{"doi":"10.1113/ep091702","title":"When is the right time to initiate rehabilitation? Time will tell…","abstract":"When is the right time for anything? Who knows? Living is an art, not a science. Rehabilitation sciences is the field of investigating interventions to facilitate tissue repair towards its pre-injury function, and similar to life, there often seem to be more uncertainties and unknowns than answers. Nonetheless, the dichotomy of the ‘unknown’ and ‘established theory’ is what lures many to spend our lives in a scientific pursuit. One such pursuit is defining evidence-based practices for rehabilitation by interrogating injury pathophysiology, testing task-specific techniques and optimizing rehabilitation programmes in terms of intensity, duration and timing. ‘When is the right time to initiate rehabilitation?’ is not a new question; it is well articulated by the rhetorical question posed by Paul Brown in his historical thoughts on rehabilitation after the Vietnam War: “Leaders and innovators in the field were asking the question— ‘Where does treatment cease and rehabilitation start?’…” (Burkhalter, 1994). Yet, when the optimal time might be to start rehabilitation after various injuries and, in particular, skeletal muscle injuries, remains a looming question. Skeletal muscle has a robust repair and regenerative capacity after various forms of injury. As a target tissue for rehabilitation, knowing when to start is expected to be a key part to successful recovery. Skeletal muscle is highly responsive to a range of physiological stimuli and cues. For example, progressive aerobic or anaerobic training programmes can take a ‘couch potato’ to ‘5K finisher’ in no time. One key to these programmes is the progressive changes in overload on the system. Successful training programmes usually involve various modalities, types, durations and intensities of exercise. Thus, the programmes are likely to include stretching (or range-of-motion) exercises, isometric exercises, dynamic exercises and aerobic exercises. The progressive and phased approach to rehabilitation is no different. Following injuries, the responsiveness of muscle is still there; that is, until it is not. Large-scale skeletal muscle injuries, such as volumetric muscle loss injuries, are, unfortunately, a great example of the ‘until it is not’. Volumetric muscle loss injures are the traumatic or surgical loss of muscle resulting in irrecoverable impairments in function, and to date, the responsiveness to rehabilitation has been modest to non-existent. In the work by Basten et al. (2023), we sought to control the overload of rehabilitation tightly, with a phased approach using both passive range-of-motion exercise and isometric muscle training (i.e., neuromuscular electrical stimulation). Using a rodent model of volumetric muscle loss injury to the posterior compartment (soleus, plantaris and gastrocnemius muscles), rehabilitation was initiated early, at 3 days post-injury, and was structured twice per week for 8 weeks, with a single change in overload at the 4-week point. In comparison to the field at large, initiating rehabilitation 3 days post-injury was ‘early’, because most studies have been starting interventions ≥7 days post-injury. In efforts to understand how activity could impact the functional response to rehabilitation, we compared an experimental group that underwent the same rehabilitation programme but had restricted housing for the duration of the experiment, which could allow for highly targeted interventions. Akin to what others have shown across the volumetric muscle loss field, the rehabilitation was not able to recover the injury-induced functional impairments, even with the ‘early’ intervention. However, restricting activity was able to mitigate some negative functional impairments, but this was at the expense of impaired whole-body metabolism. The task-specific and early rehabilitation protocol that Basten et al. (2023) designed is common clinically, as exemplified by the collective work of Bayer et al. including the Tendon Research Group Bispebjerg (2017) ","journal":"Experimental Physiology","year":2024,"id":475533,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.948,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":706698,"name":"Jarrod A. Call","orcid":"0000-0002-1094-4940","position":1,"is_corresponding":false},{"id":654047,"name":"Sarah M. Greising","orcid":"0000-0001-9285-4908","position":0,"is_corresponding":true}],"reference_count":4,"raw_metadata":null,"created_at":"2026-07-19T02:06:21.071690Z","pmid":"38493319","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}