Context: Nordic hamstring exercise (NHE) has been widely employed to prevent hamstring strain injuries. However, it is still not clear which adaptations are responsible for the NHE preventive effects. Objectives: The aim of this study was to investigate the effects of NHE on knee flexors eccentric strength and fascicle length. Evidence Acquisition: The search strategy included MEDLINE, PEDro, and Cochrane CENTRAL from inception to April 2020. Randomized clinical trials that have analyzed the effects of NHE training on hamstring eccentric strength and/or fascicle length were included. Evidence Synthesis: From the 1932 studies identified, 12 were included in the systematic review, and 9 studies presented suitable data for the meta-analysis. All studies demonstrated strength increments in response to NHE training (10%–15% and 16%–26% in tests performed on the isokinetic dynamometer and on the NHE device, respectively), as well as significant enhancement of biceps femoris long head fascicle length (12%–22%). Meta-analysis showed NHE training was effective to increase knee flexors eccentric strength assessed with both isokinetic tests (0.68; 95% confidence interval, 0.29 to 1.06) and NHE tests (1.11; 95% confidence interval, 0.62 to 1.61). NHE training was also effective to increase fascicle length (0.97; 95% confidence interval, 0.46 to 1.48). Conclusions: NHE training has the potential of increasing both knee flexors eccentric strength and biceps femoris long head fascicle length.