Muscle Strain Grading: Traditional Grading versus Modern Approach
High performance therapists and trainers predict a large incidence of soft tissue injuries such as muscle strains to occur in athletes once sports return to competition around the world. Even weekend warriors and recreational athletes will likely experience the same incidence due to such a long period of deconditioning from the global quarantine. Simply put, not having been exposed to a regular stimulus of weight training and match intensity effort could put you at risk of common soft tissue injuries such as muscle strains.
Muscle strains are defined as when a muscle experiences a tear and typically occurs during movements that involve generating high levels of force and tension on a particular muscle. [1]
Traditionally muscle strains have been graded on a numerical scale of 1-3, in which 3 was most severe and 1 was the least severe. [1] A grade 3 indicates that there is a severe tear and complete loss of function. [1] A grade 2 indicates that there is a moderate tear and moderate loss of function. [1] A grade 1 indicates that there is a minimal tear with a minimal loss of range or strength. [1]
In 2012 the British Athletics muscle injury classification (BAMIC) system have proposed a new method to be used that offers a more specific diagnosis regarding a muscle strain. [2] The BAMIC system incorporates the size of the tear in the muscle, as well as the specific location on the muscle. [2] In a nutshell, tears typically occur either on the myofascia (protective sheath encasing the actual muscle), the MTJ (muscle tendon junction), or at the central tendon of the muscle. [2] In this system the size of the tear corresponds to a numerical value 0-4 (4 being most severe) and a letter grade (a-c) that indicates the location. [2] A grade “a” indicates it is myofascial, “b” is at the MTJ, and grade “c” is at the central tendon. [2]
Researchers initially suggested that the location of the tear has a more significant indication of prognosis, in which grade “c” was most severe and grade “a” is least severe. [3, 4] A grade “c” indicated that there is complete loss in strength and ROM, as well as significant pain. A grade “b” indicates there is moderate loss in strength or ROM, and moderate pain reported. A grade “a” indicates there is minimal pain with minimal to no loss in ROM or strength. [3, 4]
Although an MRI would provide a direct diagnosis of the exact location and size, physiotherapists can also provide a diagnosis based on a standard clinical assessment. A combination of examining ROM, strength testing, functional testing, reported pain levels, and palpating gaps in muscle can all help to provide a proper muscle strain classification. Although the BAMIC muscle strain classification system itself helps to provide an accurate diagnosis, the prognosis of your injury will also depend on the severity of the impairments you present with. Based on your initial assessment, your physiotherapist can help provide you with a thorough explanation of your injury, as well as provide helpful treatment strategies and therapeutic rehabilitation exercises to ensure an optimal recovery.
If you have any further questions regarding muscle strains, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.
References
Middleton, S., & Smith, J. (2007). Muscle injuries. Trauma, 9(1), 5-11.
Pollock, Noel, James, Steven L J, Lee, Justin C, & Chakraverty, Robin. (2014). British athletics muscle injury classification: A new grading system. British Journal of Sports Medicine, 48(18), 1347-13451.
Prakash, A., Entwisle, T., Schneider, M., Brukner, P., & Connell, D. (2018). Connective tissue injury in calf muscle tears and return to play: MRI correlation. British Journal of Sports Medicine, 52(14), 929-933.
Pollock, Noel, Patel, Anish, Chakraverty, Julian, Suokas, Anu, James, Stephen L J, & Chakraverty, Robin. (2016). Time to return to full training is delayed and recurrence rate is higher in intratendinous (‘c’) acute hamstring injury in elite track and field athletes: Clinical application of the British Athletics Muscle Injury Classification. British Journal of Sports Medicine, 50(5), 305-310.