Detailed Step-by-Step Instructions for Nordic Hamstring Curls

Nordic hamstring curls are considered one of the most effective exercises for ACL injury prevention and hamstring strengthening. This exercise builds powerful hamstrings that protect the knee during dynamic movements.

Nordic Hamstring Curls: Setup and Equipment

Position yourself on a padded surface with your knees on a cushion or mat for comfort. Secure your ankles using one of several methods: have a training partner hold your lower legs or ankles firmly in place, anchor your ankles under an immovable piece of equipment like a Smith machine with the barbell set to the lowest height, use a Nordic curl attachment designed for door frames or racks, or secure your ankles under a heavy bench or fixed object.

Your feet and ankles should align directly with your knees, and shoulders should be positioned directly over your hips with a neutral head and neck position. Keep your chin tucked throughout the movement, as if holding an egg under your chin.​

Proper Form and Execution

Starting Position: Kneel upright with arms at your sides, pre-tension your shoulders and hips, keep your pelvis slightly tucked, and engage your core while squeezing your glutes and hamstrings. Dig your heels into whatever is holding your legs in place to create tension.

The Descent (Eccentric Phase): This is the most critical component for injury prevention. Slowly lower your torso toward the ground while maintaining a straight line from your knees through your hips to your shoulders and head. Control the descent entirely with your hamstrings, resisting gravity throughout the movement. Continue lowering as far as possible using only your upper leg muscles, typically until you can no longer maintain control. When you reach the point where you can no longer lower yourself in a controlled manner, place your hands in front of your body to catch yourself.

The Ascent (Concentric Phase): Push off the ground with your hands to initiate the upward movement if needed. Use your hamstrings to pull your body back to the starting position while maintaining the straight body line from head to knees. Squeeze your glutes and hamstrings forcefully to complete the movement. Your shoulders should finish directly over your hips at the top of each repetition.

Critical Form Cues

Maintain a straight body alignment by contracting your glutes first, which brings your abs off the bench (if using one) and puts all tension on the hamstrings. Avoid breaking at the hips, which would turn the exercise into a different movement pattern. Keep your core engaged throughout to prevent excessive spinal extension. Control the eccentric (lowering) phase, as this provides the greatest benefit for injury prevention.​

Programming Guidelines

Start conservatively with 2-3 sets of 5-10 repetitions, choosing sets and reps based on your ability to maintain perfect technique throughout. Focus on quality over quantity, especially when beginning the exercise.

Progressions for Beginners

If you cannot perform full Nordic curls initially, use these progressions. Isometric Holds involve lowering to various angles and holding position for 5-10 seconds. Push-Up Assisted curls let you use your hands throughout the movement to control both descent and ascent. Shortened Range curls have you lower only as far as you can control, gradually increasing range over weeks. Band-Assisted variations use resistance bands attached in front to provide assistance during the movement. Complement with RDLs, bridges with multiple lever arm lengths, and sprints to build foundational hamstring strength.​​

Common Mistakes to Avoid

Breaking at the hips instead of maintaining straight body line compromises effectiveness. Dropping too quickly without controlling the eccentric phase reduces injury prevention benefits. Using momentum to return to starting position instead of muscular contraction limits strength gains. Neglecting glute activation allows the hips to sag and reduces hamstring tension. Extending the neck backward instead of maintaining neutral position creates unnecessary spinal stress.​

Why Nordic Curls Are Essential for Athletes

Research consistently demonstrates that Nordic hamstring curls significantly reduce ACL injury risk by building hamstring strength that counteracts anterior tibial translation during jumping, landing, and cutting movements. The eccentric strengthening provided by this exercise is unique and cannot be replicated by most other hamstring exercises, making it indispensable for serious injury prevention programs.

Non-Surgical Rehab Timeline for Meniscus Tears in Athletes

Athletes with meniscus tears can often successfully return to sport through conservative treatment, with rehabilitation timelines varying based on tear severity, location, and individual factors.

Initial Healing Period (Weeks 1-4)

Week 1-2: The acute phase focuses on pain management and swelling control. Apply ice and elevation regularly, use crutches if needed for protected weight-bearing, avoid movements that reproduce pain, and begin gentle range of motion exercises within pain tolerance. Begin isometric muscle activation for quadriceps and hamstrings without moving the joint.

