The Nordic hamstring exercise halves injury rates. Teams still skip it

Adding the Nordic hamstring exercise to a training programme roughly halves the rate of hamstring injuries — one of the largest and most durable prevention effects anywhere in sports medicine [s1]. The unusual part is that a cheap exercise with that much evidence behind it is still absent from most professional squads, even as the injury it prevents keeps climbing [s2].

The Nordic hamstring exercise is a single movement: kneeling with the ankles held down, the athlete lowers the torso toward the floor as slowly as possible, resisting through the hamstrings as they lengthen under load. It trains the muscle eccentrically — while it is being stretched — which is the mechanism most sprint and kicking injuries happen through. No equipment beyond a partner or a strap is required.

The size of the effect

The anchor study is a 2019 systematic review and meta-analysis by Nick van Dyk and colleagues at Aspetar in Doha, pooling 15 studies covering 8,459 athletes across sports, ages and both sexes [s1]. Programmes that included the exercise carried an overall injury risk ratio of 0.49 (95% CI 0.32 to 0.74, p=0.0008) against those that did not — a reduction of roughly half [s1]. The effect held up under scrutiny: restricting the pool to the eight randomised controlled trials gave a risk ratio of 0.52 (95% CI 0.32 to 0.85), and removing the studies at high risk of bias moved it only to 0.55 (95% CI 0.34 to 0.89, p=0.006) [s1]. The authors' summary was that programmes including the exercise reduce hamstring injuries by up to 51% [s1].

A 2024 umbrella review — a review of reviews — reached the same figure from a wider base, drawing on 10 systematic reviews spanning 125 studies and 17,260 subjects [s3]. It again put the injury reduction at up to 51%, and found consistent secondary benefits on sprint performance, eccentric strength and muscle architecture [s3]. That convergence, from independent syntheses using different methods, is why the exercise is treated as settled where much of sports science is not.

The problem it hasn't solved

The evidence has not translated into practice, and the injury has moved the wrong way. UEFA's Elite Club Injury Study, tracking 3,909 players across 54 teams in 20 European countries over 21 seasons, found hamstring injuries rose from 12% of all injuries in the first season to 24% in the most recent [s2]. The share of total injury-absence days caused by hamstring problems doubled from 10% to 20% over the same span, and training-time hamstring injury incidence rose by 6.7% a year across the final eight seasons (95% CI 1.7% to 12.5%) [s2]. The injury the exercise most directly targets is, in elite men's football, becoming more common, not less.

Several things pull against uptake. Compliance is the recurring one: the effect in the trials depends on athletes actually doing the exercise through the season, and the movement is demanding enough that soreness discourages consistency. The 2024 umbrella review's practical recommendation speaks to this — build volume up, then hold it with a low-volume maintenance dose of around 48 reps a week, folded into the warm-up rather than added as extra work [s3]. Fixture congestion, squad rotation and the perception that the exercise blunts performance in the short term all compete for the same training minutes.

What the evidence supports, and its limits

The claim the data supports is narrow and strong: programmes that include the Nordic hamstring exercise, done consistently, roughly halve hamstring injury rates across a range of sports [s1][s3]. What it does not claim is that the exercise eliminates the injury, works without adherence, or substitutes for managing the other drivers — sprint exposure, fatigue and fixture load — that the UEFA data implicate in the rising trend [s2]. It is prevention at the population level, not a guarantee for any individual athlete.

That distinction matters because injury prevention is an area thick with weaker claims. Static stretching before exercise, by contrast, has little evidence of reducing injuries, and the newer promise of algorithms flagging at-risk players runs into hard limits on how well injuries can be predicted. Against a backdrop where soft-tissue injuries cost the top leagues enormous sums, a free exercise with a halving effect is the rare intervention whose main obstacle is not evidence but follow-through.