When you strain a muscle, waiting a week or two before doing anything about it can seem reasonable. Maybe the injury simply needs time to heal. Maybe exercising an injured muscle too soon sounds like it could make things worse. And if the pain is already beginning to settle down, you may wonder whether physical therapy is really necessary.
Research on acute muscle strains suggests that waiting may actually prolong recovery.
A study published in the New England Journal of Medicine found that amateur athletes who began rehabilitation just two days after an acute muscle strain returned to their sport substantially sooner than athletes who waited nine days before beginning the same rehabilitation program.[1]
What Is a Muscle Strain?
A muscle strain occurs when muscle fibers are overstretched or torn. People often call it a “pulled muscle.” Strains are especially common in the hamstrings, quadriceps and calf muscles. They may occur while sprinting, jumping, changing direction, lifting or simply making a movement that places more force on the muscle than it can tolerate.
Symptoms can include:
Sudden pain
Tenderness
Swelling
Bruising
Weakness
Pain when stretching or contracting the injured muscle
Difficulty walking, running or participating in normal activities
The severity can vary considerably. Some strains involve relatively minor muscle fiber damage. Others involve substantial tearing and may require a much longer recovery.
Researchers Put Early Rehabilitation to the Test
Researchers from the Institute of Sports Medicine in Copenhagen studied 50 amateur athletes with acute muscle injuries of the thigh or calf.[1] The participants had imaging-confirmed muscle strains and averaged 34 years of age. Researchers randomly divided them into two groups.
One group began rehabilitation two days after the injury.
The other group began nine days after the injury.
After that difference in starting time, both groups followed the same progressive exercise program. Recovery required more than simply feeling better. Participants had to return fully to their sport, report little or no pain and otherwise be free of symptoms. The difference was substantial.
Athletes who waited nine days to begin rehabilitation took about 33% longer to recover.[1]
The researchers concluded that beginning rehabilitation shortly after an acute muscle injury can shorten the time required to return to sport.
Does an Injured Muscle Need Complete Rest?
An injured muscle certainly needs protection from activities that could cause additional damage. That does not necessarily mean complete inactivity. Healing tissue responds to appropriately controlled movement and loading. During the early stages of rehabilitation, exercises may be quite gentle. A physical therapist can adjust the amount of movement and resistance according to the location of the strain, its severity, pain levels and the stage of healing.
As recovery progresses, treatment may include increasingly challenging exercises for strength, flexibility, balance and movement control. For an athlete, rehabilitation eventually may include running, jumping, acceleration, deceleration and sport-specific movements.
The Copenhagen researchers suggested that appropriately controlled loading during the early healing process may also help influence the organization of newly developing tissue.[1] The important word is controlled. Early rehabilitation does not mean immediately returning to normal workouts or attempting to exercise through significant pain.
Feeling Better Is Only Part of Recovery
One reason muscle strains can be deceptive is that pain may improve before the muscle has fully recovered its strength and ability to tolerate demanding activity. Someone may feel comfortable walking and assume the injury has healed, then experience another strain when returning to running, sports or heavier activity. Physical therapy can help determine when the recovering muscle is ready for progressively greater loads.
Treatment may address:
Range of motion
Muscle strength
Flexibility
Balance and coordination
Walking and running mechanics
Gradual return to demanding activity
Strategies for reducing the risk of reinjury
The goal is a safe progression from an injured muscle toward normal activity.
Earlier Physical Therapy Has Shown Benefits Elsewhere, Too
The findings on muscle strains fit into a larger body of research examining when rehabilitation begins.
Back Pain: Studies involving back pain have associated earlier physical therapy with improvements in function, lower healthcare utilization and reduced overall costs.[2,3]
Whiplash: Research involving whiplash injuries has also found better long-term outcomes among patients who began active treatment early.[4-6]
Knee Pain: Among Medicare beneficiaries with nontraumatic knee pain, earlier outpatient rehabilitation was associated with lower utilization of opioids, injections and surgery.[7]
Different injuries require different treatment plans, and these studies do not mean that every painful condition should immediately be exercised. They do suggest that simply waiting for a musculoskeletal problem to disappear is not always the fastest route back to normal activity.
Do Not Wait for an Injury to Become “Chronic”
If you have recently strained a muscle, an early physical therapy evaluation can help determine what the muscle is ready to do. Your physical therapist can assess the injury, identify movements that should temporarily be limited and establish an appropriate progression of exercise as healing takes place. In many cases, rehabilitation can begin while the injury is still quite new. For acute muscle strains, research suggests that getting started sooner may mean getting back to the activities you enjoy sooner, too.[1]
Sources
Bayer ML, Magnusson SP, Kjaer M. Early versus delayed rehabilitation after acute muscle injury. N Engl J Med. 2017;377(13):1300-1301.
Campian M, Hedin T, Hansen P, et al. Rapid access to physical therapy for low back pain: a continuous quality improvement project. Presented at: Annual Meeting of the Association of Academic Physiatrists; 2017; Sacramento, CA.
Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs. Spine. 2012;37(25):2114-2121.
Rosenfeld M, Gunnarsson R, Borenstein P. Early intervention in whiplash-associated disorders. Spine. 2000;25(14):1782-1787.
Rosenfeld M, Seferiadis A, Carlsson J, Gunnarsson R. Active intervention in patients with whiplash-associated disorders improves long-term prognosis. Spine. 2003;28:2491-2498.
Rosenfeld M, Seferiadis A, Gunnarsson R. Active involvement and intervention in patients exposed to whiplash trauma in automobile crashes reduces costs. Spine. 2006;31:1799-1804.
Stevans JM, Fitzgerald GK, Piva SR, Schneider M. Association of early outpatient rehabilitation with health service utilization in managing Medicare beneficiaries with nontraumatic knee pain: retrospective cohort study. Phys Ther. 2017;97(6):615-624.