Week 3-4: As symptoms decrease, gradually increase weight-bearing activities and progress to active range of motion exercises. Initiate gentle strengthening exercises for quadriceps, hamstrings, and glutes, and begin stationary cycling with minimal resistance if tolerated. The goal is reducing inflammation while preventing muscle atrophy.

Progressive Strengthening Phase (Weeks 5-8)

This intermediate phase emphasizes building foundational strength. Progressive resistance exercises target all muscle groups around the knee, with single-leg stance and balance training developing proprioception. Increase cycling duration and resistance gradually, add swimming or pool-based exercises for low-impact cardiovascular fitness, and strengthen core and hip muscles for better femoral control during running.

During this period, most athletes notice significant improvements in pain and function, with research showing clinically meaningful improvements typically appearing within 8-12 weeks of proper conservative treatment.​

Return to Activity Phase (Weeks 9-12)

Week 9-10: Begin sport-specific movement patterns at reduced intensity, initiate light jogging if cleared by physical therapist, progress to agility drills without cutting, and continue strength training with increased loads.

Week 11-12: Advance to dynamic movements including controlled cutting and pivoting, sport-specific skills at increasing intensities, plyometric exercises appropriate for sport demands, and continued maintenance of strength and flexibility. Complete functional performance tests to assess readiness for return to sport.

Total Timeline Expectations

Healing for meniscus tears typically takes 4-8 weeks for initial symptom resolution, though the timeframe depends heavily on tear severity and location. Full return to sport usually requires 12 weeks (3 months) for conservative management with comprehensive rehabilitation. Some athletes may return earlier for less demanding activities, while contact sports may require extended rehabilitation.

Research on professional athletes shows that 80% return to sport following meniscus treatment, with return timelines varying by procedure type. For meniscal repair (when surgery is needed), athletes typically return in 4-6 months, while partial meniscectomy allows faster return at 7-8.5 weeks for professional athletes.

Success Factors for Conservative Treatment

Success rates improve with early initiation of proper treatment protocols, high compliance with rehabilitation exercises, absence of mechanical symptoms like locking or catching, appropriate activity modification during healing, and realistic expectations about timeline and outcomes. Studies show that 68% of meniscus tears treated conservatively avoid surgery when these factors are present.​

When to Consider Surgery

If symptoms persist after 3 months of proper conservative treatment, surgical intervention should be reconsidered. Other indicators include mechanical locking or catching that limits function, significant functional limitations despite rehabilitation, desire to return to high-level competition quickly, and younger age with high activity demands.

PRP Therapy vs Conservative Treatment for Knee Injuries

Platelet-rich plasma (PRP) therapy has emerged as an intermediate treatment option between conservative management and surgery for knee injuries, with recent research providing clearer guidance on effectiveness.

PRP Therapy Effectiveness

Recent meta-analyses demonstrate significant clinical benefits for knee osteoarthritis. PRP provides clinically relevant functional improvement at 1, 3, 6, and 12 months compared to placebo, with improvements exceeding the minimal clinically important difference (MCID). For pain relief, PRP shows clinically significant reduction at 3 and 6 months compared to placebo, exceeding MCID thresholds. Patient-reported outcomes include reduced pain and stiffness within the first few weeks, improved mobility and daily activity performance, higher satisfaction rates compared to traditional injections, and fewer side effects since treatment uses the body’s own healing components.

Superior to Hyaluronic Acid: Meta-analyses from 2024-2025 reveal that PRP produces greater improvements in pain reduction and physical function compared to hyaluronic acid (gel) injections, particularly for mild to moderate osteoarthritis. Emerging imaging studies suggest PRP may slow cartilage loss progression, potentially delaying knee replacement surgery needs.​

PRP vs Conservative Treatment Comparison

A large randomized trial with 804 patients comparing PRP alone, supervised exercise alone, and PRP combined with exercise provides critical insights.​

Short-Term Results (0-8 weeks): PRP demonstrated comparable efficacy to exercise or PRP plus exercise during initial weeks, with all groups showing significant pain reduction.​

