors for hamstring strain injury, both NH strength and SLBT scores should be measured.

A low-volume Nordic hamstring curl programme improves change of direction ability, despite no architectural, strength or speed adaptations in elite youth soccer players

Nordic hamstring curls (NHC) are a commonly used injury intervention method in amateur team sports. Seventeen elite male academy soccer players performed an 8-week low volume NHC programme. Pre-post intervention measures of isokinetic eccentric knee flexor (KF) strength, linear speed, COD performance, hamstring muscle thickness, pennation angle and fascicle length were recorded. No significant main effects were observed for measures of isokinetic KF strength (P ≥ 0.19), linear sprint speed (P ≥ 0.47) or hamstring muscle architecture (P ≥ 0.30). However, significance was noted for improved COD performance (P < 0.01; mean difference, -0.06, p = 0.001, 95% CI = 0.03 to 0.09; d = 0.80), exceeding the minimal detectable difference (MDD = 0.05 s). A low-volume NHC intervention may contribute to significant improvements in COD ability, independent of no significant changes in eccentric KF strength, linear sprint speed or muscle architectural properties in elite youth soccer players.

Quantifying demands on the hamstrings during high-speed running: A systematic review and meta-analysis

INTRODUCTION

Hamstring strain injury (HSI) remains a performance, economic, and player availability burden in sport. High-speed running (HSR) is cited as a common mechanism for HSI. While evidence exists regarding the high physical demands on the hamstring muscles in HSR, meta-analytical synthesis of related activation and kinetic variables is lacking.

METHODS

A systematic search of Medline, Embase, Scopus, CINAHL, SportDiscus, and Cochrane library databases was conducted in accordance with the PRISMA 2020 guidelines. Studies reporting hamstring activation (electromyographic [EMG]) or hamstring muscle/related joint kinetics were included where healthy adult participants ran at or beyond 60% of maximum speed (activation studies) or 4 m per second (m/s) (kinetic studies).

RESULTS

A total of 96 studies met the inclusion criteria. Run intensities were categorized as "slow," "moderate," or "fast" in both activation and kinetic based studies with appropriate relative, and raw measures, respectively. Meta-analysis revealed pooled mean lateral hamstring muscle activation levels of 108.1% (95% CI: 84.4%-131.7%) of maximal voluntary isometric contraction (MVIC) during "fast" running. Meta-analysis found swing phase peak knee flexion internal moment and power at 2.2 Newton meters/kilogram (Nm/kg) (95% CI: 1.9-2.5) and 40.3 Watts/kilogram (W/kg) (95% CI: 31.4-49.2), respectively. Hip extension peak moment and power was estimated as 4.8 Nm/kg (95% CI: 3.9-5.7) and 33.1 W/kg (95% CI: 17.4-48.9), respectively.

CONCLUSIONS

As run intensity/speed increases, so do the activation and kinetic demands on the hamstrings. The presented data will enable clinicians to incorporate more objective measures into the design of injury prevention and return-to-play decision-making strategies.

Discrete Hamstring: Quadriceps Strength Ratios Do Not Represent Angle-Specific Ratios in Premier League Soccer Players

ABSTRACT

Lunn, DE, Nicholson, G, Cooke, M, Crespo, R, Robinson, T, Price, RJ, and Walker, J. Discrete hamstring: quadriceps strength ratios do not represent angle-specific ratios in Premier League soccer players. J Strength Cond Res 37(12): 2417-2422, 2023-This study compared angle-specific hamstring:quadriceps (H:Q) ratios with their discrete counterparts during strength testing in professional male soccer players. Twenty-seven professional English Premier League soccer players were recruited for this study (age: 22 ± 4 years; stature: 1.81 ± 0.08 m; body mass: 74.7 ± 6.5 kg). Isokinetic testing of the knee flexors and extensors was conducted concentrically at two angular velocities (60° and 240°·s -1 ) and eccentrically (for the knee flexors only) at 30°·s -1 . Conventional H:Q ratio was calculated as the ratio between peak joint moment in the flexors and extensors at 60°·s -1 . Functional H:Q ratio was calculated as the peak joint moment in the flexors during the eccentric condition and the extensors at 240°·s -1 . Discrete conventional and functional H:Q ratios were 0.56 ± 0.06 and 1.28 ± 0.22, respectively. The residual differences between discrete values and angle-specific residual values were 13.60 ± 6.56% when normalized to the magnitude of the discrete value. For the functional ratios, the normalized residual was 21.72 ± 5.61%. Therefore, neither discrete ratio was representative of angle-specific ratios, although the conventional ratio had lower error overall. Therefore, practitioners should consider H:Q ratio throughout the full isokinetic range of motion, not just the discrete ratio calculated from peak joint moments, when designing and implementing training programs or monitoring injury risk, recovery from injury, and readiness to return to play.

