Effect of Injury Prevention Programs that Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis
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Hamstring injuries are among the most common non-contact injuries in sports. The Nordic hamstring (NH) exercise has been shown to decrease risk by increasing eccentric hamstring strength.
The purpose of this systematic review and meta-analysis was to investigate the effectiveness of the injury prevention programs that included the NH exercise on reducing hamstring injury rates while factoring in athlete workload.
Two researchers independently searched for eligible studies using the following databases: the Cochrane Central Register of Controlled Trials via OvidSP, AMED (Allied and Complementary Medicine) via OvidSP, EMBASE, PubMed, MEDLINE, SPORTDiscus, Web of Science, CINAHL and AusSportMed, from inception to December 2015. The keyword domains used during the search were Nordic, hamstring, injury prevention programs, sports and variations of these keywords. The initial search resulted in 3242 articles which were filtered to five articles that met the inclusion criteria. The main inclusion criteria were randomized controlled trials or interventional studies on use of an injury prevention program that included the NH exercise while the primary outcome was hamstring injury rate. Extracted data were subjected to meta-analysis using a random effects model.
The pooled results based on total injuries per 1000 h of exposure showed that programs that included the NH exercise had a statistically significant reduction in hamstring injury risk ratio [IRR] of 0.490 (95 % confidence interval [CI] 0.291–0.827, p = 0.008). Teams using injury prevention programs that included the NH exercise reduced hamstring injury rates up to 51 % in the long term compared with the teams that did not use any injury prevention measures.
This systematic review and meta-analysis demonstrates that injury prevention programs that include NH exercises decrease the risk of hamstring injuries among soccer players. A protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42015019912).
KeywordsSoccer Player Hamstring Injury Lower Extremity Injury Injury Prevention Program Australian Football
All authors of this paper have contributed substantially to the conception and design of the review, the analysis and interpretation of the data, the drafting or critical revision for important intellectual content of the article, and the final approval of the version for publication.
Compliance with Ethical Standards
Wesam Saleh A. Al Attar is supported by Umm Al Qura University in Makkah, Saudi Arabia. No sources of funding were used to assist in the preparation of this review.
Conflict of interest
Wesam Saleh A. Al Attar, Najeebullah Soomro, Peter Sinclair, Evangelos Pappas and Ross Sanders declare they have no conflicts of interest with regard to the content of this review.
- 2.Arnason A, Andersen TE, Holme I, et al. Prevention of hamstring strains in elite soccer: an intervention study. Scand J Med Sci Sports. 2008;18(1):40–8. doi: 10.1111/j.1600-0838.2006.00634.x.
- 4.Woods C, Hawkins R, Hulse M, et al. The Football Association Medical Research Program: an audit of injuries in professional football-analysis of preseason injuries. Br J Sports Med. 2002;36(6):436–41; discussion 41. doi: 10.1136/bjsm.36.6.436.
- 12.Ekstrand J, Walden M, Hagglund M. Hamstring injuries have increased by 4 % annually in men’s professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med. 2016;50(12):731– + . doi: 10.1136/bjsports-2015-095359.
- 23.Gouttebarge V, Hughes Schwab BA, Vivian A, et al. Injuries, matches missed and the influence of minimum medical standards in the A-League professional football: a 5-year prospective study. Asian J Sports Med. 2016;7(1):e31385. doi: 10.5812/asjsm.31385.
- 32.F-MARC. FIFA 11 + a complete warm-up programme. http://f-marc.com. Accessed 23 May 2016.
- 34.Steffen K, Emery CA, Romiti M, et al. High adherence to a neuromuscular injury prevention program (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomised trial. Br J Sports Med. 2013;47(12):794–802. doi: 10.1136/bjsports-2012-091886.CrossRefPubMedGoogle Scholar
- 40.Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009. doi: 10.1136/bmj.b2535.
- 41.Caine D, Maffulli N, Caine C. Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention. Clin Sports Med. 2008;27(1):19–50, vii. doi: 10.1016/j.csm.2007.10.008.
- 50.van Reijen M, Vriend I, van Mechelen W, et al. Compliance with sport injury prevention interventions in randomised controlled trials: a systematic review. Sports Med. 2016. doi: 10.1007/s40279-016-0470-8.