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There is strength in numbers for muscle injuries: it is time to establish an international collaborative registry
  1. Nicol van Dyk1,
  2. Anne D van der Made1,2,
  3. Ryan G Timmins3,
  4. David A Opar3,
  5. Johannes L Tol1,2,4,5
  1. 1 Department of Rehabilation, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
  3. 3 School of Exercise Science, Australian Catholic University, Melbourne, Australia
  4. 4 Academic Centre for Evidence-Based Sports Medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands
  5. 5 Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
  1. Correspondence to Nicol van Dyk, Department of Rehabilitation, Aspetar Orthopaedic and Sports Medicine Hospital, PO Box 29222, Aspire Zone Foundation, Doha, Qatar; nicol.vanDyk{at}Aspetar.com

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Muscle injuries are not all the same. All clinicians have experienced treating injuries that just won’t heal quickly, even though they seem like they should. We feel increasingly anxious as pressure from the patient and team management mounts. One factor that may delay healing of a ‘muscle strain’ is involvement of intramuscular tendon in the injury; we use this example to discuss how clinicians can cooperate to advance understanding and treatment of muscle injuries.

The case of the intramuscular tendon

A recent narrative review by Brukner and Connell1 has highlighted that, although athletes often present with the ‘typical’ musculotendinous injury, damage may sometimes extend into the intramuscular tendon. Intramuscular (also described as central)2 refers to the part of the tendon onto which muscle fibres insert (as opposed to the ‘free’ tendon). Brukner and Connell contend this has implications for treatment and prognosis.1 Not everybody agrees.

Are they really different?

The ‘traditional’ strain injury typically involves the musculotendinous junction, while the newly proposed injury subtype extends into the tendinous tissue. Tendon healing, characterised by a slow metabolic rate due to lower oxygen consumption, is a more time-consuming process than muscle …

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