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The purpose was to examine tissue regeneration and the effectiveness of early versus delayed rehabilitation onset on functional and structural recovery after strain injuries. A total of 50 recreational athletes with a severe acute strain injury in their thigh or calf muscles were randomized to early or delayed rehabilitation onset. Magnetic resonance imaging (<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>) was obtained initially, 3 and 6\u00a0months postinjury, and dynamic contrast\u2010enhanced <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">DCE<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>) estimated tissue inflammation initially and after 6\u00a0months. Muscle strength was determined 5\u00a0weeks, 3\u00a0months, and 6\u00a0months postinjury, and a questionnaire determined soreness, pain, and confidence. <jats:styled-content style=\"fixed-case\">DCE<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> microvascular perfusion was higher in the injured compared to an uninjured muscle acutely (<jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.01) and after 6\u00a0months (<jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.01), for both groups (<jats:italic>P\u00a0<\/jats:italic>&gt;<jats:italic>\u00a0<\/jats:italic>0.05) and unrelated to <jats:styled-content style=\"fixed-case\">RTS<\/jats:styled-content> (<jats:italic>P\u00a0<\/jats:italic>&gt;<jats:italic>\u00a0<\/jats:italic>0.05). Total volume of the injured muscle decreased from the acute to the 3\u2010month scan, and to the 6\u2010month scan (<jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.01) in both groups. Muscle strength was similar in both groups at any time. There was a nonsignificant trend (<jats:italic>P\u00a0<\/jats:italic>\u2264<jats:italic>\u00a0<\/jats:italic>0.1) toward less pain and higher confidence with early rehabilitation. One reinjury was recorded. In conclusion, our data showed prolonged tissue repair with the initial response linked to muscle atrophy but did not explain why early rehabilitation onset accelerated recovery considering that structural and functional recovery was similar with early and delayed rehabilitation.<\/jats:p>","DOI":"10.1111\/sms.13269","type":"journal-article","created":{"date-parts":[[2018,7,25]],"date-time":"2018-07-25T11:08:35Z","timestamp":1532516915000},"page":"2579-2591","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Role of tissue perfusion, muscle strength recovery, and pain in rehabilitation after acute muscle strain injury: A randomized controlled trial comparing early and delayed rehabilitation"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6720-6543","authenticated-orcid":false,"given":"Monika L.","family":"Bayer","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery M Faculty of Health and Medical Sciences Institute of Sports Medicine Copenhagen Bispebjerg Hospital and Center for Healthy Aging University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maren","family":"Hoegberget\u2010Kalisz","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery M Faculty of Health and Medical Sciences Institute of Sports Medicine Copenhagen Bispebjerg Hospital and Center for Healthy Aging University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikkel H.","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery M Faculty of Health and Medical Sciences Institute of Sports Medicine Copenhagen Bispebjerg Hospital and Center for Healthy Aging University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens L.","family":"Olesen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery M Faculty of Health and Medical Sciences Institute of Sports Medicine Copenhagen Bispebjerg Hospital and Center for Healthy Aging University of Copenhagen  Copenhagen Denmark"},{"name":"Research Unit for General Practice in Aalborg Department of Clinical Medicine Aalborg University  Aalborg Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rene B.","family":"Svensson","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery M Faculty of Health and Medical Sciences Institute of Sports Medicine Copenhagen Bispebjerg Hospital and Center for Healthy Aging University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Coupp\u00e9","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery M Faculty of Health and Medical Sciences Institute of Sports Medicine Copenhagen Bispebjerg Hospital and Center for Healthy Aging University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Physical Therapy Bispebjerg Hospital  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikael","family":"Boesen","sequence":"additional","affiliation":[{"name":"Radiology Bispebjerg Frederiksberg Hospital University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janus D.","family":"Nybing","sequence":"additional","affiliation":[{"name":"Radiology Bispebjerg Frederiksberg Hospital University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Engin Y.","family":"Kurt","sequence":"additional","affiliation":[{"name":"Radiology Bispebjerg Frederiksberg Hospital University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. 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