Long-Term Results (24 weeks): Exercise groups showed statistically greater impact than PRP alone, with large to very large effect sizes for pain, self-reported function, and functional performance tests. The PRP and exercise combination produced greatest pain reduction from baseline to 24 weeks (Δ -5.40 points). PRP alone demonstrated a negative tendency for long-term clinical improvements compared to other groups.​

Key Finding: PRP alone is not as effective as supervised exercise for long-term outcomes, though it can be offered as an alternative if patients have difficulties maintaining exercise programs.​

Treatment Timeline and Expectations

PRP therapy protocols typically recommend 1-3 injections spaced several weeks apart. Improvements appear gradually as natural healing processes are activated, with patients noticing benefits over weeks to months rather than immediate relief. Benefits can continue for months after the final injection as healing cascades remain active.

Conservative treatment (physical therapy and exercise) shows gradual improvement with clinically meaningful changes appearing within 8-12 weeks and sustained results at 1-year follow-up.

Platelet Concentration Matters

Research demonstrates that high-platelet PRP provides superior pain relief and more durable functional improvement compared to low-platelet PRP. This finding emphasizes the importance of preparation protocols and concentration standards for optimal outcomes.​

Long-Term Sustainability

PRP therapy promotes the body’s natural healing processes and may repair damaged tissues, potentially reducing the need for more invasive treatments. However, research suggests that conservative exercise-based treatment produces more sustainable long-term outcomes than PRP alone.

Traditional conservative treatments combined with PRP may offer synergistic benefits, with the combination showing greatest overall improvements in pain and function. Conservative exercise alone demonstrates excellent long-term efficacy without additional costs or procedures.​

Clinical Recommendations

Best Candidates for PRP: Patients with mild to moderate knee osteoarthritis, individuals unable to consistently maintain exercise programs, athletes seeking accelerated healing combined with rehabilitation, and patients who have not responded adequately to physical therapy alone.

Best Candidates for Conservative Treatment Alone: Patients capable of high compliance with exercise protocols, individuals with adequate time for graduated rehabilitation, athletes with less severe injuries, and those preferring non-invasive approaches.​

Optimal Approach: Research suggests that PRP combined with supervised exercise provides superior outcomes to either treatment alone, particularly for long-term pain relief and functional improvement. This combination approach addresses both tissue healing (PRP) and neuromuscular function (exercise), creating comprehensive knee joint restoration.​

Cost and Accessibility Considerations

Conservative treatment through physical therapy typically costs less and has broader insurance coverage than PRP injections. PRP therapy may involve significant out-of-pocket expenses as insurance coverage varies. However, if PRP prevents the need for eventual surgery, it may prove cost-effective long-term.​

Best Low-Impact Cross-Training for Knee Injury Prevention

Low-impact cross-training activities minimize joint stress while maintaining cardiovascular fitness, building strength, and supporting recovery from knee injuries.

Swimming: The Ultimate Low-Impact Exercise

Swimming represents the top choice for low-impact cross-training due to water’s supportive environment that reduces body weight by up to 90%. This allows full range of motion without compressive forces, making it perfect for knee injuries.​

Cardiovascular Benefits: Swimming improves lung capacity and heart efficiency, building endurance for other athletic activities. Research demonstrates effectiveness for improving VO2 peak and overall aerobic capacity.

Muscle Development: Swimming strengthens upper body and core while providing balanced muscle development. For athletes recovering from patellofemoral pain, aquatic training outperforms land-based options in enhancing knee function. Post-ACL surgery, early aquatic therapy helps regain normal gait and conditioning faster, lowering long-term complication risks.

Specific Benefits: High-intensity interval swimming improves endurance and muscular power while enhancing balance and agility, key factors for injury prevention. Water resistance builds strength without joint compression.

Implementation: Begin with 20-30 minutes of continuous swimming 2-3 times weekly, incorporate various strokes to work different muscle groups, use pool buoys or kickboards to isolate upper or lower body, and progress to high-intensity interval training as tolerance improves.​

Cycling: Joint-Friendly Cardiovascular Training

Cycling provides excellent cardiovascular conditioning without impact stress on knees, hips, and ankles.

