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Three Part Question

In [Adults with post traumatic myositis ossificans of the quadriceps femoris] does [an aggressive physiotherapy regime instead of a more conservative approach] improve [quadriceps pain and function]

Clinical Scenario

A 28 years old man is referred to physiotherapy with a clinical and radiographic diagnosis of myositis ossificans 3 months after direct trauma to his right quadriceps muscle. He only has about 450 of right knee flexion and severe pain in the right thigh. You wonder whether an aggressive knee mobilisation regime rather than a more conservative approach might be beneficial to improve function quicker.

Search Strategy

MEDLINE 1966-08/05, CINAHL 1982 –08/05, AMED 1985-08/05, SPORTDiscus 1830-08/05, via the OVID interface.
[{(exp.myositis ossificans OR exp.thigh OR quadriceps.mp) AND (physiotherapy.mp OR exp physical therapy techniques )] LIMIT to human AND English language.
In addition the Cochrane database and PEDro database were also searched using search terms: [myositis ossificans OR calcification OR myositis$]
EMBASE 1996-08/05 also: ossifying myositis

Search Outcome

There were no papers retrieved that could answer the 3 part question comparing physiotherapy treatment regimes. One review reported a varying incidence rate for this condition of 20%, 17% and 9% in military cadets or athletes; it also commented on the lack of any prospective trial.
King JB. Post-traumatic ectopic calcification in the muscles of athletes. Br.J.Sports Med. 1998;32: 287-290.

Comment(s)

There has never been any RCT to compare conservative treatments regimes or modalities. It seems, therefore, that the anecdotal view of treating myositis ossificans with RICE remains unopposed based on intuitive clinical reasoning rather than an RCT.

Clinical Bottom Line

Presently there is no evidence base for the conservative treatment of this condition.