The L-Protocol for Hamstring Rehabilitation

In many sports, hamstring injuries are commonly.  Unfortunately, rehab from this injury can be slow and recovering from an initial hamstring injury doesn’t mean an athlete will be free from further re-injury as recurrence of hamstring strains is quite common.

Researchers in this study decided to compare two different rehab protocols, called the L-protocol and C-protocol, in male and female football (soccer for us ‘Mericans).  The L-protocol focused on eccentric loading of the hamstrings (see below) while the C-protocol consisted of conventional hamstring rehab exercises (contract-relax stretching, standing hip extensions, pelvic lifts). Both groups perceived 3 exercises: one focused on flexibility, another on strength of the core and hips, and a third was more specific to the protocol.

Participants in the L-protocol group were able to return to full sports participation significantly faster than those in the C-protocol group, mean 28 vs. 51 days.  Only one re-injury was during the follow up period, which didn’t allow researchers to make a conclusion on which protocol is best to prevent chronic problems.

Researchers concluded that rehab protocols consisting of eccentric exercises are more effective in returning athletes to their sports following hamstring injury. Stretching and strengthening exercises selected should involve heavier loading in lengthened states.

Here is the L-Protocol:

L1 – The Extender – Athlete lies supine and holds the thigh at approximately 90 degrees of flexion.  The knee is slowly extended but stopped prior to pain.  Three sets of 12 twice every day.

L1 - The Extender

L2 – The Diver – Athlete stands on the injured leg with the knee flexed 10-20 degrees.  Both arms are reached forward as the opposite leg is reached backwards.  The lifted leg is held at 90 degrees of flexion and the goal is to lift that leg as high as possible.  Thee sets of six reps are performed every other day at a slow tempo.

L2 - The Diver

L3 – The Glider – Athlete starts with one hand holding a railing or support and 90% of the weight on the injured leg with 10-20 degrees of knee flexion.  The uninjured leg is glided backwards, stopping before pain on the injured leg.  The arms are then used to return the athlete to the starting position (avoiding contraction of hamstrings).  Progress this exercise by increasing the range of motion and speed at which it is performed.  Three sets of four reps every third day.

L3 - The Glider

(See my article on another hamstring rehab protocol here)

Askling, Tengvar, & Thorstensson (2013).  Acute hamstring injuries in Swedish elite football: a prospective randomized controlled clinical trial comparing two rehabilitation protocols. BJSM

  One thought on “The L-Protocol for Hamstring Rehabilitation

  1. February 25, 2014 at 7:48 am

    I would love to see a video of the L2 and L3 exercises. I am not sure I am executing them properly.

    • February 25, 2014 at 7:51 am

      Video by another physical therapist demonstrating all the exercises.

      • jenazzariti
        February 25, 2014 at 7:55 am

        thank you!

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