Performing Nordic hamstring strength testing with additional weight affects the maximal eccentric force measured: do not compare apples to oranges

Background

Nordic hamstring test devices are commonly used to measure maximal eccentric hamstring force. The ability to control the final phase of the exercise has been adopted as a criterion to add weight when testing, without substantial evidence. We investigated if adding weight affected the maximal force measured, and if there were differences between players who could and could not control the final phase.

Methods

Female (n=84) and male (n=56) football players performed a Nordic hamstring strength test with 0, 5 and 10 kg. We used visual inspection to assess the ability to control the final phase (approximately last 20°), as per previously published studies.

Results

Maximal force was higher when tested with 5 kg (females: +8 N (2%), p<0.001; males: +18 N (4%), p<0.001) and 10 kg (females: +17 N (5%), p<0.001; males: +27 N (6%), p<0.001) compared with 0 kg. This was the case for both groups, those who could control the final phase (5 kg: +16 N (4%), p<0.001; 10 kg: +28 N (7%), p<0.001) and those who could not (5 kg: +9 N (3%), p<0.001; 10 kg: +15 N (4%), p<0.001).

Conclusion

Both players who could and could not control the final phase of the Nordic hamstring test demonstrated higher maximal force when adding weight to testing. Therefore, this should not be used to decide if players should perform testing with or without weight. Either all participants or none should be tested with weight, and the same approach should be used both for pre-testing and post-testing.

The effects of hip- vs. knee-dominant hamstring exercise on biceps femoris morphology, strength, and sprint performance: a randomized intervention trial protocol

BACKGROUND

The hamstrings are an important muscle group that contribute to horizontal force during sprint acceleration and are also the most injured muscle group in running-based sports. Given the significant time loss associated with hamstrings injury and impaired sprinting performance following return to sport, identifying exercises that drive adaptations that are both protective of strain injury and beneficial to sprint performance is important for the strength and conditioning professional. This paper describes the study protocol investigating the effects of a 6-week training program using either the hip-dominant Romanian deadlift (RDL) or the knee-dominant Nordic hamstring exercise (NHE) on hamstring strain injury risk factors and sprint performance.

METHODS

A permuted block randomized (1:1 allocation) intervention trial will be conducted involving young, physically-active men and women. A target sample size of 32 will be recruited and enrolled participants will undergo baseline testing involving extended-field-of-view ultrasound imaging and shear wave elastography of the biceps femoris long head muscle, maximal hamstrings strength testing in both the RDL and NHE, and on-field sprint performance and biomechanics. Participants will complete the 6-week training intervention using either the RDL or NHE, according to group allocation. Baseline testing will be repeated at the end of the 6-week intervention followed by 2 weeks of detraining and a final testing session. The primary outcome will be regional changes in fascicle length with secondary outcomes including pennation angle, muscle cross sectional area, hamstring strength, and maximal sprint performance and biomechanics. An exploratory aim will determine changes in shear wave velocity.

DISCUSSION

Despite extensive research showing the benefits of the NHE on reducing hamstring strain injury risk, alternative exercises, such as the RDL, may offer similar or potentially even greater benefits. The findings of this study will aim to inform future researchers and practitioners investigating alternatives to the NHE, such as the RDL, in terms of their effectiveness in reducing rates of hamstring strain injury in larger scale prospective intervention studies.

TRIAL REGISTRATION

The trial is prospectively registered on ClinicalTrials.gov (NCT05455346; July 15, 2022).

Building for the Future: A Systematic Review of the Effects of Eccentric Resistance Training on Measures of Physical Performance in Youth Athletes

BACKGROUND

Eccentric resistance training is recognised as an effective stimulus for enhancing measures of muscular strength and power in adult populations; however, its value in youth athletes is currently not well understood.

OBJECTIVE

The aim of this systematic review was to critically appraise the effects of eccentric resistance training on measures of physical performance (i.e. muscular strength, jump, sprint and change of direction) in youth athletes 18 years of age and under.

