Page 29 - ISAKOS 2021 Newsletter Volume 1
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The first stage aims to promote healing of the affected tissue, the second and third stages aim to recover muscle function and neuromuscular control, and the last 3 stages reintegrate the athlete into the sport.
Askling Protocol
As most injuries occur during an eccentric contraction, muscle strengthening during treatment should focus on preparing the muscles for the specific situation that caused the injury. Askling et al. demonstrated that a hamstring strengthening protocol that focused on eccentric contractions was more effective than a conventional strengthening protocol5, which is why the Aspetar protocol incorporates not only the protocol by Askling et al. but also the Nordic hamstring exercise.
03 The Askling protocol5
03A “The Extender.” The player holds and stabilizes the thigh of the
injured leg with the hip flexed approximately 90° and then performs slow knee extensions to a point just before pain is felt. This exercise is performed twice every day, with 3 sets of 12 repetitions each.
03B “The Diver.” The exercise should be performed as a simulated dive. From an upright trunk position, the player flexes the hip of the injured (standing) leg while simultaneously stretching the arms forward and attempting to achieve maximum hip extension on the side of the lifted leg while keeping the pelvis horizontal; the angle of the knee should be maintained at 10°-20° in the standing leg and at 90° in the lifted leg. Because of its complexity, this exercise should be performed very slowly in the beginning. This exercise should be performed once every other day, with 3 sets of 6 repetitions each.
03C “The Glider.” This exercise is started from an upright position, with one hand holding on to a support and with the legs slightly split. The body weight should be on the heel of the injured leg (in this case, the left leg) with approximately 10°-20° of flexion of the knee. The motion is started by gliding backward on the other leg (note the low-friction sock) and is stopped before pain is reached. The movement back to the starting position should be performed with the help of both arms, without use of the injured leg. Progression is achieved by increasing the gliding distance and performing the exercise faster. This exercise should be performed once every third day, with 3 sets of 4 repetitions each.
Communication Between Stakeholders
Although studies have shown that prevention programs that include the Nordic hamstring exercise result in a 51% reduction in hamstring injuries, only 11% of elite European teams incorporate the practice into their training. This finding may suggest that communication between the medical department and the other stakeholders, mainly the technician, must be improved, so that scientific knowledge is translated into clinical benefit for athletes and financial benefit for clubs.
1. Ekstrand J, Waldén M, Hägglund M. Hamstring injuries have increased by 4% annually in men’s professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med. 2016 Jun; 50 (12): 731–7. 2. Ekstrand J. Keeping your top players on the pitch: the key to football medicine at a professional level. Br J Sports Med. 2013 Aug 1; 47 (12): 723–4. 3. Valle X Tol H Hamilton. Muscle Injury Classification [Internet]. Aspetar, FC Barcelona; Available from: wp-content/uploads/2015/04/MUSCLE-INJURIES-CLINICAL-GUIDE- 3.0-LAST-VERSION.pdf. 4. Aspect the Hamstring Protocol [Internet]. Available from: UploadCenter/636209313253275549_Aspetar%20Hamstring%20 Protocol.pdf 5. Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomized controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2013 Oct; 47 (15): 953–9.
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