Start rehabilitation early following acute muscle injuries.

Early rehabilitation following an acute muscle injury (usually involving the hamstring, quadriceps or calf in a football context) is more effective than delaying treatment.

It is not often that sports medicine research appears in mainstream medical journals like the New England Journal of Medicine. When they do we generally need to take notice!

A randomised controlled trial (involving 50 amateur athletes) was conducted comparing early vs. delayed treatment following an acute injury to either the thigh or calf.1 The early therapy group received treatment starting two days following the injury while the delayed therapy group started treatment after nine days. The group that received early treatment could return to sport more quickly than those who had delayed treatment. Starting rehabilitation early reduced the time to a pain-free recovery and return to sport by about three weeks (21 days).

The participants in this study all completed a standardised rehabilitation programme including:

  • daily static stretching in week one;
  • progressive isometric loading in weeks 2 to 4;
  • dynamic loading with increasing resistance (three times per week) in weeks 5-8;
  • functional exercise and heavy strength training in weeks 9-12.

While it can be tempting to delay rehabilitation following an acute injury, either because your patient is in pain or is relatively disabled, this appears to compromise their recovery. Early rehabilitation appears to be safe and is associated with a substantially faster return to sport.

To learn more about the treatment of muscle injuries complete the ‘thigh injury’ module in the FIFA Diploma in Football Medicine. This has been written by the team at FC Barcelona.


1 Bayer ML, Magnusson SP and Kjaer M. Early versus Delayed Rehabilitation after Acute Muscle Injury. N Engl J Med 2017; 377:1300-1301


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Dr Bertrand Tamalet
Dr Bertrand Tamalet

thank you for this post. Of course it sounds great to bring serious prouf for early rehabilitation in muscular injury. Nevertheless, the isometric phase II of the protocole doesn’t really seems logical. We’d rather teach simple eccentric painless functional exercises as soon as possible, particularly for hamstrings. It may be more difficult for calf injury at the early phase. Delays even for amateur athletes look really long in this program.

Mark Fulcher

Hi Bertrand. I can’t disagree. In my view this paper confirms what many of us already have discovered clinically – early rehabilitation is a good idea. The type of exercise used does depend on the degree of injury and a clinician’s experience. It is hard to reflect this in a clinical trial – hence the conservative treatment regime.

Ali Saghandian
Ali Saghandian

thanks for this post, injuries differ in mechanism and severity, How can we decide which benefit from early rehabilitation? all of them?

Modise Pego

How do i rehabilitate hallux rigidis?


Les lésions musculaires en général occupent une place de choix chez les sportifs de haut niveau. Une véritable problématique entre soigneurs joueurs et dirigeants sportifs.
Devant toute lésion musculaire la précocité du traitement entraîne un bon pronostic.
1 procéder à une bonne imagerie
Reprise progressive en fonction de la gravité des lesions


Thanks for the post


Thanks for your information


Consideró que la rehabilitación es un factor importante no solo en la recuperación de los jugadores una vez lesionados, sino como pilar fundamental en la prevención de las mismas..