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Hamstring injury prevention: Nordic curls and eccentric dosing

The Nordic hamstring exercise has some of the strongest prevention evidence in sports medicine and some of the worst uptake. That mismatch comes down mostly to dose.

By Sonia Bhatt··2 min read
Browse:Hamstring strain
Hamstring injury prevention: Nordic curls and eccentric dosing

The Nordic hamstring exercise has some of the strongest prevention evidence in sports medicine and some of the worst uptake. That mismatch comes down mostly to dose. A programme only protects athletes if they complete it, and soreness is the main reason they don't. 

What Does the Evidence Show?

  • Injury reduction: Prevention programmes that include the Nordic roughly halve hamstring injuries, according to a meta-analysis of 8,459 athletes. About half of those programmes combined the Nordic with other exercises, though, so how much of the benefit comes from the Nordic alone is less clear.
  • Adoption: Across 150 team-seasons in the Champions League and the Norwegian top flight, the programme was completed in full in only 10.7%, and 83.3% were non-compliant.
  • Barriers: In Major League Soccer, only 21% of clubs completed the full programme, and 83% of respondents named player perception and muscle soreness as barriers.

The prevention problem is not the exercise. It is getting enough athletes to keep doing it.

How Much Is Enough?

The original programmes were demanding. Prevention trials progressed to about 90 Nordic repetitions per week, while a reduced-dose approach used only 8.

  • Low volume works for adaptation: After interventions of six weeks or more, high-volume and low-volume programmes produced similarly large gains in eccentric strength, with comparable improvements in fascicle length.
  • Detraining is fast: Fascicle length gains have been shown to reverse within two weeks of stopping, although eccentric strength lasted at least four weeks. Maintaining the programme through the competitive season therefore matters more than a big preseason block. 
  • Caution on outcomes: The low-volume evidence covers strength and muscle architecture. Direct evidence that low-volume programmes reduce injury is limited.

Assessment

  • Risk profile: Older age and previous hamstring injury are the strongest risk factors for hamstring strain.
  • Eccentric strength: Nordic force on a dedicated device or dynamometer, recorded for both limbs.
  • Exposure: Weekly high-speed running volume, since the hamstrings need regular sprint exposure as well as gym strength.
  • Tolerance: Previous experience of Nordics, including how sore they made the athlete.

Physiotherapy Management

  • Start low, with a small number of sets and repetitions once or twice weekly, and build over four to six weeks.
  • Schedule sessions well away from competition, since soreness is the main reason athletes stop.
  • Regress with band assistance or partial range rather than dropping the exercise.
  • Combine Nordics with hip-dominant work such as Romanian deadlifts and with regular high-speed running.
  • Keep a low-volume maintenance dose through the season to avoid detraining.

Tip: If a squad has abandoned Nordics before, ask how many repetitions per week they would genuinely complete. A modest dose done consistently beats an ideal dose done for three weeks.

Before You Sign Off a Prevention Programme

Treat adherence, not the prescription, as the main outcome. A programme the squad will actually complete, maintained all season and paired with regular sprint exposure, is worth more than the textbook protocol. Be honest with coaches that the Nordic is one part of hamstring prevention rather than the whole of it.

References

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