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Is Pre-season Eccentric Strength Testing During the Nordic Hamstring Exercise Associated with Future Hamstring Strain Injury? A Systematic Review and Meta-analysis

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A Correction to this article was published on 08 May 2021

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Abstract

Background

Interventions utilising the Nordic hamstring exercise (NHE) have resulted in reductions in the incidence of hamstring strain injury (HSI). Subsequently, quantifying eccentric knee flexor strength during performance of the NHE to identify an association with the occurrence of future HSI has become increasingly common; however, the data to date are equivocal.

Objective

To systematically review the association between pre-season eccentric knee flexor strength quantified during performance of the NHE and the occurrence of future HSI.

Design

Systematic review and meta-analysis.

Data sources

CINAHL, Cochrane Library, Medline Complete, Embase, Web of Science and SPORTDiscus databases were searched from January 2013 to January 10, 2020.

Eligibility criteria for selecting studies

Prospective cohort studies which assessed the association between pre-season eccentric knee flexor strength quantified during performance of the NHE and the occurrence of future HSI.

Methods

Following database search, article retrieval and title and abstract screening, articles were assessed for eligibility against pre-defined criteria then assessed for risk of bias. Meta-analysis was used to pool data across studies, with meta-regression utilised where possible.

Results

A total of six articles were included in the meta-analysis, encompassing 1100 participants. Comparison of eccentric knee flexor strength during performance of the NHE in 156 injured participants and the 944 uninjured participants revealed no significant differences, regardless of whether strength was expressed as absolute (N), relative to body mass (N kg−1) or between-limb asymmetry (%). Meta-regression analysis revealed that the observed effect sizes were generally not moderated by age, mass, height, strength, or sport played.

Conclusion

Eccentric knee flexor strength quantified during performance of the NHE during pre-season provides limited information about the occurrence of a future HSI.

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Author information

Authors and Affiliations

  1. School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia

    David A. Opar, Ryan G. Timmins, Jack T. Hickey, Kara Price & Nirav Maniar

  2. Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC, Australia

    David A. Opar & Ryan G. Timmins

  3. Musculoskeletal Mechanics Group, Imperial College London, London, UK

    Fearghal P. Behan

  4. High Performance Unit, Irish Rugby Football Union, Dublin, Ireland

    Nicol van Dyk

  5. Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar

    Nicol van Dyk

Authors
  1. David A. Opar
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Corresponding author

Correspondence to David A. Opar.

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Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Dr David Opar is listed as a co-inventor on a patent filed for a field-testing device of eccentric hamstring strength (PCT/AU2012/001041.2012) and is a minority shareholder in Vald Performance Pty Ltd, the company responsible for commercialising the device. The association between measures derived from the device and future hamstring strain injury is directly examined in this manuscript. Dr Opar is also the Chair of the Vald Performance Research Committee, a role that is unpaid. Dr Opar has received funding from Vald Performance for research unrelated to the current manuscript. Dr Opar’s brother and brother-in-law are employees of Vald Performance. Dr Opar’s brother is a minority shareholder in Vald Performance Pty Ltd. Ryan Timmins, Fearghal Behan, Jack Hickey, Nicol van Dyk, Kara Price and Nirav Maniar declare that they have no conflicts of interest relevant to the content of this review.

Availability of data and material

Access to data and/or material can be sought via contacting the corresponding author.

Code availability

Not applicable.

Authorship contributions

DAO, RGT, FPB, JTH, NM conceived the study. DAO, FPB and KP completed study protocol and registration. DAO and RGT completed database searches and extraction. RGT and JTH completed title and abstract screening. FPB and JTH completed full text review. RGT, NvD and FPB completed risk of bias assessment. NM, JTH and NvD completed data extraction. NM and JTH completed data analysis. DAO drafted the Introduction and Methods. NM drafted the Results and Discussion. All authors reviewed, revised and approved the final manuscript.

Additional information

The original artilce has been updated: Due to authors middle name udpate.

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Opar, D.A., Timmins, R.G., Behan, F.P. et al. Is Pre-season Eccentric Strength Testing During the Nordic Hamstring Exercise Associated with Future Hamstring Strain Injury? A Systematic Review and Meta-analysis. Sports Med 51, 1935–1945 (2021). https://doi.org/10.1007/s40279-021-01474-1

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