METHODS

Original journal articles published between 1950 and June 2022 were retrieved from electronic search engines of PubMed, SPORTDiscus and Google Scholar's advanced search option. Full journal articles investigating the acute and chronic effects of eccentric resistance training on measures of physical performance in youth athletes (i.e. a person 18 years of age or under who competes in sport) were included. The methodological quality and bias of each study were assessed prior to data extraction using a modified Downs and Black checklist.

RESULTS

The search yielded 749 studies, of which 436 were duplicates. Three-hundred studies were excluded based upon title and abstract review and a further 5 studies were removed following the modified Downs and Black checklist. An additional 14 studies were identified during backward screening. Accordingly, 22 studies were included in our systematic review. The Nordic hamstring exercise and flywheel inertial training were the most frequently used eccentric resistance training methods in youth athletes. Improvements in physical performance following the Nordic hamstring exercise are dependent upon an increase in the breakpoint angle, rather than training volume (sets and repetitions), and are further elevated with the addition of hip extension exercises or high-speed running. A minimum of 3 familiarisation trials is necessary to elicit meaningful adaptations following flywheel inertial training. Furthermore, an emphasis should be placed upon decelerating the rotating flywheel during the final one to two thirds of the eccentric phase, rather than gradually throughout the entire eccentric phase.

CONCLUSIONS

The findings of this systematic review support the inclusion of eccentric resistance training in youth athletes to improve measures of muscular strength, jump, sprint and change of direction performance. The current eccentric resistance training methods are predominantly limited to the Nordic hamstring exercise and flywheel inertial training; however, the efficacy of accentuated eccentric loading to improve jump performance warrants attention in future investigations.

Correlations Between Hamstring Muscle Architecture, Maturation, and Anthropometric Measures in Academy Soccer Players

PURPOSE

Muscle architecture is associated with motor performance and muscle injury. While muscle architecture and knee-flexor eccentric strength change with growth, the influence of anthropometric measures on these properties is rarely considered. This study aimed to investigate the relationship between hamstring muscle architecture and knee-flexor eccentric strength with anthropometric measurements.

METHODS

Sixty male footballers (16.6 [1.05] y) from the U16, U17, and U19 teams of an elite soccer club were included in this study. Fascicle length, pennation angle, and muscle thickness of the biceps femoris long head (BFlh) and semimembranosus muscles were measured in both legs using ultrasound. Knee-flexor eccentric strength, height, body mass, leg length, femur length, and peak height velocity (PHV) were measured within 1 week of the ultrasound images. A stepwise regression and 1-way analysis of variance tests were used to evaluate the effects of age, maturity, and anthropometric measurements on muscle properties.

RESULTS

Variance within BFlh and semimembranosus muscle thickness (r < .61), semimembranosus pennation angle (r < .58), and knee-flexor eccentric strength (r = .50) were highly related to body mass. We observed no significant correlations between muscle architecture and age (P > .29). However, moderately greater BFlh muscle thickness was shown for the post-PHV compared with the PHV group (effect size ± 90% CI: 0.72 ± 0.49).

CONCLUSIONS

In conclusion, weak correlations between muscle architecture and anthropometric measurements suggest that other factors (ie, genetics, training regimen) influence muscle architecture. The moderate effect of maturity on BFlh muscle thickness strongly suggests post-PHV hypertrophy of the BFlh muscle. Our results confirmed previous findings that eccentric knee-flexor strength is influenced by body mass.

Effect of two eccentric hamstring exercises on muscle architectural characteristics assessed with diffusion tensor MRI

OBJECTIVES

To evaluate the effect of a Nordic hamstring exercise or Diver hamstring exercise intervention on biceps femoris long head, semitendinosus and semimembranosus muscle's fascicle length and orientation through diffusion tensor imaging (DTI) with magnetic resonance imaging.

METHODS

In this three-arm, single-center, randomized controlled trial, injury-free male basketball players were randomly assigned to a Nordic, Diver hamstring exercise intervention or control group. The primary outcome was the DTI-derived fascicle length and orientation of muscles over 12 weeks.

RESULTS

Fifty-three participants were included for analysis (mean age 22 ± 7 years). Fascicle length in the semitendinosus over 12 weeks significantly increased in the Nordic-group (mean [M]: 20.8 mm, 95% confidence interval [95% CI]: 7.8 to 33.8) compared with the Control-group (M: 0.9 mm, 95% CI: -7.1 to 8.9), mean between-groups difference: 19.9 mm, 95% CI: 1.9 to 37.9, p = 0.026. Fascicle orientation in the biceps femoris long head over 12 weeks significantly decreased in the Diver-group (mean: -2.6°, 95% CI: -4.1 to -1.0) compared with the Control-group (mean: -0.2°, 95% CI: -1.4 to 1.0), mean between-groups difference: -2.4°, 95% CI: -4.7 to -0.1, p = 0.039.

