As always, thank you very much for taking the time to read my blog. This latest blog starts to look at some of the criticisms of the Nordic Hamstring Exercise. I think that these are important to look at the arguments against the exercise for a couple of reasons. The first of which is that if we are to prescribe exercises then we must understand how they may affect other structures and what influence this may have upon our athletes ability to perform. Also when working in professional sport we are now being challenged by the players, and also potentially a number of external practitioners who will believe that other exercises are potentially more beneficial for their clients. We must therefore have an understanding of exactly why we believe the arguments for may outweigh the arguments against. We stand a much better chance of getting our players to perform the exercise if we are in a position to have a reasoned discussion with them to try and display understanding of the arguments against the exercise.
Preferential Recruitment of Semitendinosus
The first argument that may be presented upon discussion of the NHE is that for an exercise aiming to decrease the incidence of hamstring injury, it does not preferentially recruit the Biceps Femoris muscle. This is the muscle that is suggested to be involved in up to 84% of hamstring injuries (Ekstrand et al, 2011) and plays a key role in sprinting.
Bourne et al. (2017a) looked to study the EMG activity of Semitendinosus and Biceps Femoris upon performance of of a number of exercises. They found that when performing the NHE there is the greatest level of medial hamstring EMG activity with a figure of 101.8% of the Maximum Voluntary Contraction. This is in contrast to the Biceps Femoris which only displayed 71.9% of Maximal Voluntary Contraction in the eccentric phase of the activity.
This means that if someone presents us with an argument of preferential semitendinosus recruitment as a reason for which the NHE should not be included in a hamstring injury prevention program then we must acknowledge that as correct. However if we look at Figure One then we also see that the NHE induced the greatest eccentric EMG activity of all activities monitored as part of the study.
Figure One: Taken From Bourne et al. (2017a)
Therefore there is there not a counter-argument that this is an excellent exercise to prescribe as part of a hamstring injury prevention program? An exercise that exposes both the medial and lateral hamstrings to high levels of eccentric activity surely is exactly what we are looking for?
It could then maybe be suggested that the exercise does not provide a great enough stimulus to induce physiological change within the lateral hamstrings. However there appears to be a strong group of evidence from papers such as the previously mentioned Alonso-Fernandez et al. (2018) and Bourne et al. (2017b), to name just two, that provided evidence of physiological adaptations in the LhBF muscle resulting from a NHE protocol.
For those who had not already realised from my previous blog posts, it will probably now be pretty clear that I am a big advocate of the NHE as a tool for decreasing the risk of the problematic hamstring injury. Please do therefore take my obvious bias into consideration when reading this blog, and feel free to challenge my beliefs and comments if they are not in line with yours. Being challenged and reflecting on our practice is the best way to improve as clinicians.
Alonso-Fernandez et al. (2018). Changes in muscle architecture of biceps femoris induced by eccentric strength training with nordic hamstring exercise.
Bourne et al. (2017a). Impact of exercise selection on hamstring muscle activation.
Bourne et al. (2017b). Impact of the Nordic hamstring and hip extension exercises on hamstring architecture and morphology: implications for injury prevention.
Ekstrand et al. (2011). Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play