The Effects of Nordic Hamstring Exercise on Performance and Injury in the Lower Extremities: An Umbrella Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Study Selection Process
2.3. Data Extraction and Syntheses
2.4. Outcomes
2.5. Quality Assessment
3. Results
3.1. Selection of Studies
3.2. Methodological Quality
3.3. Study Characteristics
4. Discussion
4.1. Performance
4.2. Injuries
4.3. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Inclusion The Studies Must | Exclusion The Studies Cannot |
---|---|
have at least one the keywords; | |
be systematic reviews (with or without meta-analysis), prior to January 2024; | be books, case reports, expert opinions, conference papers, academic thesis, literature reviews or narrative reviews; |
be published in peer-review journals; | |
include injured and non-injured athletes or recreationally active or healthy individuals; | include experimental or control groups composed of any kind of animal; |
Studies (A to Z) | AMSTAR 2-Items | AMSTAR-2 Score | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | ||
Al Attar et. al., 2017 [24] | Yes | Yes | No | Partially yes | Yes | Yes | No | Yes | Yes | No | Yes | No | No | No | No | Yes | Critically Low |
Bautista et al., 2021 [25] | Yes | No | Yes | Partially yes | No | No | No | Yes | Yes | No | Yes | No | Yes | No | Yes | Yes | Low |
Cuthbert et al., 2020 [26] | No | No | No | Partially yes | No | No | No | Yes | Yes | No | Yes | No | No | No | No | Yes | Critically Low |
Gérard et al., 2020 [27] | Yes | Yes | No | Partially yes | Yes | Yes | No | Yes | Yes | No | Yes | No | No | No | No | No | Critically Low |
Hibbert et al., 2008 [28] | Yes | Yes | No | Partially yes | Yes | Yes | No | Yes | Partially yes | No | No meta-analysis was conducted | No meta-analysis was conducted | No | No | No meta-analysis was conducted | No | Critically Low |
Llurda-Almuzara et al., 2021 [29] | Yes | Yes | No | Partially yes | Yes | No | No | Partially yes | Yes | No | No meta-analysis was conducted | No meta-analysis was conducted | No | No | No meta-analysis was conducted | Yes | Low |
Medeiros et al., 2021 [30] | No | Yes | No | Partially yes | Yes | Yes | No | Partially yes | Yes | No | Yes | No | No | No | No | No | Critically Low |
Opar et al., 2021 [31] | Yes | Yes | Yes | Partially yes | Yes | Yes | No | Yes | Yes | No | Yes | No | Yes | Yes | Yes | Yes | Moderate |
Van Dyk et al., 2019 [32] | Yes | Yes | No | Partially yes | Yes | Yes | No | Partially yes | Yes | No | Yes | No | No | No | Yes | Yes | Low |
Yagiz et al., 2021 [33] | No | No | No | Partially yes | Yes | Yes | No | Partially yes | Yes | No | Yes | No | No | No | Yes | Yes | Critically Low |
Study | Objective | Nº of Studies (Subjects and Characteristics) | Results and Conclusions |
---|---|---|---|
Injuries | |||
Al Attar et al., 2017 [24] | Investigate the effectiveness of the injury prevention programs that included the NHE on reducing hamstring injury rates while factoring in athlete workload. | 5
| The pooled results showed 51% overall injury reduction per 1000 h of exposure in the NHE injury prevention program group compared to the control group (IRR 0.490; 95% CI 0.291 to 0.827; p = 0.008). |
Hibbert et al., 2008 [28] | Determine the effectiveness of eccentric exercise in preventing hamstring strains. | 7
| The cohort studies showed a lower incidence of hamstring strains with NHE, but no significant difference in severity of injury. The RCT found that the NHE did not decrease the risk of hamstring strains; however, participants who completed at least two training sessions sustained fewer hamstring injuries. |
Opar et al., 2021 [31] | Identify the association between pre-season eccentric knee flexor strength quantified during performance of the NHE and the occurrence of future hamstring strain injury. | 6
| No significant differences in absolute knee flexor strength were observed between the prospectively injured limbs and the uninjured control group (SMD −0.22; 95% CI −0.50 to 0.05) or the recurrent injured limbs compared to the uninjured control group (SMD −0.32; 95% CI −0.77 to 0.13). Additionally, no significant differences in between-limb knee flexor strength asymmetry were found between all injured participants (SMD 0.01; 95% CI −0.24 to 0.25) or recurrently injured participants (SMD 0.28; 95% CI −0.14 to 0.70) compared to the uninjured group. Normalizing knee flexor strength to body mass had no effect on any outcome, and the pooled effect sizes were almost identical to the absolute knee flexor strength. Specifically, the effect size remained small for all injured limbs (SMD −0.23; 95% CI −0.55 to 0.10) or recurrently injured limbs (SMD −0.32; 95% CI −0.90 to 0.26) when compared to the uninjured group. The meta-regression did not show significant relationships between absolute knee flexor strength and any covariate investigated (sport played; athlete age, height, and mass; or average absolute NHE strength of cohort) were found (p ≥ 0.26). For between-limb asymmetry, a significant effect was found for average age (p = 0.007), but not any other variable (p ≥ 0.24). |
van Dyk et al., 2019 [32] | Understand if the NHE prevents hamstring injuries when included as part of an injury prevention intervention. | 15
