There’s a particular kind of dread that sets in when you feel a twinge sprinting for a ball, or a sharp pull deep in your groin cutting back on the footy field. You know instantly it’s not “just a niggle.” A hamstring or adductor strain has a way of sidelining athletes – weekend warriors and semi-professionals alike – for anywhere from two to twelve weeks, and it has an irritating habit of coming back for round two if the rehab isn’t done properly.

The good news is that a huge amount of research has gone into working out how to stop these injuries before they happen. Two unglamorous, slightly uncomfortable exercises keep coming out on top: the Nordic hamstring curl and the Copenhagen plank. Neither requires fancy equipment. Both have solid evidence behind them. And both are exercises we prescribe regularly here at Praxis for footballers, runners, netballers, and anyone whose sport involves sprinting, kicking, or rapid change of direction.

If you’ve read our piece on hamstring strain injuries and the latest research, you’ll know how frustrating and recurrence-prone these injuries can be. This post is about the flip side – prevention.

WHY THESE TWO EXERCISES?

Hamstring strains and groin/adductor strains are consistently among the most common injuries in field and court sports, and they share a common thread: both muscle groups are asked to produce huge eccentric (lengthening) forces at high speed – the hamstrings decelerating the leg at the end of a sprint stride, the adductors controlling hip abduction during cutting, kicking, and change of direction. Ryan, DeBurca, and Mc Creesh (2014) identified reduced hip adduction strength and previous injury as consistent risk factors for groin and hip injuries in field sports, which is exactly why targeted eccentric strengthening – rather than generic core or gym work – has become the focus of prevention research.

The Nordic hamstring curl trains the hamstrings eccentrically in a lengthened position, closely mimicking the demands of late-swing-phase sprinting. The Copenhagen plank does the same job for the adductors, loading them through a long lever in a side-plank position. Both are simple, both are brutal the first few sessions, and both have research behind them that most gym exercises simply don’t.

THE EVIDENCE FOR NORDIC CURLS

This is where the evidence gets genuinely compelling. Petersen et al. (2011) ran a cluster-randomised controlled trial across 50 Danish soccer teams and found that a progressive Nordic curl programme significantly reduced the rate of both new and recurrent acute hamstring injuries compared with teams doing standard training alone.

That finding has since been confirmed at a much larger scale. Al Attar et al. (2017), in a systematic review and meta-analysis, found that injury prevention programmes including the Nordic hamstring exercise reduced hamstring injury rates by around 51% compared with teams using no such programme. Then van Dyk, Behan, and Whiteley (2019) pooled data from over 8,000 athletes across multiple sports and confirmed an injury rate ratio of roughly 0.49 – essentially, teams doing Nordic curls consistently were about half as likely to suffer a hamstring strain.

There’s also a mechanistic explanation for why it works. Cuthbert et al. (2020) showed that Nordic curl training reliably increases fascicle length in the biceps femoris (the hamstring muscle most commonly injured), meaning the muscle can tolerate greater lengthening at speed before it’s strained – exactly the adaptation you’d want for a sprinting athlete.

WHAT ABOUT THE COPENHAGEN PLANK?

The Copenhagen plank is the adductor equivalent, and the research trail here follows a similar pattern. Ishoi et al. (2016), in a randomised controlled trial with football players, found that an eight-week progressive Copenhagen adduction programme produced large increases in eccentric hip adduction strength – in the order of 9-36% – a strength quality that’s directly linked to groin injury risk.

More importantly, Haroy et al. (2019) tested a Copenhagen-plank-based “Adductor Strengthening Programme” in a cluster-randomised controlled trial across men’s football teams and found it reduced the prevalence of groin problems by roughly 41% over a season. That’s a real-world, injury-outcome level of evidence – not just a strength-testing study.

If you’ve dealt with lingering groin pain before, our article on chronic groin pain and athletic pubalgia covers what happens when adductor-related pain becomes a persistent problem rather than a one-off strain – prevention really is the better option. And for our fast-bowling readers, the same principle of building lengthened-position eccentric capacity applies to the trunk, which is exactly what we discuss in understanding the “side strain” in cricket fast bowlers.

