Effect of Pre-training and Post-training Nordic Exercise on Hamstring Injury Prevention, Recurrence, and Severity in Soccer Players
31 Aug 2019-Annals of Rehabilitation Medicine (Korean Academy Of Rehabilitation Medicine)-Vol. 43, Iss: 4, pp 465-473
TL;DR: The use of NHE as a prevention protocol was effective in reducing all hamstring injuries with the use ofNHE during pre-training and post-training having the greatest effect.
Abstract: Objective To investigate the effect of adding Nordic exercise as post-training in decreasing hamstring initial, recurrent injuries rates, and their severity. Methods In this randomly controlled trial study, 34 professional football players aged 21 to 35 years were randomly assigned into two groups (17 players each) from Sporting clubs at Alexandria, Egypt. For group one, Nordic hamstring exercise (NHE) was performed pre-training and post-training. For group two, NHE was only performed pre-training. The control group was the same team during the previous season. Length of the trial was 12 weeks. The Australian football association injury form was used to collect incidence of injuries for each subject in both groups. Results Pooled results based on total injuries showed that group one had significantly less hamstring initial injuries (92% less) than the previous season, while group two had 80% less initial injuries and 85% less recurrent injuries than previous season. Regarding the severity of injuries in term of mean number of absent days, it was 1 day for group one and 2.7 days for group two while it was 7.95 days for the previous season during total risk time of 116.3±13.2 and 117.6±5.7 exposure hours for group one and group two, respectively. Conclusion The use of NHE as a prevention protocol was effective in reducing all hamstring injuries with the use of NHE during pre-training and post-training having the greatest effect.
Citations
More filters
TL;DR: A 12‐week eccentric hamstring strengthening program increased strength and sEMG to a similar magnitude irrespective of its scheduling relative to the football training session, however, architectural adaptations to support the strength gains differed according to the timing of the injury prevention program.
Abstract: We examined the effects of a 12-week program of Nordic hamstring exercises (NHE), administered before or after football training, upon eccentric hamstring strength, muscle activity, and architectural adaptations. Amateur soccer players were randomized into three groups. The control group (CON; n=11) undertook core stability exercises, whereas a periodized NHE program was delivered either before (NHEBEF ; n=10) or after (NHEAFT ; n=14) biweekly training sessions. Outcome measures included peak torque and concomitant normalized peak surface electromyography signals (sEMG) of the biceps femoris (BF) and medial hamstring (MH) muscles during knee flexor maximal eccentric contractions, performed at 30°·s-1 . Ultrasonography was used to determine BF muscle thickness, muscle fiber pennation angle, and fascicle length. Performing the NHE derived likely moderate peak torque increases in both NHEBEF (+11.9%; 90% confidence interval: 3.6%-20.9%) and NHEAFT (+11.6%; 2.6%-21.5%) vs CON. Maximum sEMG increases were moderately greater in the BF of both NHE training groups vs CON. There were likely moderate increases in BF muscle thickness (+0.17 cm; 0.05-0.29 cm) and likely small pennation angle increases (+1.03°; -0.08° to 2.14°) in NHEAFT vs CON and NHEBEF . BF fascicle length increases were likely greater in NHEBEF (+1.58 cm; 0.48-2.68 cm; small effect) vs CON and NHEAFT . A 12-week eccentric hamstring strengthening program increased strength and sEMG to a similar magnitude irrespective of its scheduling relative to the football training session. However, architectural adaptations to support the strength gains differed according to the timing of the injury prevention program.
66 citations
TL;DR: Limited scientific evidence is found to support exercise-based strategies to prevent muscle injury in elite footballers.
