An understanding of the pathophysiology of poliomyelitis and its late sequelae (part 1) in conjunction with contemporary principles of rehabilitation practice, provides a basis for revising the principles for acute management to optimise function over the long term. This article outlines such a revised basis for treatment of early poliomyelitis. First, treatment is based on a definitive diagnosis and multi-system assessment given the systemic effects of the disease (part 1). A nutritional assessment is also essential in developing countries where this disease is prevalent. Treatment should be implemented early and continued throughout the first year after onset when most recovery is likely to occur. Rest, comfort, and the prevention of deformity with proper body positioning and range of motion exercise remain priorities. In the post-acute stage, however, the routine procedures outlined by Sister Kenny that dominated management in the epidemic in the industrialised countries should be replaced with prescriptive physiologically-based treatment. Heat may reduce pain, spasm and stiffness, and optimise the effect of range of motion exercise. Exercise needs to be prescribed in such a way that over-exertion, fatigue, pain and further muscle damage are minimised. Dynamic moderate resistive exercise can be supported for strength and endurance training. Heavy resistive exercise may contribute to muscle irritation, pain and muscle damage. The frequency, duration and time course of treatment are based on the assessment. We conclude that the revision of management of poliomyelitis based on an understanding of its pathophysiology and the late sequelae will promote long-term function and minimise the demands of these patients on the health care delivery system over time.