BUSTING THE MYTH: “THESE ARE JUST FOR ELITE FOOTBALLERS”

A common reason these exercises don’t make it into club or weekend-sport training is the assumption they’re only relevant at the professional level. Ironically, Bahr, Thorborg, and Ekstrand (2015) found that even among Champions League and Norwegian Premier League clubs – the exact population the Nordic curl research was built on – only around 11% of teams had fully implemented the protocol, largely due to discomfort, muscle soreness in early weeks, and poor buy-in. If elite clubs with full-time medical staff struggle with compliance, it’s not because the exercise is “too advanced” for amateurs – it’s because dosing and coaching matter, and soreness is manageable with a sensible progression. The upside – roughly halving your hamstring injury risk (van Dyk et al., 2019) – applies to any athlete doing repeated sprinting or change of direction, not just professionals.

HOW TO PROGRAM THEM SAFELY

Both exercises reward patience over bravado. Start with partial-range, assisted Nordic curls (2 sets of 3-5 reps) and low-rep Copenhagen planks (holding from the knee rather than full extension) for the first one to two weeks – expect some genuine delayed-onset soreness early on, which settles quickly with consistent, gradual loading (Cuthbert et al., 2020). From there, progress volume and range over 6-10 weeks toward full-range Nordics and full Copenhagen planks, aiming for two to three sessions a week during pre-season and one maintenance session weekly in-season – mirroring the dosing used in the trials above.

For a visual guide, our physiotherapists have demonstrated the Nordic curl (listed as “Nordic / Hamstring Lower”) on our YouTube channel, @praxisphysiotherapy – well worth a watch before you try it for the first time. The Copenhagen plank is also demonstrated on our YouTube channel, @praxisphysiotherapy.

THE TAKEAWAY

The Nordic hamstring curl and the Copenhagen plank aren’t glamorous, and they’re not comfortable – especially in the first fortnight – but they’re two of the best-evidenced injury prevention exercises in sports medicine. Done consistently and progressed sensibly, they can meaningfully cut your risk of the kind of hamstring or groin strain that ends a season, not just a game.

If you want a strength program tailored to your sport, position, and current niggles rather than a generic YouTube routine, book in with one of our physiotherapists at Praxis. We’ll assess your strength and movement, build a progression that suits your training load, and help you stay on the park.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Woolloongabba, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

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Al Attar, W.S.A., Soomro, N., Sinclair, P.J., Pappas, E., & Sanders, R.H. (2017). Effect of Injury Prevention Programs that Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis. Sports Medicine, 47(5), 907-916.

Bahr, R., Thorborg, K., & Ekstrand, J. (2015). Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey. British Journal of Sports Medicine, 49(22), 1466-1471.

Cuthbert, M., Ripley, N., McMahon, J.J., Evans, M., Haff, G.G., & Comfort, P. (2020). The Effect of Nordic Hamstring Exercise Intervention Volume on Eccentric Strength and Muscle Architecture Adaptations: A Systematic Review and Meta-analyses. Sports Medicine, 50(1), 83-99.

Haroy, J., Clarsen, B., Wiger, E.G., Oyen, M.G., Serner, A., Thorborg, K., Holmich, P., Andersen, T.E., & Bahr, R. (2019). The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. British Journal of Sports Medicine, 53(3), 145-152.

Ishoi, L., Sorensen, C.N., Kaae, N.M., Jorgensen, L.B., Holmich, P., & Serner, A. (2016). Large eccentric strength increase using the Copenhagen Adduction exercise in football: A randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports, 26(11), 1334-1342.

Petersen, J., Thorborg, K., Nielsen, M.B., Budtz-Jorgensen, E., & Holmich, P. (2011). Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men’s Soccer: A Cluster-Randomized Controlled Trial. American Journal of Sports Medicine, 39(11), 2296-2303.

Ryan, J., DeBurca, N., & Mc Creesh, K. (2014). Risk factors for groin/hip injuries in field-based sports: a systematic review. British Journal of Sports Medicine, 48(14), 1089-1096.

van Dyk, N., Behan, F.P., & 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, 53(21), 1362-1370.

“I wasn’t even sprinting…” It’s one of the most common stories I hear in the clinic. “I pushed off to chase the football” “I accelerated after my dog.” “I was only halfway through my run.” “It felt like someone kicked me in the calf.” The diagnosis is usually the same: a calf strain.