Abstract: Exercise-based strategies are used to prevent muscle injuries in football and studies on different competitive-level populations may provide different results. To evaluate the effectiveness of exercise-based muscle injury prevention strategies in adult elite football. A systematic search was conducted in PubMed (MEDLINE), Web of Science, Cochrane Library, and SPORTDiscuss (EBSCO). We considered only elite adult (> 16 year-old) football players with no distinction for gender; the intervention to be any exercise/s performed with the target to prevent lower-limb muscle injuries; the comparison to be no injury prevention exercise undertaken; the outcome to be the number of injuries, injury incidence, and severity. We searched systematic reviews, randomized-controlled trials (RCTs), and non-randomized-controlled trials (NRCTs), limited for English language. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool, the Cochrane Collaboration’s Tool for assessing risk of bias in RCTs, and the Risk of Bias in NRCTs of Interventions tool. 15 studies were included. Three systematic reviews showed inconsistent results, with one supporting (high risk of bias) and two showing insufficient evidence (low risk of bias) to support exercise-based strategies to prevent muscle injuries in elite players. Five RCTs and seven NRCTs support eccentric exercise, proprioception exercises, and a multi-dimensional component to an injury prevention program; however, all were deemed to be at high/critical risk of bias. Only one RCT was found at low risk of bias and supported eccentric exercise for preventing groin problems. We found limited scientific evidence to support exercise-based strategies to prevent muscle injury in elite footballers. PROSPERO CRD42017077705.
27 citations
Cites background from "Effect of Pre-training and Post-tra..."
...Arnason 2008 [18] Critical Serious Critical Critical NI Serious Moderate Critical Croisier 2008 [19] Critical Serious Serious Serious Critical Serious Moderate Critical Kraemer 2009 [20] Serious NI Serious Critical NI Moderate Moderate Critical Owen 2013 [22] Critical NI Serious Critical NI Serious Moderate Critical Melegati 2013 [23] Critical NI NI Critical Critical Critical Serious Critical Elerian 2019 [21] Critical Moderate Serious Moderate Moderate Moderate Moderate Critical Izzo 2019 [24] Critical NI Serious Critical NI Serious Moderate Critical...
[...]
..., Nordic Hamstrings) [18, 21] and another study suggested restoring the isokinetic strength balance between opposite muscles (quadriceps and hamstrings) to prevent hamstring injuries [19]....
[...]
...In our study, the results of the level 3 studies revealed two studies supporting the implementation of eccentric exercises for the hamstrings (i.e., Nordic Hamstrings) [18, 21] and another study suggested restoring the isokinetic strength balance between opposite muscles (quadriceps and hamstrings) to prevent hamstring injuries [19]....
[...]
...RCT randomized-controlled trail, NRCT non-randomized-controlled trial Author, year Study OCEBM level Michalis 2016 [11] Systematic review 1 McCall 2015 [3] Systematic review 1 Rogan 2013 [12] Systematic review 1 Askling 2003 [13] RCT 2 de Hoyo 2015 [16] RCT 2 Engebretsen 2008 [17] RCT 2 Espinosa 2015 [14] RCT 2 Harøy 2018 [15] Cluster RCT 2 Arnason 2008 [18] NRCT 3 Croisier 2008 [19] NRCT 3 Kraemer 2009 [20] NRCT 3 Elerian 2019 [21] NRCT 3 Owen 2013 [22] NRCT 4 Melegati 2013 [23] NRCT 4 Izzo 2019 [24] NRCT 4...
[...]
...[21] registered (retrospectively) their study protocol; however, no statistical analysis has been presented in the method section of the protocol; therefore, the rating given was moderate....
[...]
TL;DR: Hamstring strain injury (HSI) may result in considerable impairment, activity limitation, and participation restriction, including time lost from competitive sports as mentioned in this paper , which may lead to considerable impairment and activity limitation.
Abstract: Hamstring strain injury (HSI) may result in considerable impairment, activity limitation, and participation restriction, including time lost from competitive sports. This CPG includes sports-related overloading and overstretching injuries to myofascial or musculotendinous structures in any combination of the 3 hamstring muscles (the semitendinosus, semimembranosus, and biceps femoris). J Orthop Sports Phys Ther, Epub 14 Feb 2022. doi:10.2519/jospt.2022.0301.
18 citations
TL;DR: The Nordic hamstring exercise (NHE) has been strongly recommended to reduce hamstring injuries in previous meta-analyses (50% reduction in risk of injury) to underline the importance and impact of adopting appropriate methodology for evidence synthesis, this article revisited the study selection, reanalyzed and updated the findings of the most recent meta-analysis.
