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Classification and grading of muscle injuries: a narrative review
  1. Bruce Hamilton1,
  2. Xavier Valle2,3,4,
  3. Gil Rodas3,
  4. Luis Til2,
  5. Ricard Pruna Grive2,
  6. Josep Antoni Gutierrez Rincon2,
  7. Johannes L Tol5
  1. 1Medical Lead HPSNZ, National Training Centre, Millenium Institute of Sport and Health, Auckland, New Zealand
  2. 2F.C. Barcelona Medical Services, Barcelona, Spain
  3. 3Sports Medicine School, University of Barcelona, Barcelona, Spain
  4. 4Clinica Mapfre de Medicina del Tenis, Barcelona, Spain
  5. 5Sports Medicine Department, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  1. Correspondence to Dr Bruce Hamilton, High Performance Sport NZ, Millenium Institute of Sport and Health, Mairangi Bay, Auckland 0632, New Zealand; Bruce.hamilton{at}


A limitation to the accurate study of muscle injuries and their management has been the lack of a uniform approach to the categorisation and grading of muscle injuries. The goal of this narrative review was to provide a framework from which to understand the historical progression of the classification and grading of muscle injuries. We reviewed the classification and grading of muscle injuries in the literature to critically illustrate the strengths, weaknesses, contradictions or controversies. A retrospective, citation-based methodology was applied to search for English language literature which evaluated or utilised a novel muscle classification or grading system. While there is an abundance of literature classifying and grading muscle injuries, it is predominantly expert opinion, and there remains little evidence relating any of the clinical or radiological features to an established pathology or clinical outcome. While the categorical grading of injury severity may have been a reasonable solution to a clinical challenge identified in the middle of the 20th century, it is time to recognise the complexity of the injury, cease trying to oversimplify it and to develop appropriately powered research projects to answer important questions.

  • Hamstring
  • MRI
  • Muscle damage/injuries
  • Ultrasound

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