In sporting circles, particularly AFL, this injury has become so common that it has earned its own nickname: “Old Man Calf.” The term is tongue in cheek, but the injury certainly isn’t. Calf strains are one of the most frustrating soft-tissue injuries affecting middle-aged athletes and recreational runners. They also have a well documented habit of recurring when they aren’t managed properly.

As someone who treats these injuries regularly, and who has experienced a few myself, I know how debilitating and frustrating they can be. The encouraging part is that they’re also one of the more preventable injuries once you understand why they happen.

Why does it happen?

Age itself isn’t really the problem. What ageing does is create a perfect storm of small physiological changes that gradually chip away at the calf’s ability to tolerate high speed loading.

These changes include a reduction in muscle mass, known as sarcopenia, driven largely by the progressive loss of motor neurons and the muscle fibres they supply (Larsson et al., 2019; Nishikawa et al., 2021). Achilles tendon stiffness also appears to decline with age: research using ultrasound and biofeedback found that older adults produced up to 44% less tendon stiffness than younger adults at matched levels of muscle activation, altering how efficiently force transfers from muscle to bone during push-off (Gray et al., 2024). Interestingly, when load rather than effort is matched, some studies find no real difference in tendon stiffness between younger and older adults, suggesting a good portion of this “stiffness loss” is really a downstream effect of age-related strength loss rather than the tendon tissue itself deteriorating (Jakubowski et al., 2024). Either way, the practical implication is the same: rebuilding strength is central to rebuilding tendon function. Alongside these structural changes, recovery between training sessions slows, maximal strength and power decline, and most people simply stop exposing their calves to genuine sprinting on a regular basis.

None of these changes is dramatic on its own. Together, though, they mean the calf has less “reserve capacity” available when a sudden, explosive movement is demanded of it. That’s why so many people tear a calf doing something they’ve done hundreds of times before without issue.

Why AFL players seem particularly vulnerable

If you’ve watched AFL over the past decade, you’ve probably heard the commentary: “another calf injury,” with veteran players seeming especially susceptible. This isn’t coincidence.

Older AFL players typically retain excellent aerobic fitness and game awareness, but they’re still required to produce repeated maximal accelerations, decelerations and changes of direction, and these explosive actions place enormous force through the calf complex. Data from the AFL’s Soft Tissue Injury Registry back this up. An early analysis of muscle strains across the competition found that age was an independent risk factor for calf strains even after adjusting for injury history, while it wasn’t a risk factor for quadriceps strains, suggesting there’s something specific about how the calf tolerates ageing under repeated high-speed loading (Orchard, 2001). A later 23-year cohort of more than 3,600 muscle strains across the AFL confirmed the pattern, with each additional year of age increasing the odds of a calf strain by around 60% (Orchard et al., 2020). Older players who do sustain a calf strain also tend to take longer to recover (Gray et al., 2025), and a history of calf strain combined with older age substantially raises the risk of a further injury within the following two seasons (Green et al., 2020).

Elite sport doesn’t create this vulnerability; it simply exposes it more publicly.

Recreational runners aren’t immune

You don’t need to play AFL to be at risk. Many of the calf tears seen in clinic occur in park runners, masters athletes, weekend footballers, tennis and pickleball players, golfers walking steep courses, and parents chasing kids around the backyard. Pickleball in particular has seen a sharp rise in soft tissue injuries as participation among older adults has grown, with calf strains featuring among the most commonly recorded injuries at one US orthopaedic centre (Herzberg et al., 2025).

The common thread in all these cases is an athlete who remains active, but who isn’t regularly exposing their calves to high-speed loading. Your cardiovascular fitness might still be excellent. Your calf’s capacity to absorb a sudden sprint or lunge may not be.

Which muscle actually tears?

Most people simply say they’ve “done their calf,” but several distinct structures can be involved, and it’s worth knowing the difference.

Gastrocnemius is the larger, more superficial of the two major calf muscles. It’s typically injured during explosive acceleration, jumping or sprinting, and pain is often felt high in the calf and occurs suddenly. In a 10-year cohort of elite AFL players, gastrocnemius injuries most commonly affected the medial head (78% of cases), with acceleration being the single most common mechanism of injury (Gray et al., 2025).