16 citations
TL;DR: In this paper, the effect of preventive strategies and protocols in reducing the incidence of hamstring muscle injuries in professional and semi-professional football teams was investigated. And the results showed that the Nordic hamstring exercise, the FIFA 11+ programme and exercises for core stability or balance training proved to have a successful effect on prevention of hamstring injuries.
Abstract: Hamstring Strain Injuries (HSIs) are the most common type of lesion in professional footballers and the leading cause of absence days from sports. However, recent studies have shown that high-level football teams apparently do not apply any HSI prevention protocol. The aim of the study was to determine the effect of preventive strategies and protocols in reducing the incidence of hamstring muscle injuries in professional and semi-professional football teams. A literature search of PubMed/MEDLINE, ISI/Web of Science and Scopus databases was conducted with the keywords "hamstring* and (injury* or strain) and prevent* and (soccer or football)". Quality and bias assessment was completed through the Kennelly modified scale. The Injury Incidence Rate (IIR) and the Incidence Rate Ratio (IRR) were assessed in the statistical analysis. In the meta-analysis, data were extracted, pooled and analysed with "Comprehensive Meta-Analysis Version 3.3.070" software. In total, 8 of the 1017 original search studies met the inclusion criteria of this review. The total exposure of the studies was 170,221.8 h, while the number of HSIs recorded was 165 in the intervention groups and 224 in the control groups. The average score of the quality assessment was 23.6/34. The meta-analysis of six of the eight included studies provided strong evidence that interventions are effective in reducing hamstring injuries. The IRR of the effect size was 0.443, with p-value = 0.001. The studies analysed applied different preventive strategies: the Nordic hamstring exercise, the FIFA 11+ programme and exercises for core stability or balance training. All these interventions proved to have a successful effect on prevention of hamstring injuries.
15 citations
References
More filters
TL;DR: In this paper, the authors used eccentric strength training with Nordic hamstring lowers combined with warm-up stretching to reduce the risk of hamstring strains, while no effect was detected from flexibility training alone.
Abstract: who did not [relative risk (RR) 5 1.53, P 5 0.22], nor was there a difference compared with the baseline data (RR 5 0.89, P 5 0.75). The incidence of hamstring strains was lower in teams who used the eccentric training program compared with teams that did not use the program (RR 5 0.43, P 5 0.01), as well as compared with baseline data for the same intervention teams (RR 5 0.42, P 5 0.009). Eccentric strength training with Nordic hamstring lowers combined with warm-up stretching appears to reduce the risk of hamstring strains, while no effect was detected from flexibility training alone. These results should be verified in randomized clinical trials.
515 citations
TL;DR: Different delivery methods of the FIFA 11+ to coaches influenced players’ physical performance minimally, however, high player adherence to the 11+ resulted in significant improvements in functional balance and reduced injury risk.
Abstract: Background A protective effect on injury risk in youth sports through neuromuscular warm-up training routines has consistently been demonstrated. However, there is a paucity of information regarding the quantity and quality of coach-led injury prevention programmes and its impact on the physical performance of players. Objective The aim of this cluster-randomised controlled trial was to assess whether different delivery methods of an injury prevention programme (FIFA 11+) to coaches could improve player performance, and to examine the effect of player adherence on performance and injury risk. Method During the 2011 football season (May– August), coaches of 31 tiers 1–3 level teams were introduced to the 11+ through either an unsupervised website or a coach-focused workshop with and without additional on-field supervisions. Playing exposure, adherence to the 11+, and injuries were recorded for female 13-year-old to 18-year-old players. Performance testing included the Star Excursion Balance Test (SEBT), single-leg balance, triple hop and jumping-over-a-bar tests. Results Complete preseason and postseason performance tests were available for 226 players (66.5%). Compared to the unsupervised group, singleleg balance (OR=2.8; 95% CI 1.1 to 4.6) and the anterior direction of the SEBT improved significantly in the onfield supervised group of players (OR=4.7; 95% CI 2.2 to 7.1), while 2-leg jumping performance decreased (OR=�5.1; 95% CI �9.9 to �0.2). However, significant improvements in 5 of 6 reach distances in the SEBT were found, favouring players who highly adhered to the 11+. Also, injury risk was lower for those players (injury rate ratio, IRR=0.28, 95% CI 0.10 to 0.79). Conclusions Different delivery methods of the FIFA 11+ to coaches influenced players’ physical performance minimally. However, high player adherence to the 11+ resulted in significant improvements in functional balance and reduced injury risk.