CONCLUSION

The Nordic hamstring exercise intervention did significantly increase the fascicle length of the semitendinosus and the Diver hamstring exercise intervention did significantly change the orientation of fascicles of the biceps femoris long head. As both exercises are complementary to each other, the combination is relevant for preventing hamstring injuries.

The dose-response of pain throughout a Nordic hamstring exercise intervention

The Nordic hamstring exercise (NHE) reduces hamstring injury incidence. Compliance to large exercise volumes of the NHE is poor, with exercise related soreness often seen as a contributing factor. We investigated the dose-response of NHE exposure with delayed onset muscle soreness (DOMS) and non-DOMS pain. Forty males were randomized to a 6-week intervention of four different NHE dosages: Group 1: very low volume; Group 2: low volume; Group 3: initial high to low volume; Group 4: low to high volume. Group 4 experienced more DOMS (p < 0.05) and non-DOMS pain (p = 0.030) than other groups. High volumes of NHE increase DOMS and non-DOMS pain while lower volume protocols have lesser DOMS and non-DOMS pain responses.

London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport

Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.

Does an Adjusted Kinematic Model Predict the Relative Eccentric Force During Nordic Curl?

This study aimed to assess the combination of video-based kinematic variables adjusted by intrinsic covariates to predict the relative eccentric force (RelF) during the Nordic curl. The participants (n = 21) performed Nordic curls (3 trials; 3-min rest) on a device measuring the eccentric force. The peaks were normalized by body weight. Kinovea software was used to track angular and linear velocity and acceleration from recorded videos. Two prediction models with multiple linear regression equations associated kinematic, anthropometric, and age variables to adjust the actual RelF. The equations obtained the predicted RelF. The actual RelF was inversely correlated with height (r = -.52), tangential (r = -.50) and centripetal accelerations (r = -.715), and angular velocity (r = -.70). The best prediction models combined angular velocity with age (F2,18 = 15.1, P = .001, r = .792, r2 = .627) and with height (F2,18 = 14.5, P = .001, r = .785, r2 = .616). No differences were observed between actual and predicted values (P = .993-.994), with good levels of agreement and consistency (intraclass correlation coefficient = .77-.78; Cronbach α = .86-.87). Bland-Altman results showed high levels of agreement and low biases. The standard error of measurement and minimal detectable change ranges were 0.46 to 0.49 N/kg and 1.28 to 1.36 N/kg, respectively. Also, the percentage of standard error of measurement was below 10% (7.92%-8.35%). The coefficient of variation analysis returned a 14.54% and 15.13% for each model, respectively. Kinematic analysis offers portability and low cost to current expensive or technical impaired dynamometry-based techniques to assess the RelF.

The architectural characteristics of the hamstring muscles do not differ between male and female elite-level rugby union players

Purpose: To determine whether differences exist in the architectural characteristics of the hamstring muscles of elite-level male and female rugby union players. Methods: Forty elite-level rugby union players (male n = 20, female n = 20) participated in this cross-sectional study. A sonographer acquired static ultrasound images using a 92 mm linear transducer to quantify (via a semi-automated tracing software tool) the architectural characteristics (muscle length, fascicle length, pennation angle, and muscle thickness) of the biceps femoris long head and semimembranosus muscles of participants' left limb. Muscle length and muscle thickness of the biceps femoris short head and semitendinosus muscles of participants' left limb were also quantified. Bonferroni adjusted independent samples t-tests were performed to evaluate whether differences exist in the architectural characteristics of the hamstring muscles of elite-level male and female rugby union players. Results: There were no significant differences in fascicle length or pennation angle of the hamstring muscles of elite-level male and female rugby union players. Some significant differences in muscle thickness (biceps femoris short head, and semimembranosus) and muscle length (biceps femoris short head, biceps femoris long head, semitendinosus, and semimembranosus) were observed; in all cases the male players had thicker and longer muscles. Conclusion: At a group level, hamstring muscle fascicle length and pennation angle are unlikely to be a sex-specific intrinsic risk factor for Hamstring strain injuries.

