Terminology and classification of muscle injuries in sport

NewsBot · Oct 18, 2012

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Terminology and classification of muscle injuries in sport: a consensus statement
Hans-Wilhelm Mueller-Wohlfahrt, Lutz Haensel, Kai Mithoefer, Jan Ekstrand, Bryan English, Steven McNally, John Orchard, C Niek van Dijk, Gino M Kerkhoffs, Patrick Schamasch, Dieter Blottner, Leif Swaerd, Edwin Goedhart, Peter Ueblacker
Br J Sports Med 18 October

Objective To provide a clear terminology and classification of muscle injuries in order to facilitate effective communication among medical practitioners and development of systematic treatment strategies.

Methods Thirty native English-speaking scientists and team doctors of national and first division professional sports teams were asked to complete a questionnaire on muscle injuries to evaluate the currently used terminology of athletic muscle injury. In addition, a consensus meeting of international sports medicine experts was established to develop practical and scientific definitions of muscle injuries as well as a new and comprehensive classification system.

Results The response rate of the survey was 63%. The responses confirmed the marked variability in the use of the terminology relating to muscle injury, with the most obvious inconsistencies for the term strain. In the consensus meeting, practical and systematic terms were defined and established. In addition, a new comprehensive classification system was developed, which differentiates between four types: functional muscle disorders (type 1: overexertion-related and type 2: neuromuscular muscle disorders) describing disorders without macroscopic evidence of fibre tear and structural muscle injuries (type 3: partial tears and type 4: (sub)total tears/tendinous avulsions) with macroscopic evidence of fibre tear, that is, structural damage. Subclassifications are presented for each type.

Conclusions A consistent English terminology as well as a comprehensive classification system for athletic muscle injuries which is proven in the daily practice are presented. This will help to improve clarity of communication for diagnostic and therapeutic purposes and can serve as the basis for future comparative studies to address the continued lack of systematic information on muscle injuries in the literature.

What are the new things Consensus definitions of the terminology which is used in the field of muscle injuries as well as a new comprehensive classification system which clearly defines types of athletic muscle injuries.
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NewsBot · Dec 6, 2012

Editorial
Palpating muscles, massaging the evidence? An editorial relating to 'Terminology and classification of muscle injuries in sport: The Munich consensus statement'.
Johannes L Tol, Bruce Hamilton, Thomas M Best
Br J Sports Med doi:10.1136/bjsports-2012-091849

Full text

NewsBot · May 8, 2013

Muscle Injuries in Athletes
Enhancing Recovery Through Scientific Understanding and Novel Therapies
Demetris Delos, Travis G. Maak, Scott A. Rodeo
Sports Health: A Multidisciplinary Approach April 30, 2013

Context: Muscle injuries are extremely common in athletes and often produce pain, dysfunction, and the inability to return to practice or competition. Appropriate diagnosis and management can optimize recovery and minimize time to return to play.

Evidence Acquisition: Contemporary papers, both basic science and clinical medicine, that investigate muscle healing were reviewed. A Medline/PubMed search inclusive of years 1948 to 2012 was performed.

Results: Diagnosis can usually be made according to history and physical examination for most injuries. Although data are limited, initial conservative management emphasizing the RICE principles and immobilization of the extremity for several days for higher grade injuries are typically all that is required. Injection of corticosteroids may clinically enhance function after an acute muscle strain. Additional adjunctive treatments (nonsteroidal anti-inflammatory drugs, platelet-rich plasma, and others) to enhance muscle healing and limit scar formation show promise but need additional data to better define their roles.

Conclusion: Conservative treatment recommendations will typically lead to successful outcomes after a muscle injury. There is limited evidence to support most adjunctive treatments.
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NewsBot · Jul 17, 2014

British athletics muscle injury classification: a new grading system
Noel Pollock, Steven L J James, Justin C Lee, Robin Chakraverty
Br J Sports Med doi:10.1136/bjsports-2013-093302

The commonly used muscle injury grading systems based on three grades of injury, representing minor, moderate and complete injuries to the muscle, are lacking in diagnostic accuracy and provide limited prognostic information to the clinician. In recent years, there have been a number of proposals for alternative grading systems. While there is recent evidence regarding the prognostic features of muscle injuries, this evidence has not often been incorporated into the grading proposals. The British Athletics Muscle Injury Classification proposes a new system, based on the available evidence, which should provide a sound diagnostic base for therapeutic decision-making and prognostication. Injuries are graded 0–4 based on MRI features, with Grades 1–4 including an additional suffix ‘a’, ‘b’ or ‘c’ if the injury is ‘myofascial’, ‘musculo-tendinous’ or ‘intratendinous’. Retrospective and prospective studies in elite track and field athletes are underway to validate the classification for use in hamstring muscle injury management. It is intended that this grading system can provide a suitable diagnostic framework for enhanced clinical decision-making in the management of muscle injuries and assist with future research to inform the development of improved prevention and management strategies.
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NewsBot · Dec 31, 2015

