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Palpating muscles, massaging the evidence? An editorial relating to 'Terminology and classification of muscle injuries in sport: The Munich consensus statement'
  1. Johannes L Tol1,
  2. Bruce Hamilton1,
  3. Thomas M Best2
  1. 1Department of Sports Medicine, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2Division of Sports Medicine, Department of Family Medicine, Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio, USA
  1. Correspondence to Dr Johannes L Tol, Department of Sports Medicine, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, PO Box 29222, Doha 29222, Qatar; Johannes.tol{at}aspetar.com

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Practice-based classification

There is no denying the fact that appropriate classification of muscle injuries is a major challenge for both clinicians and researchers. The classification system proposed in this issue has been developed by highly experienced clinicians, and has the potential to impact upon both our daily practice and future research.1

Although the proposed classification of muscle injuries may reflect the daily practice of many physicians, it will likely challenge the practice and mindset of others. Notably, this classification system is broadly inclusive of various forms of muscle-related pain, and reaffirms the central role of history taking and physical examination in the diagnosis of muscle injuries and in predicting their subsequent clinical trajectory. The emphasis on clinical assessment contrasts with manuscripts in recent years which have prioritised the use of imaging as a key diagnostic determinant—at the expense of clinical assessment.2 ,3 The authors are therefore to be commended.

The proposed classification, perhaps more than any other classification, highlights the paucity of evidence from which to develop classifications. We lack high-level studies to confidently guide clinical management of muscle injuries. As a result of both the poor state of evidence and the complexity of the challenge, this proposed classification of muscle injuries raises as many questions as solutions and, thus, it has the potential to promote urgently needed research in this area.

Massaging, managing or ignoring the existing evidence?

When determining an athlete's prognosis after muscle injury, the only consistently reported (level II) evidence suggests that ‘MRI-negative’ muscle injuries have a better prognosis than injuries which are evident on MRI (MRI-positive).4–7 Several studies have provided convincing evidence that ‘MRI-negative’ (without increased signal intensity) predicts a favourable outcome and a quick return to sports.4–7 For example, Ekstrand …

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