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Experts recommend early rehabilitation after acute muscle injury

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Athletes with muscle injuries return to sports sooner if they begin physical therapy within a few days, a new study has shown.

Monika L. Bayer, PhD, S. Peter Magnusson, PT, DMSc, and Michael Kjaer, MD, DMSc, all from Bispebjerg Hospital in Copenhagen, Denmark, discussed the results of their randomised controlled trial in a letter to the editor in the New England Journal of Medicine.

The trial involved 50 amateur athletes with acute injury of the thigh muscle (in approximately 60% of the patients) or calf muscle (in approximately 40%), as confirmed on ultrasonography and magnetic resonance imaging. The injuries were most commonly associated with playing football or participating in track-and-field events.

Patients were recruited less than 48 hours after injury and underwent randomisation to receive early therapy (two days after injury) or delayed therapy (nine days after injury) and were followed for 12 months.

All the patients completed a standardised four-stage therapy regimen which included: daily repeated static stretching (week 1), daily isometric loading with increasing load (weeks 2 to 4), dynamic loading with increasing resistance three times per week (weeks 5 to 8), and functional exercises combined with heavy strength training three times per week (weeks 9 to 12). Five patients in the early-therapy group and three in the delayed-therapy group discontinued treatment.

The results of the study showed that the interval between severe muscle injury and return to sports was shorter in the early-therapy group than in the delayed-therapy group, with a median interval of 62.5 days and 83.0 days, respectively.

During the follow-up period, one patient (in the early-therapy group) suffered a repeat injury.

“This study shows the clinical consequences of protracted immobilisation after a recreational sports injury,” the researchers wrote. “Starting rehabilitation two days after injury rather than waiting for nine days shortened the interval from injury to pain-free recovery and return to sports by three weeks without any significant increase in the risk of reinjury.”

http://www.nejm.org/doi/full/10.1056/NEJMc1708134