Muscle Tear
Indirect injury from excessive tensile force, usually at the myotendinous junction during eccentric contraction. Biarticular muscles are most at risk: hamstrings, rectus femoris, gastrocnemius.
Presentation
- Sudden pain, “pull” or “pop”, often mid-sprint
- Localised tenderness, palpable defect in complete tears
- Bruising appearing over days
- Weak, painful resisted contraction
Grading
| Grade I | Grade II | Grade III | |
|---|---|---|---|
| Damage | Few fibres | Partial tear | Complete rupture |
| Defect | None | Sometimes palpable | Palpable gap |
| Function | Near normal | Reduced | Lost |
Munich consensus
types 1 to 2 are functional (no macroscopic tear). Types 3 to 4 are structural (3A minor, 3B moderate, 4A subtotal, 4B complete).
BAMIC grades MRI severity (0 to 4) and adds site: (a) myofascial, (b) muscle-tendon junction, (c) intratendinous. Type c heals slowest and re-injures most.
Imaging
- Ultrasound is first-line: immediate, dynamic, cheap, repeatable, useful for haematoma size and follow-up.
- MRI for equivocal ultrasound, deep or proximal injuries, suspected intratendinous extension, or elite return-to-play planning.
- MRI grade alone has limited prognostic value. Clinical and functional assessment predicts return better.
Treatment
Progressive loading rehabilitation is the evidence-based treatment.
| Option | Verdict |
|---|---|
| PRP | No consistent benefit over structured rehab. Case-by-case in elite settings only |
| Stem cells, combined “regenerative” protocols | Experimental, case series only |
| Corticosteroid | Avoid. Masks symptoms, may delay healing |
Return to play
- Grade I: 1 to 2 weeks. Grade II: about 3 to 6 weeks. Grade III: considerably longer.
- Intratendinous injuries: often 5+ weeks, with more re-injury if rushed.
- Re-injury up to 20 to 30%, highest in the first 2 weeks back.
- Return on functional criteria, not the calendar.
- The Nordic hamstring exercise cuts hamstring injury rates by about 50%.
References
- Mueller-Wohlfahrt et al., Munich consensus, Br J Sports Med 2013, doi:10.1136/bjsports-2012-091448
- Pollock et al., BAMIC, Br J Sports Med 2014, doi:10.1136/bjsports-2013-093302
- Opar et al., Sports Med 2012, doi:10.2165/11594800-000000000-00000
Related
Medical disclaimer: this article is general information, not personal medical advice. Always consult a qualified doctor about your own situation.