When to Start Mobilisation after Muscle Injury

For these injuries, premature active mobilisation is connected with increased risk of re-rupture which is often worse than the original injury. 2 On the other hand, prolonged immobilisation leads to slower recovery and less functional healing.3 The short answer is that mobilisation should begin as soon as possible with pain being the guide.3 Physiotherapy should be initiated immediately to evaluate the level of protection needed and to train the patient on restricted activity, ice, and elevation.

Therapists should strive to limit immobilisation of injured muscles to less than a week. Passive mobilisation should begin as soon as three days after the injury.4 Isometric strengthening and thermal modalities may also be appropriate at this point. Active or functional mobilisation (such active stretching or controlled strength training) may begin five to seven days after an injury. Individual assessment and pain-free motion is the guide.

The healing of a skeletal muscle tends to follow a consistent pattern, regardless of the mechanism of injury (contusion, strain, or laceration). The consistently timed pattern of destruction phase, followed by repair phase, followed by the remodelling phase creates a timeline that can guide recommendations regarding movement of injured muscles. Early restriction of the related joints allows granulation tissue to form between the injured muscle stumps.

A small amount of time is needed for the granulation tissue to develop tensile strength. On the other hand, more than a few days of immobilisation, restriction, or rest is connected with a number of undesirable effects such as muscle atrophy, retarded recovery, and disorganised healing.3-7 If the muscle does not receive timely mobilisation, collagen formation and myofiber regeneration typically occur in disorganised patterns that can inhibit pain-free range of motion long term.

Advantages of Timely Mobilisation Include:

• Enhance the penetration of muscle fibres through the connective tissue scar.4

• Limit the size of the permanent scar.4

• Encourage more rapid collagen formation and capillary growth in the injured area.8 • Facilitate proper alignment of muscle fibres.3

• Improve tensile strength of the injured muscle.9

• Facilitate faster strength recovery.9

 References

1. Aufwerber S, Heijne A, Grävare Silbernagel K, Ackermann PW. High plantar force loading after achilles tendon rupture repair with early functional mobilization. The American Journal of Sports Medicine. 2019 Mar;47(4):894-900.

2. Järvinen TAH, Järvinen TLN, Kääriäinen M, Kalimo H, Järvinen M. Biology of muscle trauma. Am J Sports Med 2005; 33:745-766.

3. Järvinen TA, Järvinen M, Kalimo H. Regeneration of injured skeletal muscle after the injury. Muscles, Ligaments and Tendons Journal. 2013 Oct;3(4):337.

4. Järvinen TA, Järvinen TL, Kääriäinen M, Kalimo H, Järvinen M. Muscle injuries: biology and treatment. The American Journal of Sports Medicine. 2005 May;33(5):745-64.

5. Braunstein M, Baumbach SF, Boecker W, Carmont MR, Polzer H. Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2018 Mar 1;26(3):846-53.

6. Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M (2012) Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am 94:2136–2143.

7. Brooks JH, Fuller CW, Kemp SP. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Br J Sports Med. 2007;41:543-4.

8. Valkering KP, Aufwerber S, Ranuccio F, Lunini E, Edman G, Ackermann PW. Functional weightbearing mobilization after Achilles tendon rupture enhances early healing response: a singleblinded randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy. 2017 Jun 1;25(6):1807-16. 9. Järvinen M. Healing of a crush injury in rat striated muscle. Effect of early mobilization and immobilization on the tensile properties of gastrocnemius muscle. Acta Chirurgica Scandinavica. 1976;142 (1): 47-56.