Rehabilitation Benefits: Research confirms cycling as a staple for endurance athletes’ cross-training, aiding recovery from intense sessions while building aerobic base. For patellofemoral pain, high-intensity cycling boosts knee strength and reduces symptoms. Cycling promotes bone regeneration through mechanical stimulation, ideal for stress injury recovery.​

Muscle Engagement: Strengthens quadriceps, hamstrings, and glutes while improving knee range of motion. Lower-body dominant activity complements swimming’s upper-body focus.

Practical Application: Start with stationary cycling for controlled resistance and positioning, maintain cadence of 80-100 RPM for optimal knee mechanics, begin with 20-30 minutes at moderate intensity, progress outdoor cycling once indoor tolerance is established, and avoid excessive resistance that stresses knee structures.

Elliptical Training: Controlled Movement Patterns

Elliptical machines provide cardiovascular exercise with reduced joint stress compared to running while maintaining similar movement patterns.

Advantages: Mimics running gait without impact forces, allows adjustable resistance and incline, provides upper and lower body engagement, and maintains weight-bearing benefits for bone health. Elliptical training helps maintain running-specific conditioning during knee injury recovery.

Usage Guidelines: Begin with 15-20 minutes at comfortable resistance, focus on smooth, controlled motion without bouncing, gradually increase duration before increasing resistance, and maintain upright posture with core engagement.

Yoga: Flexibility, Strength, and Body Awareness

Yoga combines flexibility, strength development, and enhanced body awareness crucial for injury prevention.

Knee-Specific Benefits: Improves flexibility in muscles surrounding the knee, builds eccentric strength through controlled movements, enhances proprioception and balance, develops core stability essential for proper lower extremity mechanics, and teaches breath control and body awareness.

Safe Practice: Avoid poses requiring deep knee flexion if experiencing pain, modify warrior poses and lunges to comfortable range, emphasize alignment and proper form over depth, use props (blocks, straps) to support positions, and focus on gentle, restorative yoga during acute injury phases.​

Walking: Accessible Foundation Exercise

Walking provides accessible, low-impact exercise suitable for all fitness levels and injury stages.

Benefits: Maintains cardiovascular fitness without impact stress, promotes joint mobility and circulation, allows gradual progression of intensity and duration, easily integrated into daily routine, and provides outdoor options for mental health benefits.

Progressive Walking Program: Start with 10-15 minutes on flat terrain, increase duration by 5 minutes weekly, add gentle inclines as tolerance improves, progress to brisk walking for cardiovascular challenge, and consider Nordic walking poles for upper body engagement.

Rowing: Full-Body Low-Impact Power

Rowing machines provide comprehensive cardiovascular and strength training with minimal knee stress when performed with proper technique.

Advantages: Engages 85% of body’s muscles in coordinated movement, builds posterior chain strength (hamstrings, glutes, back), improves cardiovascular endurance, and allows high-intensity intervals without impact.​

Proper Technique: Focus on driving through legs while maintaining slight knee bend, avoid excessive knee flexion beyond comfortable range, emphasize smooth, controlled stroke pattern, and maintain upright posture throughout movement.​

Cross-Training Implementation Strategy

For optimal knee injury prevention, incorporate 2-3 different low-impact activities weekly to provide variety and balanced muscle development. Alternate activities to prevent overuse of specific movement patterns, with swimming on Monday, cycling on Wednesday, and yoga on Friday as a sample rotation.

Use low-impact cross-training for active recovery days between high-intensity or high-impact training sessions. During injury rehabilitation, replace high-impact activities entirely with low-impact alternatives until cleared for progression.

Key Principles for Success

Reduced joint stress protects knees, hips, and ankles from excessive wear and tear. Enhanced recovery facilitates active recovery, allowing quicker tissue repair. Cardiovascular maintenance sustains endurance without high impact. Balanced development addresses muscle imbalances created by sport-specific training.

The most effective approach combines multiple low-impact activities, adjusts intensity based on knee symptoms and recovery needs, maintains consistency with 3-5 sessions weekly, and progresses gradually as tolerance and function improve.