• Dr. Michael Cocozziello (Chiropractor)

Hamstring injury and prevention

Hamstring injuries represent 12% - 16% of all athletic injuries and have a re-injury rate of around 22% - 34% depending on which studies you read (Schmitt et al, 2012).

What are the risk factors for hamstring injury?

  • Poor flexibility

  • Strength discrepancies

  • Fatigue

  • Poor core stability

  • Prior history of hamstring injury (largest risk factor which can increase risk of injury by 2 - 6 times)

What can we do to prevent hamstring injury?

Although we can’t prevent all hamstring injuries, we can aim to reduce them by utilizing what’s in our control. That is an injury prevention program.

Just how effective are injury prevention programs?

Well, one large study which investigated multiple other studies (this is called a meta-analysis) found that hamstring injury prevention programs which included the nordic exercise (we’ll go through this in a bit) reduced injury by 51%. This was found in over 8000 athletes (Dyk et al, 2019). No bad for investing an hour or so a week into prevention.

What exercise can I do with minimal equipment and low time investment?

Answer: Nordic Hamstring Exercise

The Nordic Hamstring Exercise (aka NHE) is an extremely challenging exercise, particularly to the untrained. At first, most athletes will only be able to perform the lowering phase of the exercise (this is called “eccentric muscle contraction”).

This is absolutely fine as most hamstring injuries occur during the lengthening/lowering phase of muscle contraction. So even as a beginner you can start reaping some benefits.

Did I mention that this exercise not only reduces injury risk but can improve your sprint capacity? (that is your ability to perform repeated bouts of sprinting) (Ishoi, et al 2017).

What's the protocol?

Week 1: Sets/reps 2x5, sessions per week: 1

Week 2: Sets/reps 2x6, sessions per week: 2

Week 3: Sets/reps 3x6 - 8, sessions per week: 3

Week 4: Sets/reps 3x8 - 10, sessions per week: 3

Weeks 5 - 10: Sets/reps 3x 12 10 8, sessions per week: 3

Weeks 10+: Sets/reps 3x 12 10 8, sessions per week: 1

*As you can see there is a progressive increase in sets and repetitions until weeks 5 - 10, which then tapers in weeks 10 +. I assume this is to allow for dissipation of fatigue and allows full recovery from the 10 weeks of hard training.


  • The above program serves only as a guide and your program should be tailored to your fitness level, needs and performed at your own risk.

  • The NHE is not the be all and end all of hamstring training. For a more comprehensive program, other exercises and warm up drills should be included.


Schmitt B, Tim T and McHugh M (2012). Hamstring injury rehabilitation and prevention of reinjury using lengthened state eccentric training: A new concept. International Journal of Sports Physical Therapy.

Dyk V.N, Behan P.F and Whiteley R (2019). Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. British Journal of Sports Medicine.

Petersen J, Thorborg K, Nielsen B. M, Budtz-Jørgensen E, Hölmich P (2011). Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men's Soccer: A Cluster-Randomized Controlled Trial. The American Journal of Sports Medicine.

Ishøi L, Hölmich P, Aagaard P, Thorborg K, Bandholm T and Serne A (2018). Effects of the Nordic Hamstring exercise on sprint capacity in male football players: a randomized controlled trial. Journal of Sports Sciences.

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