Single-Leg Romanian Deadlifts for Hamstring Injury Prevention
High school track sprinters did this exercise, and mild-to-moderate hamstring strains dropped significantly.
I’ve seen a few promising track seasons derail because of hamstring pulls or training sessions adjusted for a sharp twinge in the back of the thigh during a sprint. We know how devastating these injuries can be for the athlete, physically and mentally.
Hamstring strain injuries remain the most common acute injury in track and field, with nearly half of elite athletes experiencing them during their careers. This study examined whether adding a simple, equipment-free exercise, like the Single-Leg Romanian Deadlift to warm-ups could offer a practical alternative to the notoriously difficult-to-maintain Nordic hamstring exercise.
PMID: 40322523
Study Overview
This cohort study followed 77 high school track and field athletes across two consecutive seasons to determine whether incorporating the Single-Leg Romanian Deadlift (SLRDL) into pre-training warm-ups could reduce hamstring strain injury risk. The research was conducted by the same coaching and athletic training staff at a single Japanese high school, comparing a control season (2022) with an intervention season (2023).
Aim
The primary objective was to examine whether the SLRDL could effectively reduce hamstring strain injury risk as a more compliant alternative to the Nordic hamstring exercise (NHE). The NHE often suffers from poor adherence due to causing delayed-onset muscle soreness, requiring partners or equipment, and potentially decreasing sprint performance.
Methods
Participants
Seventy-seven high school track and field athletes participated: 40 athletes in the control season (21 men, 19 women, average age 16.8 years) and 37 in the intervention season (16 men, 21 women, average age 17.0 years). Twenty-eight athletes participated in both seasons. Athletes specialised primarily in short-distance running (70-75%), jumping (17.5-21.6%), and combined events (7.5-8.1%), excluding long-distance runners. Athletes with prior hamstring injury history were excluded.
Intervention Protocol
During the intervention season, athletes added the SLRDL to their standard warm-up routine, which otherwise remained unchanged from the control season. The SLRDL protocol consisted of 3 sets of 3 repetitions per leg, performed during the dynamic stretching portion of warm-up. Athletes performed the exercise using only bodyweight, maintaining balance by touching a wall or handrail with the opposite hand. The athletic trainer instructed athletes to maintain a neutral spine while flexing the hip joint and slightly bending the knee of the loaded leg, keeping the unloaded leg extended.
Injury Surveillance
An athletic trainer recorded all hamstring strain injuries throughout both seasons, defined as acute posterior thigh pain during practice or competition that caused immediate cessation of activity and inability to participate in the next session. Athlete-hours (AH) were calculated by multiplying practice/competition days by the number of participating athletes and activity hours. Time to return to full training (TRFT) was recorded, with mild-to-moderate injuries classified as 1-47 days and severe injuries as 48 days or longer.
Statistical Analysis
Injury incidence was calculated per 1,000 athlete-hours. Risk ratios (RR) with 95% confidence intervals were calculated comparing control and intervention seasons for mild-to-moderate, severe, and total hamstring injuries. Athletes completed compliance questionnaires at the end of the intervention season.
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Results
Injury Incidence
In the control season, 15 hamstring strain injuries occurred over 25,011 athlete-hours (0.60 injuries per 1,000 AH), while the intervention season saw 8 injuries over 26,445 athlete-hours (0.30 injuries per 1,000 AH). Training injuries decreased from 9 to 5, and competition injuries dropped from 6 to 3 between seasons.
Mild-to-Moderate Injuries
The SLRDL intervention demonstrated significant effectiveness for mild-to-moderate hamstring injuries, indicating a 66% reduction in risk. Specifically, 14 mild-to-moderate injuries occurred in the control season (0.56 per 1,000 AH) compared to 5 in the intervention season (0.19 per 1,000 AH).
Severe Injuries
No significant effect was observed for severe injuries, with a risk ratio of 2.84 (95% CI: 0.30-27.28). One severe injury occurred during the control season (0.04 per 1,000 AH) versus three during the intervention season (0.11 per 1,000 AH). However, these numbers were too small to draw definitive conclusions.
Compliance
Athletes demonstrated exceptional adherence to the SLRDL protocol, with 98.67% compliance. On average, athletes performed the exercise 5.92 times per week out of a possible 6 practice/competition sessions.
Practical Takeaways
For Track Athletes and Sprint-Based Athletes
Add 3 sets of 3 reps of bodyweight-only, single-leg Romanian deadlifts per leg to your warm-up routine before sprint training or competitions. This takes minimal time, requires no equipment beyond a wall for balance, and can reduce your risk of mild-to-moderate hamstring strains by approximately 66%.
For Strength Training Programs
The SLRDL activates both the hamstrings and gluteus maximus muscles through eccentric contractions, making it valuable not just for injury prevention but also for strengthening these posterior chain muscles. If you find Nordic hamstring exercises too difficult, cause excessive soreness, or interfere with your sprint training, the SLRDL offers a practical starting point.
Implementation Strategy
Perform the exercise unilaterally (one leg at a time) during your dynamic warm-up phase. Stand on one leg, keep your core tight, slightly bend the loaded knee, and hinge at the hip while keeping your spine neutral. Lower until your spine is roughly parallel to the floor (or as far as your hamstring flexibility allows), then return to standing by contracting your hamstrings and glutes. Use your opposite hand against a wall for balance.
When SLRDL May Not Be Enough
This exercise appears less effective for preventing severe hamstring injuries—those requiring 48+ days to return to full training. The researchers suggest this may be because the SLRDL generates less muscle force than the Nordic hamstring exercise and was performed with bodyweight only. For more comprehensive protection, particularly if you have a history of severe hamstring injuries, consider using the SLRDL as a heavy, loaded primary hamstring lift. Or as an alternative eccentric training tool to the Nordic hamstring exercise.
Key Takeaways
The Single-Leg Romanian Deadlift presents a highly practical and compliant warm-up intervention that significantly reduces mild-to-moderate hamstring strain injuries in track athletes, with 98.67% adherence compared to the typically poor compliance with Nordic hamstring exercises. The exercise cut the risk of less severe hamstring injuries by 66% when performed as just 3 sets of 3 reps per leg during warm-ups. However, its lower intensity compared to Nordic hamstring exercises may limit effectiveness against severe injuries, suggesting it could work well as an accessible entry point for injury prevention. It would have been great to have tried heavier 3-6 RM loads for a more demanding eccentric training protocol. Would we have seen an increased protection against hamstring strain injuries more closely resembling what has been noted with NHE use?
Finally, the exceptional compliance rate demonstrates that simpler, equipment-free exercises performed during existing warm-up routines can overcome the adherence barriers that undermine more evidence-based but difficult-to-maintain prevention programs.
Reference
Otani R, Nishikawa H, Matsunaga S, Hiroshige Y, Nakamura M. The Effect of Single Leg Romanian Deadlift on the Risk of Hamstring Strain Injuries in Track and Field Athletes: A Cohort Study. Int J Sports Phys Ther. 2025 May 2;20(5):657-665. doi: 10.26603/001c.136803. PMID: 40322523; PMCID: PMC12048357.
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Excellent breakdown of this study. That 98.67% complance rate is wild compared to how NHE programs usually fall apart after a few weeks. The catch is that bodyweight-only SLRDLs missed the severe injuries entirely, which kinda suggests we're leaving adaptations on the table. Seems like there's an obvious middle ground here: start with bodyweight for complance, then progressively load them as intensty tolerance builds instead of jumping straight to max eccentric protocols.