Carl Askling Swedish School of Sport and Health Sciences and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. - Lengthening type of exercises are effective! (6

1. Lengthening type of exercises is effective?
mail:carl.askling@gih.se
twitter:@CAskling

2. L-PROTOCOL
Askling 2014
THE LENGTHENING PROTOCOL

3. Acute hamstring injuries in Swedish elite football: a prospective randomized
controlled clinical trial comparing two rehabilitation protocols.
Askling C, Tengvar M, Thorstensson A
Br J Sports Med, 2013
75 Swedish elite football players included
Askling 2014

4. STUDY DESIGN
• clinical examination - MRI to confirm
• stratify - type of injury
• randomized – L-protocol or C-protocol
• repeated clinical examinations
• before return – Askling H-test
Askling 2014

5. Askling H-test
Askling 2014
Askling C, Nilsson J, Thorstensson A
Knee Surg Sports Traumatol Arthrosc, 2010

6. Askling H-test
• clinical examination – no signs of remaining injury
• knee brace to keep the leg in extension
• straps stabilizing the upper body/contralateral leg
• perform SLR as fast as possible to the highest point
• 3 trials per leg/uninjured leg first/no warm-up
• if experienced any insecurety (VAS) – extended rehab.
Askling 2014

7. OUTCOME
• Time to return: full participation in team
training and aviailability for match selektion
• Re-injuries: was registered during 12 months
after return
Askling et al. 2014

8. L-PROTOCOL
THE LENGTHENING PROTOCOL
1. THE EXTENDER 2. THE DIVER 3. THE GLIDER
twice every day every other day every 3rd day
3 set X 12 reps 3 set x 6 reps 3 set x 4 reps
AsklinAgs ektl ianlg. 22001124

9. Askling H-test
• 13 players (35%) in L-protocol - insecurity
•27 players (71%) in C-protocol - insecurity
•ext. of rehab. – mean 7d (range 3-14d)
Askling Aest kalli.n 2g0 2120 14

10. 100
80
60
40
20
0
Min
Min
Max
Time to return (days)
***
Max
L - group C - group
Askling et al. 2014

11. Max
Sprinting-type Stretching-type Sprinting-type Stretching-type
100
80
60
40
20
0
C-group
***
***
***
***
Min
Min
Min
Min
Max
Max
Max
Time to return (days)
L-group
Askling et al. 2014

12. Max
PT not involved PT involved PT not involved PT involved
100
80
60
40
20
0
C-group
***
**
**
***
Min
Min
Min
Min
Max
Max
Max
Time to return (days)
L-group
Askling et al. 2014

13. SPRINTING-TYPE L-PROTOCOL
• time to return: mean 23 days
• longitudinal length edema: mean 17cm
Askling 2014

14. RE-INJURIES
• 1 re-injury – C-protocol
• location: BFlh
Askling 2014

15. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective
randomized controlled clinical trial comparing two rehabilitation protocols.
Askling C, Tengvar M, Tarassova O, Thorstensson A
Br J Sports Med, 2014
56 Swedish elite sprinters & jumpers included
Askling 2014

16. 160
140
120
100
80
60
40
20
0
Min
L-protocol
Min
Max
C-protocol
Time to return (days)
***
Max
Askling et al. BJSM 2014

17. Askling H-test
• 8 athletes (29%) in L-protocol - insecurity
•19 players (68%) in C-protocol - insecurity
•ext. of rehab. – mean 10d (range 3-20d)
AsklingA estk aliln. g2 021021 4

18. RE-INJURIES
• 2 re-injuries – C-protocol
• location: BFlh
Askling 2014

19. LENGTHENING EXERCISES?
• mirror injury situation
• difficult to restore eccentric strength
• increase strength at longer muscle lengths
Askling 2014