Minimal Evidence for a Secondary Loss of Strength After an Acute Muscle Injury: A Systematic Review and Meta-Analysis

BACKGROUND: An immediate loss of strength follows virtually all types of muscle injury but there is debate whether the initial strength loss is maximal or if a secondary loss of strength occurs during the first 3 days post-injury. OBJECTIVE: The objective of this analysis was to conduct a systematic review and meta-analysis of the research literature to determine if a secondary loss of strength occurs after an injurious initiating event. METHODS: Literature searches were performed using eight electronic databases (e.g., PubMed, Cochrane Library). Search terms included skeletal muscle AND (injur* OR damage*) AND (strength OR force OR torque). The extracted strength data were converted to a standard format by calculating the standardized mean difference, which is reported as the effect size (ES) along with its 95 % confidence interval (CI). The calculation of ES was designed so that a negative ES that was statistically less than zero would be interpreted as indicating a secondary loss of strength. RESULTS: A total of 223 studies with over 4000 human and animal subjects yielded data on 262 independent groups and a total of 936 separate ESs. Our overall meta-analysis yielded a small-to-medium, positive overall ES that was statistically greater than zero (overall ES = +0.34, 95 % CI 0.27–0.40; P < 0.00000001). Considerable variation in ES was observed among studies (I (2) = 86 %), which could be partially explained by the research group conducting the study, sex of the subject, day of post-injury strength assessment, whether fatigue was present immediately post-injury, and the muscle group injured. From the subgroup meta-analyses probing these variables, 36 subgroup ESs were calculated and none were statistically less than zero. CONCLUSION: Overall, our findings do not support the presence of a secondary loss of strength following an acute muscle injury, and strongly suggest that strength, on average, recovers steadily over the first 3 days post-injury. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40279-016-0528-7) contains supplementary material, which is available to authorized users.