| There is a reduction in the overall injury risk ratio of 0.49 (95% CI 0.32 to 0.74; p = 0.0008) in favor of programs including the NHE. When pooling the RCTs, a small increase in the overall injury risk ratio of 0.52 (95% CI 0.32 to 0.85; p = 0.0008), still favors the NHE. Additionally, when studies with a high risk of bias were removed, there is an increase of 0.06 in the risk ratio to 0.55 (95% CI 0.34 to 0.89; p = 0.006). |
Performance | |||
Bautista et al., 2021 [25] | To investigate the effects of the NHE on sprint performance (i.e., 5, 10, and 20 m) and explore associations between study characteristics and sprint outcomes in team sport players. | 20
| NHE interventions showed a positive effect on sprint performance (MD −0.04 s; 95% CI −0.08 to −0.01). Sub-group meta-analyses indicated no significant differences in 5 (MD −0.02 s; 95% CI −0.10 to 0.06) and 20 m (MD −0.05 s; 95% CI −0.30 to 0.19) sprint performance. A significant difference was however found for 10 m sprint performance (MD −0.06 s; 95% CI −0.10 to −0.01). Meta-analysis on the effects of the NHE on eccentric strength of the knee flexors showed a significant benefit in favor of the intervention group (SCMD 0.83; 95% CI 0.55 to 1.12). |
Cuthbert et al., 2020 [26] | To investigate the effect of NHE-training volume on eccentric hamstring strength and biceps femoris fascicle length adaptations. | 13
| Within-study differences showed that following interventions of ≥ 6 weeks, very large positive effect sizes were seen in eccentric strength following both high-volume (g = 2.12) and low-volume (g = 2.28) NHE interventions. Similar results were reported for changes in fascicle length (g ≥ 2.58) and a large-to-very large positive reduction in pennation angle (g ≥ 1.31). Between-study differences were estimated to be at a magnitude of 0.374 (p = 0.009) for strength and 0.793 (p < 0.001) for architecture. |
Gérard et al., 2020 [27] | To determine the effects of an eccentric hamstring strength-training program, performed for at least 4 weeks by healthy adults, on muscle architecture and eccentric strength | 10
| Eccentric strength training was associated with an increase in fascicle length (MD 1.97; 95% CI 1.48 to 2.46) and muscle thickness (MD 0.10; 95% CI 0.06 to 0.13), and a decrease in pennation angle (MD 2.36; 95% CI 3.11 to 1.61). An increase was also found after eccentric strength training compared with concentric strength training (SMD 1.06; 95% CI 0.26 to 1.86), usual level of activity (SMD 2.72; 95% CI 1.68 to 3.77), and static stretching (SMD 0.39; 95% CI −0.97 to 1.75). |
Llurda-Almuzara et al., 2021 [29] | To evaluate the biceps femoris long head activation across cross-sectional hamstring strength exercise studies. | 29
| Isokinetic and NHE as the categories with highest biceps femoris activation (>60% of MVIC). NHE ankle dorsiflexion was the exercise that achieved the highest biceps femoris long head activation (128.1% of its MVIC). |
Medeiros et al., 2021 [30] | To investigate the effects of NHE on knee flexor eccentric strength and fascicle length. | 12
| The studies demonstrated strength increments in response to NHE (10–15% and 16–26% in tests performed on the isokinetic dynamometer and on the NHE device, respectively), as well as significant enhancement of biceps femoris long head fascicle length (12–22%). Meta-analysis showed NHE training was effective in increasing knee flexor eccentric strength, assessed with both isokinetic tests (SMD 0.68; 95% CI 0.29 to 1.06) and NHE tests (SMD 1.11; 95% CI 0.62 to 1.61). NHE was also effective in increasing fascicle length (SMD 0.97; 95% CI 0.46 to 1.48). |
Yagiz et al., 2021 [33] | To explore the effects of eccentric training based on biceps femoris fascicle length using ultrasound assessment and extrapolation methods. | 8
| NHE showed small (g = 0.23; 95% CI −1.02 to 1.47), medium (g = 0.38; 95% CI −0.50 to 1.27) and large (g = 1.98; 95% CI 0.52 to 3.44) ES based on manual linear extrapolation, panoramic ultrasound scanning, and trigonometric equation methods, respectively. |
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Nunes, H.; Fernandes, L.G.; Martins, P.N.; Ferreira, R.M. The Effects of Nordic Hamstring Exercise on Performance and Injury in the Lower Extremities: An Umbrella Review. Healthcare 2024, 12, 1462. https://doi.org/10.3390/healthcare12151462
Nunes H, Fernandes LG, Martins PN, Ferreira RM. The Effects of Nordic Hamstring Exercise on Performance and Injury in the Lower Extremities: An Umbrella Review. Healthcare. 2024; 12(15):1462. https://doi.org/10.3390/healthcare12151462
Chicago/Turabian StyleNunes, Hugo, Luís Gonçalves Fernandes, Pedro Nunes Martins, and Ricardo Maia Ferreira. 2024. "The Effects of Nordic Hamstring Exercise on Performance and Injury in the Lower Extremities: An Umbrella Review" Healthcare 12, no. 15: 1462. https://doi.org/10.3390/healthcare12151462
APA StyleNunes, H., Fernandes, L. G., Martins, P. N., & Ferreira, R. M. (2024). The Effects of Nordic Hamstring Exercise on Performance and Injury in the Lower Extremities: An Umbrella Review. Healthcare, 12(15), 1462. https://doi.org/10.3390/healthcare12151462