Muscle injuries make up more than 30% of sports injuries. It occurs that a professional football team can expect to suffer an average of 15 incidents related to muscle injuries per season, losing more than 200 days of training and competition. In addition to working on prevention, it is also essential to establish a correct diagnosis in order to minimise repercussions. This diagnosis determines the severity and the best treatment and also provides guidance on the recovery period and risk of re-injury.

Useful tools for this process are imaging tests such as ultrasound and magnetic resonance, which is more precise and decisive. In recent years, three different classifications of muscle injuries have been proposed: the Munich classification, the British system and the more recent F.C. Barcelona-Aspetar classification. All of these classifications seek to categorise and narrow down the different types of injuries in order to help establish a diagnosis and prognosis. However, they each use different criteria to categorise muscle injuries, which leads to discrepancies between them. There is also still no clear evidence on their validity or utility.

In order to better evaluate these classifications, a team of F.C. Barcelona doctors and radiologists analysed their usefulness for assessing the prognosis and recovery time of the injured players from the Club’s first division football team over the course of one year. They published their results and conclusions in the magazine healthmanagement.org.

An Analysis of the Classifications

During the 2017/18 season, eight different muscle injuries occurred in the club’s first division team. All of the players underwent a magnetic resonance imaging scan in the first 24 to 48 hours post-injury, and after a variable period of time, they all returned to competition without re-injury. “The study evaluated the ability of each of the three classifications to predict recovery time”, explains Jaime Isern, assistant radiologist at Hospital Clínic de Barcelona and in the club’s medical services. There are many differences between them, but, “the F.C. Barcelona-Aspetar classification is the most recent and the most complete, as it incorporates concepts such as injury mechanism and location. However, it does sometimes overestimate the recovery time in some of the cases”, Isern summarises.

“This is the classification that we are using on a regular basis”, comments Sandra Mechó, radiologist for the club’s medical services and the Hospital de Barcelona. “Among its benefits is the simplicity of the categorisation, which allows us to evaluate the location and whether there is a significant damage to the connective tissue”, she concludes.

However, despite its strengths, there is still a certain amount of variability in terms of recovery time, and it is not an exact predictor of return to play. This is currently based on clinical evaluation and on field tests using GPS analysis. To improve its usefulness, the authors propose the incorporation of variations to the classification. These would be the main additions:

• Consider the amount of connective tissue affected more closely, since recent studies have pointed to its great importance in recovery. This would involve evaluating whether the free tendon, intramuscular tendon or intramuscular connective tissue are damaged, as well as assessing the thickness.
• Establish individualised criteria for each muscle group (the Barcelona classification was mainly established based on hamstring injuries and the rectus femoris).
• Assess if there is a previous scar in the area (not only a re-injury, as it occurs now).
• Take the direction of the tear into account.
• Stop considering oedema and the accumulation of intermuscular fluid as important factors, since they never predict its evolution or progress.

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Conclusions

The classifications that define the severity and the prognosis of muscle injuries based on magnetic resonance imaging are helping professionals to manage the type of treatment and estimate the recovery time. However, the complexity of the tissues and the specific characteristics of each muscle mean that they are not infallible. Still, nowadays, it isn’t sufficient to detail the time off due to injury with absolute reliability.

Of the three available classifications, the most complete and most useful seems to be the F.C. Barcelona-Aspetar, but investigations are still underway. “We are currently working on an analysis of the muscle injuries diagnosed and treated in the club during the last three seasons. We want to check that the parameters and the variations we suggested signify a real improvement”, Mechó concludes.

The Barça Innovation Hub team