Activity Distribution Among the Hamstring Muscles During the Nordic Hamstring Exercise: A Multichannel Surface Electromyography Study

This study assessed activity distribution among the hamstring muscles during the Nordic hamstring exercise (NHE). The objective was to compare muscle activity between and within muscles during the NHE to add insights in its underlying protective mechanism. Through multichannel electromyography, we measured muscle activity in male basketball players during the NHE. Electromyography was assessed at 15 locations: 5 for biceps femoris long head, 4 for semitendinosus, and 6 for semimembranosus. For each percent of the eccentric phase of the NHE, muscle activity was calculated for each electrode location within each hamstring muscle individually. To quantify whole muscle head activity, means and variances across electrodes within each muscle were calculated. Thirty-five noninjured participants were included (mean age, 18 [2] y; mass, 87 [12] kg; height, 192 [9] cm). Heterogeneous muscle activity was found between 38% and 62% and over the whole eccentric contraction phase within the semitendinosus and the semimembranosus, respectively. Muscle activity of the semitendinosus was significantly higher than that of the biceps femoris long head. During the NHE, the relative contribution of the semitendinosus is the highest among hamstring muscles. Its strong contribution may compensate for the biceps femoris long head, the most commonly injured hamstring muscle head.

Effect of additional Nordic hamstring exercise or sprint training on the modifiable risk factors of hamstring strain injuries and performance

The Nordic hamstring exercise (NHE) has commonly been investigated in isolation, however, within practice multiple modalities are commonly incorporated. However, the NHE has a low level of compliance within sport, with sprinting being potentially being preferred. The present study aimed to observe the effect of a lower-limb program with either additional NHE or sprinting on the modifiable risk factors hamstring strain injury (HSI) and athletic performance. 38 collegiate athletes were randomly assigned into three groups: control standardised lower-limb training program (n = 10 (2 female, 8 male), age = 23.50 ± 2.95 years, height = 1.75 ± 0.09 m, mass 77.66 ± 11.82 kg), additional NHE (n = 15 (7 female, 8 male), age = 21.40 ± 2.64 years, height = 1.74 ± 0.04 m, mass 76.95 ± 14.20 kg) and additional sprinting (n = 13 (4 female, 9 male), age = 22.15 ± 2.54 years, height = 1.74 ± 0.05 m, mass 70.55 ± 7.84 kg). All participants performed a standardised lower-limb training program twice per week for seven weeks, including Olympic lifting derivatives, squatting movements, and the Romanian deadlift, with experimental groups performing with either additional sprinting or NHE. Bicep femoris architecture, eccentric hamstring strength, jump performance, lower-limb maximal strength and sprint ability were measured pre and post. All training groups demonstrated significant (p < 0.001), small-moderate increases in Bicep femoris architecture (g = 0.60-1.22), with significant (p < 0.001), small-large increases in absolute and relative eccentric peak force (g = 0.60-1.84). Significant and small increases were observed in take-off velocity and mean propulsion force (p < 0.02, g = 0.47-0.64), with non-significant and small increases for both the sprint and control training groups for mean propulsion force (p > 0.05, g = 0.42-0.50). Nordic and sprint training groups had significant and small increases in peak absolute and relative net force (p < 0.001, g = 0.44-0.60). The control group had a non-significant trivial increase in absolute peak net force (p > 0.05, g = 0.22), with a significant and small increase in relative peak relative net force (p = 0.034, g = 0.48). Significant and small decreases for the NHE and sprinting training groups was observed for 0-10 m, 0-20 m, and 10-20 m sprint time (p < 0.010, g = 0.47-0.71). Performing multiple modalities, with either additional NHE or sprinting, as part of a complete resistance training program was superiorly effective for measures of modifiable risk factors HSI, with similar increases observed in measures of athletic performance derived from the standardised lower-limb training program.

Shape differences in the semitendinosus following tendon harvesting for anterior cruciate ligament reconstruction

