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Earlier Physiotherapy Equals Faster Recovery In Acute Muscle Strain

Occasionally, patients with acute conditions may consider delaying physiotherapy. They commonly consider two rationales. One, there is concern that rehab during an acute injury phase may interfere with the initial healing response. Two, economic considerations tempt patients to see if their injuries can heal sufficiently without rehab, before electing physiotherapy. In truth, for many diagnoses, both of these rationales prove counterproductive.

. Adding to the relevant body of evidence, Dr. Monika Bayer and colleagues from the Institute of Sports Medicine in Copenhagen recently tested physiotherapy referral timing for acute muscle strains.1

Researchers randomised 50 amateur athletes with acute muscle strains into a prompt treatment group (2 days from injury) and a delayed treatment group (9 days from injury). Patients averaged 34 years in age, and each had imaging-confirmed, grade 3a -4, muscle strains of the calf or thigh. All patients received the same exercise therapy program. The research team defined recovery as full return to sport, 0-1 on a 10-point pain scale, and being otherwise asymptomatic. On average, the delayed treatment group took 33% longer to achieve recovery. The authors conclude that muscle strains should be referred to physiotherapy almost immediately for optimal outcomes. Applying controlled motion during the acute phase likely ensures the proper organisation of collagen deposits. 


This research adds to a growing body of evidence demonstrating that physiotherapy referral without delay improves outcomes. Campian and colleagues found that back pain cases referred immediately realised more than double the improvement in physical function, had less than half the radiographs, had 0 MRIs compared to 16.9% in the usual care group, and had 90% fewer injections.2 In a national health records database review, Fritz and colleagues found that earlier physio referral for back pain correlated with a $3,058 per patient reduction in costs.3 Similarly, an ambitious meta-analysis finds that delayed rehabilitation for back pain predicts longer time off work.4 Rosenfeld’s work with whiplash shows that patients receiving physiotherapy within 96 hours of the injury realise better outcomes than patients with later referrals.5-7 At three-year follow-up, only the early-referral group had neck range of motion approaching the flexibility of the uninjured control group. In nontraumatic knee pain, Dr Joel Stevans and colleagues correlated earlier referral with a 33% lower chance of taking narcotics, a 50% lower chance of nonsurgical invasive procedures, and a 42% lower chance of surgery.8    



1. Bayer ML, Magnusson SP, Kjaer M. Early versus Delayed Rehabilitation after Acute Muscle Injury. New England Journal of Medicine. 2017 Sep 28;377(13):1300-1. 

2. 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, USA.

3. Fritz J, Childs J, Wainner R, Flynn T. Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs. Spine. 2012; 37 (25): 211421.

4. Steenstra I, Munhall C, irvin E, et al. Systematic review of prognostic factors in return to work in workers with sub acute and chronic low back pain. J Occup Rehabil. 2016; DOI 10.1007/ s10926-016-9666-x.

5. Rosenfeld M, Gunnarsson R, Borenstein P. Early intervention in whiplash-associated disorders. Spine. 2000; 25 (14): 1782-87.

6. Rosenfeld M, Seferiadis A, Carlsson UJ, et al. Active intervention in patients with whiplash associated disorders improves long term prognosis. A randomised controlled clinical trial. Spine. 2003; 28, 2491-2498.

7. Rosenfeld M, Seferiadis, Gunnarsson. Active involvement and intervention in patients exposed to whiplash trauma in automobile pressures reduces costs. A randomised controlled clinical trial and health economic evaluation. Spine. 2006; 31, 1799-1804.

8. Stevans J, Fitzgerald K, Piva S, Schneider M. Association of early outpatient rehabilitation with health service utilization in managing Medicare beneficiaries with nontraumatic knee pain: retrospective cohort study. Physical Therapy. 2017; 97 (6): 614-624.


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