Soleus sits deeper and functions more as an endurance muscle. It’s commonly injured during running or prolonged loading, and pain is usually felt lower in the calf, often starting as tightness before becoming more obviously painful. In the same injury registry, soleus injuries were actually more prevalent overall than gastrocnemius injuries, accounting for around 85% of all calf strains in elite AFL players, and were far more likely to recur (Green et al., 2019). Because soleus symptoms tend to develop more gradually, they’re often under-recognised in older runners until the injury is well established.

Why do calf tears keep coming back?

This is probably the biggest source of frustration for patients. Many people feel “pretty good” after three to four weeks: they can walk, they can cycle, and they might even jog comfortably. Unfortunately, healing tissue isn’t the same as fully restored tissue.

The evidence on recurrence is sobering. In elite AFL players, a prior calf strain increased the risk of a further injury several-fold, and older age independently increased that risk further still (Green et al., 2020). A separate analysis of over 3,600 muscle strains across 23 AFL seasons found that the risk of recurrence stays elevated for around 15 weeks after return to play, and that a recent history of the same injury was, by a wide margin, the strongest predictor of injuring it again (Orchard et al., 2020). Put simply, unless strength, endurance, plyometric capacity and sprint exposure are specifically rebuilt, the calf returns to sport with reduced capacity, and eventually something gives again.

Can you prevent “Old Man Calf”?

The encouraging answer is yes. While age can’t be changed, capacity can.

Heavy calf strength. Strong calves tolerate greater force before they fail. Heavy seated and standing calf raises should be part of long-term training, not something reserved for rehab after an injury has already occurred. Eccentric loading in particular has been shown to drive meaningful adaptations in tendon properties and may be especially well suited to older adults, since it can achieve those adaptations at comparatively lower relative demands than other contraction types (Quinlan et al., 2019).

Plyometric training. Skipping, hopping and bounding, performed in small, consistent doses, help the calf improve its ability to store and release elastic energy efficiently.

Sprint exposure. This is perhaps the most overlooked factor of all. Many recreational runners train at a single, moderate pace and then, once every few months, need to sprint for a bus, a ball or a toddler heading for the road. That’s the equivalent of expecting a shoulder to throw a ball at full pace without ever having practised it. Regular controlled strides, accelerations and genuinely faster running help maintain the calf’s resilience to sudden demand.

Consistent training volume. Sharp spikes in training load remain one of the most consistently identified injury risk factors. In professional footballers, a week of unusually high external workload, particularly involving high-intensity accelerations and decelerations, regularly preceded calf strain injuries, and injured players were, on average, older than their uninjured teammates (Soler et al., 2024). The calf tends to prefer gradual, planned increases over heroic weekends bolted onto weeks of inactivity.

Recovery. Sleep, nutrition and ongoing strength training all matter more after 40, simply because recovery isn’t as forgiving as it once was.

Don’t ignore persistent calf tightness

One of the most common mistakes I see is assuming every tight calf just needs stretching. Persistent tightness can actually represent residual weakness, reduced tendon capacity, neural fatigue, or an incompletely healed muscle injury. Stretching alone rarely resolves any of these underlying issues.

A proper assessment should identify why the calf feels tight in the first place. Often, the answer is that it needs to get stronger, not longer.

When should you seek help?

It’s worth having the injury assessed if you experience sudden pain with a popping sensation, difficulty pushing up onto your toes, swelling or bruising, repeated calf strains, or calf tightness that never quite seems to resolve.

A detailed examination can usually determine which structure has been injured, whether imaging is required, and, most importantly, what needs to be rebuilt before you return to running or sport.

The bottom line

“Old Man Calf” might sound like a joke, but it reflects a genuine physiological phenomenon. As we age, our calves gradually lose reserve capacity, and without ongoing strength, power and speed exposure, they’re regularly asked to perform tasks they simply haven’t been prepared for.

Fortunately, this isn’t inevitable. With the right combination of strength training, progressive running, plyometrics and intelligent rehabilitation, many athletes continue running, competing and enjoying sport well into their 50s, 60s and beyond. Age may increase the risk, but it doesn’t have to define your future. If you have struggled (like I have) with calf tears derailing your activity participation, or you fear the return to running stage, book in with one of our physios today to get you back to your best! 

Until next time, Praxis What You Preach 

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

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References

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