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Hamstring Strain Rehab

Hamstring Strain Rehab: The Askling L-Protocol

The snow has melted (for the most part) and soccer season is fast approaching! Hamstring muscle strains are very common injuries in sports that involve sprinting, quick starting and stopping, and jumping. For this reason, they are one of the most common injuries in soccer. Getting back to the game after a hamstring strain can be frustratingly slow and reinjury can be common without the proper guidance. Evidence shows that the Askling Lengthening-Protocol (or L-Protocol) is superior to other protocol guidelines in getting you back onto the field and reducing the likelihood of reinjury.

What causes a hamstring muscle strain?
The hamstrings are a group of muscles in the back of the thigh. They lengthen as the hip flexes forward and as the knee straightens. Sometimes the amount of lengthening can exceed the mechanical limits that the muscle is accustomed to. Hamstring strains are typically caused by either a quick contraction (when sprinting) or by overstretch of the hamstrings (from a high kick). Both of these mechanisms can result in microscopic damage to the fibres of the musculotendinous unit (this is where the muscle forms tendon and connects to the bone).

What makes an athlete more prone to injury?
You are more likely to have a hamstring injury the older you are and if you have had a previous hamstring strain. While these are not things we can change, the good news is that there are factors we can address that have been shown to reduce the likelihood of injury! Modifiable risk factors include weakness in the hamstring muscle group, level of fatigue, and poor flexibility in the quadricep muscles in the front of the thigh. Research suggests that eccentric strengthening (strengthening as the muscle is getting longer) of the hamstrings can greatly improve hamstring strength. The majority of strains occur towards the end of a game or practice due to fatigue and muscle compensation which can be addressed through conditioning training. Lastly, quadriceps flexibility can be improved with stretching exercises following a good warm-up.

The Askling L-Protocol
This rehabilitation protocol was found to be the most effective in managing hamstring strains between those compared in the research paper by Askling et al. (2013). Exercises involving the lengthening phase of a muscle contraction (known as eccentric exercises) are effective in getting athletes back to their sport after a hamstring strain. The stretching and strengthening exercises in the protocol are outlined below.

The Extender (helps increase mobility)
Lie on your back and hold your thigh bent to about 90 degrees. Slowly straighten the knee but stop prior to pain. Complete 3 sets of 12 repetitions twice daily.

The Diver (for hamstring strength and trunk stabilisation)
Stand on the injured leg with the knee bent to about 10-20 degrees. Reached both arms forward as you reach the opposite leg backwards. This exercise is done at a slow and controlled tempo. Complete 3 sets of 6 repetitions every other day.

The Glider (eccentric strengthening)
Begin with one hand holding a railing for support. Stand with 90% of the weight on your injured leg with the knee bent to about 10-20 degrees. Glide your uninjured leg backwards but stop before you feel pain on the injured leg. Use your arms to return to the starting position (avoid using your hamstrings). Progress this exercise as you are able by increasing the range of motion and speed. Complete 3 sets of 4 repetitions every third day.

If you have a hamstring injury this season or are interested in learning how to prevent them, our physiotherapists can help! Give us a call at (780) 460-9977 to make an appointment today.

Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols
Br J Sports Med 2013;47:953-959.