Järvinen et al. review the biology of skeletal muscle injury and repair across three overlapping phases: destruction, repair, and remodeling. The authors translate experimental data into clinical recommendations covering RICE, immobilization timing, rehabilitation progression, medication use, and surgical indications. Few randomized trials exist — most guidance is derived from experimental models.
Apply RICE immediately after muscle injury, then hold relative immobilization for 3–7 days before starting progressive rehabilitation. The biology explains why: granulation tissue needs those first days to gain enough tensile strength to withstand muscle contraction forces without rerupture.
When you start rehab, follow the sequence — isometric first (pain-limited), then isotonic once isometric is pain-free with load, then isokinetic. Skipping steps or loading too early is the most common reason athletes rerupture.
For medications: short-term NSAIDs are reasonable in the acute phase. Glucocorticoids are contraindicated. They delay hematoma clearance, retard regeneration, and reduce the final strength of the repaired muscle.
When a muscle injury fails to improve by 10–14 days, or symptoms intensify with increasing induration and restricted motion, suspect myositis ossificans. Confirm with imaging, but defer surgical excision until the lesion is fully mature (12–24 months after symptom onset). Operating early causes recurrence. This is one of the most testable facts from this paper.
Järvinen et al. review the biology of skeletal muscle injury and repair across three overlapping phases: destruction, repair, and remodeling. The authors translate experimental data into clinical recommendations covering RICE, immobilization timing, rehabilitation progression, medication use, and surgical indications. Few randomized trials exist — most guidance is derived from experimental models.
Apply RICE immediately after muscle injury, then hold relative immobilization for 3–7 days before starting progressive rehabilitation. The biology explains why: granulation tissue needs those first days to gain enough tensile strength to withstand muscle contraction forces without rerupture.
When you start rehab, follow the sequence — isometric first (pain-limited), then isotonic once isometric is pain-free with load, then isokinetic. Skipping steps or loading too early is the most common reason athletes rerupture.
For medications: short-term NSAIDs are reasonable in the acute phase. Glucocorticoids are contraindicated. They delay hematoma clearance, retard regeneration, and reduce the final strength of the repaired muscle.
When a muscle injury fails to improve by 10–14 days, or symptoms intensify with increasing induration and restricted motion, suspect myositis ossificans. Confirm with imaging, but defer surgical excision until the lesion is fully mature (12–24 months after symptom onset). Operating early causes recurrence. This is one of the most testable facts from this paper.