Early vs. Delayed Rehab for Acute Muscle Injury

Muscle injuries are common in sport and can cause a significant amount of time away from activity if not managed appropriately. Even if a person is not playing a sport, muscle strains can occur in individuals doing regular life activities (think gardening, yard work, lifting things at home) who have placed more stress through the muscles than they are able to currently handle. [...]

Muscle injuries are common in sport and can cause a significant amount of time away from activity if not managed appropriately. Even if a person is not playing a sport, muscle strains can occur in individuals doing regular life activities (think gardening, yard work, lifting things at home) who have placed more stress through the muscles than they are able to currently handle. The question then arises as to what to do about it. It is commonly thought that rest is the initial best treatment and then after a time, treatment is initiated. Most of the time, these treatments involve such things as icing, ultrasound, electrical stimulation, kinesiotaping, and more recently cupping and platelet-rich plasma injections. The question then becomes, is this the right way to promote early recovery and return to activity?

A recent study published in the New England Journal of Medicine investigated whether or not the timing of when treatment is started for a muscle injury has any effect on when a person can return to their sport. This study took 50 people with an acute injury to their thigh (quadriceps), hamstring, or calf. Half of them had treatment initiated treatment early (2 days after injury) and the other half had their treatment delayed (9 days after injury). Interestingly, both treatments were the same and did not include passive treatments as listed above, but instead consisted of progressive loading exercises to the injured muscle.

​What this study found was that initiation of treatment early vs delayed allowed the subjects to return to their given activity sooner. Starting rehabilitation at 2 days after injury rather than waiting 9 days shortened the time from injury to pain free recovery and return to sports by 3 weeks without any increase in risk of re-injury.

This is a pretty significant amount when you consider that sport and being active is very important to these individuals and their teams.

The other important finding from this study is that in contrast to popular belief, there does not (and should not) need to be an extended “rest” time after injury and when treatment is initiated, it should consist of progressively working the muscle (and not passive treatments such as injections, ultrasound, electrical stimulation, kinesiotaping, cupping, etc). In order to get people back to their activities, the muscle needs to be treated actively-meaning progressively used so that it is able to handle the activity that the person is trying to get back to.

This finding is pretty consistent with research on acute injuries to other body regions, specifically the low back. Many studies have shown that early, active treatment is better than delaying treatment in promoting recovery, improving patient satisfaction, and decreasing expense.

If you or someone you know sustains an acute muscle injury, treatment should be initiated early with a focus on managing the injury actively and not with passive treatments.

As always, let me know if you have any questions.

Thanks for reading,

Bob