Askling Protocol

Original Editor - Shreya Pavaskar

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Description[edit | edit source]

Hamstring strains are caused by a rapid extensive contraction or a violent stretch of the hamstring muscle group which causes high mechanical stress. This results in varying degrees of rupture within the fibres of the musculotendinous unit.[1] Hamstring strains are not rare in sports activities with a dynamic athletes like sprinting, jumping, touch sports activities which includes Australian Rules football (AFL), American football  wherein short eccentric contractions are regular. They additionally have prevalence fee of reinjury, with as much as 1/3rdof hamstring accidents reoccurring, and commonly within the first 2 weeks (Brukner and Khan, 2017)[Hamstring accidents also can arise in leisure sports activities which includes water-snowboarding and bull riding, wherein the knee is forcefully completely prolonged throughout harm.)[2]

There are two main types of Hamstring injury:

Type 1 - Cause - high speed running,

Target - the long head of bicep femoris

Initially may cause a marked decline in function

Quicker rehabilitation rate

Type 2 - Cause -excessive lengthening

Target - proximal free tendon of semimembranosus, with pain near ischial tuberosity and upto buttock.

Slightly longer rehabilitation

Askling Protocol [3] - In their paper of 2003, Carl Askling and associates used seventy five elite Swedish soccer gamers to evaluate specific hamstring rehabilitation protocols referred to as the C-Protocol and L-Protocol. They then assessed results of return to play and re-injury. The L-Protocol targeted on eccentric loading of the hamstrings whilst the C-protocol consisted of traditional hamstring rehabilitation sporting events. Participants in the L-protocol have been capable of go back to recreation considerably quicker than the ones in the traditional group (mean 28 days vs fifty two days). Their studies into which protocol changed into quality for continual accidents changed into inconclusive, however the researchers have been capable of surmise that rehabilitation protocols such as eccentric sporting events are greater powerful in returning athletes to their sports activities following hamstring injury.

The time from the date of injury (overall ruptures have been excluded) to the date of RP initiation in those research changed into five days for each protocols, and no ache provocation and/or analgesic remedies have been allowed at any time for the duration of the rehabilitation process. Each RP consisted of 3 specific sporting events, all executed in the sagittal plane. In each protocols, exercise 1 changed into aimed in particular at growing flexibility, exercise 2 changed into a mixed exercise for strength and lumbopelvic control, and exercise three changed into a particular strength and conditioning. [1][4]

Additionally, it is recommended that hamstring injury rehabilitation protocols should be preferentially based on strength and flexibility exercises that primarily involve exercises with high loads at long muscle–tendon lengths

Indication[edit | edit source]

Hamstring Strain

L-Protocol[edit | edit source]

  1. THE EXTENDER (Flexibility)
    • Starting position - The athlete is lying supine, holding and stabilize the thigh of the injured leg with the hip flexed approximately 90°.
    • Instructions - The athlete is instructed to perform slow knee extensions to a point just before point of pain (3sets x 12 reps x twice per day)
    • Progression: Increase speed or repitition
  2. THE DIVER (Hamstring Strength and Trunk Stabilisation)
    • Starting position - The athlete is standing with full weight on his injured leg and the opposite knee slightly flexed backwards.
    • Instructions -The athlete is asked to perform the exercise as a simulated dive (hip flexion from an upright trunk position) of the injured, standing leg and simultaneous stretching arms forward and attempting maximal hip extension (3 sets X 6 reps X once per day) such that you attempt to be parallel to the ground
    • Good quality, ASIS/pelvis horizontally throughout the whole movement
    • Maintain 10–20° knee flexion in the standing leg.
  3. THE GLIDER (Specific Eccentric Strength Exercise)
    • Starting position - The exercise is started with the patient positioned with upright trunk, one hand holding on to a support and legs slightly split. All the body weight should be on the heel of the injured leg with approximately 10–20° knee flexion. Stand on a non friction surface or use a slider
    • Instructions - The athlete is instructed to perform a gliding backward movement on the other leg and stop the movement before pain is reached. The movement back to the starting position should be performed by the help of both arms, not using the injured leg (3 sets X 6 reps X once every third day)
    • Progression is achieved by increasing the gliding distance and speed


Resources[edit | edit source]

Aspetar Hamstring protocol

Rehabilitation of Hamstring Injuries

References[edit | edit source]

  1. Sutton G. Hamstrung by hamstring strains: a review of the literature*.J Orthop Sports Phys Ther. 1984; 5(4):184-95. ↑
  2. Landry M. Brukner & Khan's Clinical Sports Medicine. Physiotherapy Canada. 2014;66(1):109.
  3. Askling CM, Koulouris G, Saartok T, Werner S, Best TM. Total proximal hamstring ruptures: clinical and MRI aspects including guidelines for postoperative rehabilitation. Knee Surgery, Sports Traumatology, Arthroscopy. 2013 Mar;21(3):515-33.
  4. Wangensteen A, Askling C, Hickey J, Purdam C, Made AD, Thorborg K. Rehabilitation of hamstring injuries. InPrevention and Rehabilitation of Hamstring Injuries 2020 (pp. 225-270). Springer, Cham.
  5. Physiotutors. Askling Protocol | Hamstring Strain Rehabilitation. Available from:[last accessed 4/9/2022]