Out with the old, in with the new: A more detailed, functional grading system for muscle injuries
British athletics muscle injury classification: a new grading system ; https://bjsm.bmj.com/content/48/18/1347
Muscle injuries are the most prevalent injuries for athletes and historically there have been many different systems put forth to classify them. Most commonly, you’ll currently see a three tier grading system that ranges from grade I (mild) to grade II (moderate) to grade III (severe, typically a full rupture).
Here’s an example using a hamstring strain:
However, this grading system - albeit easy to understand - leaves out many nuances and oversimplifies the complexity and spectrum of muscle injuries. In clinical terms, this grading system lacks diagnostic accuracy while providing limited information.
To address those issues, the British Athletics Medical team - they provide medical support to Great Britain’s international track and field athletes - came up with the British athletics muscle injury classification system, based on the use of MRI to validate findings.
Firstly, the recommendation is to stop calling muscle injuries “strains” and more appropriately use the word “tear”.
The system has five grades with increasing severity (denoted with numbers 0-4) and then subtypes (denoted with letters a, b, and c). The sub-types refer to different locations of injury within the muscle/tendon.
Here’s a full chart of the classification system:
Key takeaways
This classification system can provide a more detailed framework for clinicians when dealing with muscle injury and better guide athletes in their rehab journeys.
Although no system is perfect, using one that is clinically reliable and relevant with a logical structure and based on reliable testing could enhance current clinical practice. As other muscular assessments become more reliable - for example, MRI is very reliable regardless of who is using it while musculoskeletal ultrasound, an emerging way to assess muscle injury, still doesn’t have that reliability - they could also be integrated into the system as well.
The overall goal would be to establish a reliable and credible framework for muscle injury and eventually, if validated, use this system as part of the foundation for player readiness and return to play.
Thank you for reading and thank you for your time. If you need our help with injury recovery, fitness, and/or mindset coaching (we offer virtual & in-person avenues, including online programs) head over to the website.
Dr. Rajpal Brar, DPT has a doctorate in physical therapy from Northern Arizona University, and runs his own in-person and online sports medicine and performance business, 3CB Performance, in West LA and Valencia, CA and partners with Quantum Performance in which he further combines his movement expertise and fitness training background to rehab & train elite athletes. He also works at a hospital — giving him experience with patients in the immediate healthcare setting and neurological patients (post stroke, post brain injury) — and has been practicing for over 6+ years. Brar is additionally training at UCLA’s mindful awareness research center (MARC), has a background in multiple sports both playing and coaching and discusses sports injuries, fitness and performance his own YouTube Channel. You can follow him on Twitter at @3cbPerformance.