Spanish Consensus Statement
The Treatment of Muscle Tears in Sport
Tomas F. Fernandez-Jaen et al
Orthopaedic Journal of Sports Medicine December 2015 vol. 3 no. 12 2325967115622434

On the 21st of March, 2015, experts met at Cl?nica CEMTRO in Madrid, Spain, under the patronage of The Spanish Society for Sports Traumatology (SETRADE), The Spanish Federation of Sports Medicine (FEMEDE), The Spanish Association of Medical Services for Football Clubs (AEMEF), and The Spanish Association of Medical Services for Basketball Clubs (AEMB) with the aim of establishing a round table that would allow specialists to consider the most appropriate current general actions to be taken when treating muscle tears in sport, based on proven scientific data described in the medical literature. Each expert received a questionnaire prior to the aforementioned meeting comprising a set of questions concerning therapeutic indications generally applied in the different stages present during muscle repair.
The present Consensus Document is the result of the answers to the questionnaire and resulting discussion and consensus over which are the best current indications in the treatment of muscle tears in sport. Avoiding immobilization, not taking nonsteroidal anti-inflammatory drugs (NSAIDs) randomly, fostering early mobilization, increasing vascularization of injured, site and regulating inflammatory mechanisms—without inhibiting these from the early stages of the recovery period—all stood out as main points of the Consensus Document. Additionally, there is controversy concerning cell stimulation techniques and the use of growth factors or cell inhibitors. The decision concerning discharge was unanimous, as was the criteria considered when it came to performing sport techniques without pain.
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NewsBot · Jun 16, 2017

Muscle Injuries in Sports: A New Evidence-Informed and Expert Consensus-Based Classification with Clinical Application
Valle, X., Alentorn-Geli, E., Tol, J.L. et al.
Sports Med (2017) 47: 1241. doi:10.1007/s40279-016-0647-1

Muscle injuries are among the most common injuries in sport and continue to be a major concern because of training and competition time loss, challenging decision making regarding treatment and return to sport, and a relatively high recurrence rate. An adequate classification of muscle injury is essential for a full understanding of the injury and to optimize its management and return-to-play process. The ongoing failure to establish a classification system with broad acceptance has resulted from factors such as limited clinical applicability, and the inclusion of subjective findings and ambiguous terminology. The purpose of this article was to describe a classification system for muscle injuries with easy clinical application, adequate grouping of injuries with similar functional impairment, and potential prognostic value. This evidence-informed and expert consensus-based classification system for muscle injuries is based on a four-letter initialism system: MLG-R, respectively referring to the mechanism of injury (M), location of injury (L), grading of severity (G), and number of muscle re-injuries (R). The goal of the classification is to enhance communication between healthcare and sports-related professionals and facilitate rehabilitation and return-to-play decision making.
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NewsBot · Jan 15, 2020

Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport – grading the evidence: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)
Lasse Ishøi et al
British Journal of Sports Medicine Published Online First: 14 January 2020

This statement summarises and appraises the evidence on diagnosis, prevention and treatment of the most common lower extremity muscle injuries in sport. We systematically searched electronic databases, and included studies based on the highest available evidence. Subsequently, we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, grading the quality of evidence from high to very low. Most clinical tests showed very low to low diagnostic effectiveness. For hamstring injury prevention, programmes that included the Nordic hamstring exercise resulted in a hamstring injury risk reduction when compared with usual care (medium to large effect size; moderate to high quality of evidence). For prevention of groin injuries, both the FIFA 11+programme and the Copenhagen adductor strengthening programme resulted in a groin injury risk reduction compared with usual care (medium effect size; low to moderate quality of evidence). For the treatment of hamstring injuries, lengthening hamstring exercises showed the fastest return to play with a lower reinjury rate compared with conventional hamstring exercises (large effect size; very low to low quality of evidence). Platelet-rich plasma had no effect on time to return-to-play and reinjury risk (trivial effect size; moderate quality of evidence) after a hamstring injury compared with placebo or rehabilitation. At this point, most outcomes for diagnosis, prevention and treatment were graded as very low to moderate quality of evidence, indicating that further high-quality research is likely to have an important impact on the confidence in the effect estimates.
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