Early Rehab Accelerates Return to Sport After Muscle Injury

Nicola M. Parry, DVM

September 27, 2017

Among athletes who experience severe muscle injuries, initiating rehabilitation earlier rather than later leads to quicker recovery from pain and return to sports, a study has found.

Monika L. Bayer, PhD; S. Peter Magnusson, PT, DMSc; and Michael Kjaer, MD, DMSc, all from the University of Copenhagen, Denmark, published the results of their randomized controlled trial online September 28 in a letter to the editor in the New England Journal of Medicine.

"This study shows the clinical consequences of protracted immobilization after a recreational sports injury," the authors write.

"Starting rehabilitation 2 days after injury rather than waiting for 9 days shortened the interval from injury to pain-free recovery and return to sports by 3 weeks without any significant increase in the risk of reinjury."

Muscle injuries are common traumas among athletes and are associated with lost time from sport activities and increased susceptibility for recurrent injury.

However, as the effect of rehabilitation timing on recovery from these injuries is unknown, the researchers conducted a study to compare the effects of early vs delayed therapy on clinical outcomes after acute muscle strain injuries.

The study included 50 amateur athletes with acute injury of the thigh muscle or calf muscle who were randomly assigned to begin an early (2 days after injury) or delayed (9 days after injury) rehabilitation program. Patients did not receive any analgesic medications or nonsteroidal antiinflammatory drugs during the study.

The researchers followed the athletes for 12 months.

All patients underwent an identical rehabilitation program that was supervised by a physical therapist. This included daily static stretching (week 1), daily isometric exercises with increasing load (weeks 2 to 4), dynamic exercises with increasing resistance three times per week (weeks 5 - 8), and functional exercises combined with heavy strength training three times per week (weeks 9 - 12).

Athletes who began rehabilitation 2 days after injury returned to sports sooner than those who delayed therapy for 9 days (median, 62.5 days [interquartile range, 48.8 - 77.8) vs 83.0 days [interquartile range, 64.5 - 97.3]; P = .01).

During follow up, reinjury occurred in one patient in the early-therapy group and in no patients in the delayed-therapy group.

"Delay in rehabilitation can result in prolonged pain and a delayed return to sports, a finding that emphasizes the importance of regular and controlled mechanical loading early after trauma to large muscles," the authors conclude.

This study was supported by grants from Bispebjerg Hospital, Greater Region of Copenhagen Grant, the Danish Rheumatism Association, Lundbeck Foundation, Novo-Nordisk Foundation, Danish Council for Independent Research, and Anti Doping Denmark. The authors have disclosed no relevant financial relationships.

New Engl J Med. Published online September 28, 2017.

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