Due to their potential positive outcomes, hamstring eccentric exercises are becoming increasingly popular in training regimens. Among the various exercises, the Nordic Hamstring Exercise (NHE) is the most common. Despite its popularity, there are still some doubts about its benefits and risks. So, the aim of this umbrella review was to summarize the effects of NHE on performance and injury prevention. Following the PRISMA guidelines, a comprehensive literature search was conducted across multiple e-databases, according to the P (injured and non-injured athletes or recreationally active or healthy individuals) I (NHE) C (no intervention, placebo, or other interventions) O (performance or injury) S (systematic reviews) model. The quality of the studies was accessed with the AMSTAR-2. From the 916 systematic reviews found, only 10 could be included. They encompassed 125 studies, enrolling 17,260 subjects. The results from the studies indicate that NHE interventions demonstrated positive effects on sprint performance, muscle activation, eccentric strength, and muscle architecture (fascicle length, muscle thickness, and pennation angle). Furthermore, NHE is effective in preventing hamstring injuries (up to 51%). In conclusion, NHE should be integrated in training (especially, in the warm-up phase) for both enhancing athletic performance and preventing hamstring injuries. For achieving more positive results, it is recommended that high-volume is followed by low-volume maintenance, targeting 48 reps/week.

Given the posterior chain configuration, it is anticipated that tibial positioning influences hamstring recruitment; medial hamstrings should be more activated during medial rotation, while lateral hamstrings should be more activated during lateral rotation. However, most studies showing this pattern have focused on concentric or isometric strength, leaving the influence on eccentric strength fairly unknown. Therefore, the aim of this study was to investigate the electromyographic response of the hamstring muscles during Nordic hamstring exercises in three leg positions: internal rotation, external rotation, and neutral. This study encompassed a randomized crossover study and used surface electromyography to analyze the activity of the biceps femoris and semitendinosus muscles during the Nordic hamstring exercise, in the three positions. Results indicated no statistically significant differences in muscle activation between positions or sides (p > 0.05), though small effect sizes were observed for the biceps femoris in different positions (η² = 0.01–0.03). Furthermore, the internal rotation position generally elicited the highest muscle activations. Notably, biceps femoris muscles exhibited higher activations compared to semitendinosus muscles, with the greatest differences seen in the internal rotation position. This suggests that tibial rotation influences hamstring recruitment patterns; however, it was lower than expected.