Following hamstring autograft anterior cruciate ligament reconstruction (ACLR), muscle length, cross-sectional area, and volume are reduced. However, these discrete measures of morphology do not account for complex three-dimensional muscle shape. The primary aim of this study was to determine between-limb semitendinosus (ST) shape and regional morphology differences in young adults following tendon harvest for ACLR and to compare these differences with those in healthy controls. In this cross-sectional study, magnetic resonance imaging was performed on 18 individuals with unilateral ACLR and 18 healthy controls. Bilaterally, ST muscles were segmented, and shape differences assessed between limbs and compared between groups using Jaccard index (0-1) and Hausdorff distance (mm). Length (cm), peak cross-sectional area (cm² ), and volume (cm³ ) were measured for the entire muscle and proximal, middle, and distal regions, and compared between limbs and groups. Compared to healthy controls, the ACLR group had significantly (p < 0.001, Cohen's d = -2.33) lower bilateral ST shape similarity and shape deviation was significantly (p < 0.001, d = 2.12) greater. Shape deviation was greatest within the distal region of the ACLR (Hausdorff: 23.1 ± 8.68 mm). Compared to both the uninjured contralateral limb and healthy controls, deficits in peak cross-sectional area and volume in ACLR group were largest in proximal (p < 0.001, d = -2.52 to -1.28) and middle (p < 0.001, d = -1.81 to -1.04) regions of the ST. Overall, shape analysis provides unique insight into regional adaptations in ST morphology post-ACLR. Findings highlight morphological features in distal ST not identified by traditional discrete morphology measures. Clinical significance: Following ACLR, risk of a secondary knee or primary hamstring injury has been reported to be between 2-to-5 times greater compared to those without ACLR. Change in semitendinosus (ST) shape following ACLR may affect force transmission and distribution within the hamstrings and might contribute to persistent deficits in knee flexor and internal rotator strength.

Efectividad de los ejercicios nórdicos sobre la incidencia de lesiones de isquiotibiales en futbolistas profesionales y amateur masculinos entre los 15 y 41 años. Revisión sistemática

Introducción: Las lesiones musculares son comunes en futbolistas, siendo la lesión de isquiotibiales la más frecuente. Objetivo: Analizar la evidencia existente sobre los efectos de los ejercicios nórdicos en la incidencia de lesiones de isquiotibiales en jugadores de fútbol profesional y amateur masculinos entre los 15 y 41 años. Materiales y métodos: Se llevó a cabo una revisión sistemática siguiendo las recomendaciones de la declaración PRISMA, realizando la búsqueda de artículos en PubMed, BVS, Cochrane, Web OF Science y SCOPUS, además de consultar Google Scholar. La búsqueda se realizó basada en la estrategia PICO con los siguientes términos: hamstring muscles, exercise, rehabilitation, therapy, athletic injuries, soccer. Resultados: un total de 257 artículos resultaron de la búsqueda, siendo 5 los artículos incluidos en este estudio. Todos los estudios evidenciaron efectos positivos de los ejercicios nórdicos para los deportistas. Conclusiones: los ejercicios nórdicos redujeron la incidencia de lesión de isquiotibiales en 4 de los estudios analizados, el porcentaje de cumplimiento de las sesiones de intervención condicionaron la calidad de los efectos mientras que el momento de aplicación de la intervención (pre- o post-entreno) no influyó

The effect of volume equated 1- versus 2-day formats of Nordic hamstring exercise training on fitness in youth soccer players: A randomised controlled trial

PURPOSE

This randomised controlled trial examined the effect of an 8-week volume-equated programme of Nordic hamstring exercise (NHE) training, executed at frequencies of 1- or 2-days per week, on fitness (10 m and 40 m sprint, '505' change of direction [COD] and standing long jump [SLJ]) in male youth soccer players (mean age: 16.4 ± 0.81 years).

METHOD

Players were divided into an experimental group (n = 16) which was further subdivided into 1-day (n = 8) and 2-day (n = 8) per week training groups and a control group (n = 8).

RESULTS

There were significant group-by-time interactions for 10-m sprint (p<0.001, η2 = 0.120, d = 2.05 [0.57 to 3.53]), 40-m sprint (p = 0.001, η2 = 0.041, d = 1.09 [-0.23 to 2.4]) and COD (p = 0.002, η2 = 0.063, d = 1.25 [-0.09 to 2.59). The experimental group demonstrated a 'very large' effect size (d = 3.02 [1.5 to 4.54]) in 10-m sprint, and 'large' effect sizes in 40-m sprint (d = 1.94 [0.98 to 2.90]) and COD (d = 1.84 [0.85 to 2.83). The control group showed no significant changes. There were no significant differences between the 1-day and 2-day training groups. In three of the four tests (40 m, COD, SLJ) the 2-day group demonstrated larger effect sizes. Ratings of perceived exertion (RPE) were significantly lower in the 2-day group (p<0.001, 3.46 [1.83 to 5.04).

CONCLUSION

The NHE increases fitness in youth soccer players and there may be advantages to spreading training over two days instead of one.