337 citations
"Effect of Pre-training and Post-tra..." refers background in this paper
...High compliance to FIFA 11+ prevention program has led to significant decreased in injury risk (by 57%) [9]....
[...]
...Compliance or adherence to the applied protocol has been mentioned as a very important factor affecting results obtained and effectiveness of the protocol [9,11]....
[...]
TL;DR: Investigating the preventive effect of the NHE on the incidence and severity of hamstring injuries in male amateur soccer players found it does not reduce hamstring injury severity, but it significantly reduces hamstring injury incidence.
Abstract: Background:Hamstring injuries are the most common muscle injuries in soccer, and they have a high rate of recurrence. Eccentric hamstrings strength is recognized as an important modifiable risk factor. This led to the development of prevention exercises such as the nordic hamstring exercise (NHE). The effectiveness of the NHE on hamstring injury prevention has never been investigated in amateur soccer.Purpose:To investigate the preventive effect of the NHE on the incidence and severity of hamstring injuries in male amateur soccer players.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:Male amateur soccer players (age, mean ± SD, 24.5 ± 3.8 years) from 40 teams were randomly allocated to an intervention (n = 20 teams, 292 players) or control group (n = 20 teams, 287 players). The intervention group was instructed to perform 25 sessions of NHE in a 13-week period. Both the intervention and control groups performed regular soccer training and were followed for hamstring injury incidenc...
263 citations
TL;DR: An injury-preventing effect of the FIFA injury prevention programmes compared with controls was shown in football, and this effect was induced by the FIFA 11+ prevention programme which has a substantial Injury Prevention effect by reducing football injuries by 39%, whereas a preventive effect ofThe FIFA 11 prevention programme could not be documented.
Abstract: Objective To investigate the effect of FIFA injury prevention programmes in football (FIFA 11 and FIFA 11+). Design Systematic review and meta-analysis. Eligibility criteria for selecting studies Randomised controlled trials comparing the FIFA injury prevention programmes with a control (no or sham intervention) among football players. Data sources MEDLINE via PubMed, EMBASE via OVID, CINAHL via Ebsco, Web of Science, SportDiscus and Cochrane Central Register of Controlled Trials, from 2004 to 14 March 2016. Results 6 cluster-randomised controlled trials had assessed the effect of FIFA injury prevention programmes compared with controls on the overall football injury incidence in recreational/subelite football. These studies included 2 specific exercise-based injury prevention programmes: FIFA 11 (2 studies) and FIFA 11+ (4 studies). The primary analysis showed a reduction in the overall injury risk ratio of 0.75 (95% CI 0.57 to 0.98), p=0.04, in favour of the FIFA injury prevention programmes. Secondary analyses revealed that when pooling the 4 studies applying the FIFA 11+ prevention programme, a reduction in the overall injury risk ratio (incidence rate ratio (IRR) 0.61; 95% CI 0.48 to 0.77, p Conclusions An injury-preventing effect of the FIFA injury prevention programmes compared with controls was shown in football. This effect was induced by the FIFA 11+ prevention programme which has a substantial injury-preventing effect by reducing football injuries by 39%, whereas a preventive effect of the FIFA 11 prevention programme could not be documented. Trial registration number PROSPERO CRD42015024120.
204 citations
TL;DR: This systematic review and meta-analysis demonstrates that injury prevention programs that include NH exercises decrease the risk of hamstring injuries among soccer players.
Abstract: 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).
172 citations