Muscle Injury Terminology & Classification

Study Title: Terminology and classification of muscle injuries in sport: a consensus statement
Authors: H-W Mueller-Wohlfahrt & colleagues
Journal: British Journal of Sports Medicine
Date: 2012
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Summary:

• Rather than an actual "study" this paper is a consensus statement by world-renown German physician, Mueller-Wohlfahrt, and colleagues. The impetus for this statement was based on the lack of standardization with traditional clinical- and imaging-based grading schemes of muscle injury. Utilizing the assistance of several of the top scientific and medical experts in the field of sports medicine, Mueller-Wohlfaht and colleagues undertook a two-part project to create this consensus statement. Part one consisted of a questionnaire based on terminology sent out to sport medicine experts in an attempt to identify potential discrepancies in muscle injury terminology. Based on this questionnaire (completed by 19 individuals), it was revealed that much variability exists in key definitions of injury. Specifically, a lack of consensus exists in the descriptions of muscle strain, muscle tear, and structural vs functional injuries.
• Part two of this project entailed a one-day gathering of various experts to create a consensus statement for improved classification and standardized definitions. A brief description of the consensus statement is as follows:
• Functional Muscle Disorder: "acute indirect muscle disorder 'without macroscopic' evidence (i.e. on imaging) of muscular tear.
• Structural Muscle Injury: "acute indirect muscle injury 'with macroscopic' evidence (i.e. on imaging) of muscle tear.
• Interestingly, the authors highly recommended against the use of the term muscle strain due to it's "layman" nature and lack of standardization in definition (in comparison to the varying degree in injury).

• Classification of Acute Muscle Disorders and Injuries:
• Indirect Muscle Disorder/Injury
• Functional muscle disorders subclassified as Type 1 (Overexertion-related muscle disorder: A - Fatigue-induced; B - Delayed-onset muscle soreness) and Type 2 (Neuromuscular muscle disorder: A - Spine-related neuromuscular Muscle disorder; B - Muscle-related neuromuscular Muscle disorder)
• Structural muscle injury subclassified as Type 3 (Partial muscle tear: A - Minor partial muscle tear; B - Moderate partial muscle tear) and Type 4 ((Sub)total tear: Subtotal or Complete muscle tear; Tendinous avulsion)
• Direct Muscle Injury - Contusion or laceration

• I thought that this article was a nice step in the right direction, especially as a complement to understanding muscle injury healing phases. However, I do think it was somewhat bold to proclaim a "consensus statement", considering the fact that it has yet to be put through the rigours of scientific scrutiny. That said, such standardized terminology and classification will likely lead to improved diagnostics, management and return to play recommendations.
• My more detailed review on this paper will likely come out on Research Review Service sometime in the next several weeks but in the meantime, Johannes, Hamilton and Best wrote a nice editorial piece as a follow up.

Mueller-Wohlfart, H-W et al. (2012). Terminology and classification of muscle injuries in sport: a consensus statement. BJSM; 0:1-9