Konstantinos Natsis, Christos Lyrtzis , Dimitrios Aftosmidis,


Despite increased knowledge of hamstring muscle injuries, the incidence has not diminished. Nowadays it is well known that not all hamstring injuries are the same and that certain types of injuries require prolonged rehabilitation and return to performance. The slow stretch type of injury and injuries involving the central tendon both require longer times to return to physical activity.

Recurrence rates remain high and it is now considered that strength deficits may be an important factor. Preventing programmes achieve lower injury and re-injury possibility.

Prospective studies have identified modifiable Hamstrings Strain Injury (HIS) risk factors such as eccentric knee flexor weakness, and muscle architecture characteristics (eg, biceps femoris fascicle length) as main contributors to HSI injury prevention programs. At present, the Nordic Hamstring Exercise (NHE) is considered as the most pragmatic exercise choice for HSI injury prevention, which addresses both eccentric knee flexor strength and muscle architecture. The NHE is well known in elite soccer, since 88% of European teams became familiar with the exercise, ranked in the top five injury prevention exercises by practitioners.

Prevention is better than cure and there is evidence that a programme of eccentric hamstring exercises can reduce the incidence of hamstring muscle injuries. The recommended NHE programme of three sessions per week, during a 10-week preseason programme and one session a week subsequently, has been incorporated in the training regimes of many football clubs.

It is important to recognise the factors influencing the adoption, implementation and sustained use of such a programme. We will present our HIS strategy, which contains research evidence as well as clinical experience in a truly evidence-based approach, adoptable to all elite-level teams. Our goal is to share our approach with colleagues.