Magnetic resonance imaging (MRI) and ultrasound are the imaging modalities of choice to assess muscle injuries in athletes. Most authors consider MRI as the reference standard for evaluation of muscle injuries, since it superiorly depicts the extent of injuries independently of its temporal evolution, and due to the fact that MRI seems to be more sensitive for the detection of minimal injuries. Furthermore, MRI may potentially allow sports medicine physicians to more accurately estimate recovery times of athletes sustaining muscle injuries in the lower limbs, as well as the risk of re-injury. However, based on data available, the specific utility of imaging (including MRI) regarding its prognostic value remains limited and controversial. Although high-quality imaging is systematically performed in professional athletes and data extracted from it may potentially help to plan and guide management of muscle injuries, clinical (and functional) assessment is still the most valuable tool to guide return to competition decisions.
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Junge A, Engebretsen L, Mountjoy ML, et al. Sports injuries during the Summer Olympic Games 2008. Am J Sports Med. 2009;37:2165–72.
Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, seasons 1997-2000. Br J Sports Med. 2002;36:39–44.
Darrow CJ, Collins CL, Yard EE, Comstock RD. Epidemiology of severe injuries among United States high school athletes: 2005-2007. Am J Sports Med. 2009;37:1798–805.
Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med. 2011;39:1226–32.
Elliott MC, Zarins B, Powell JW, Kenyon CD. Hamstring muscle strains in professional football players: a 10-year review. Am J Sports Med. 2011;39:843–50.
Ekstrand J, Healy JC, Walden M, Lee JC, English B, Hagglund M. Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Br J Sports Med. 2012;46:112–7. Largest study evaluating the relationship between MRI findings of hamstring injuries and return to play in professional football.
Askling CM, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med. 2007;35:197–206.
Askling CM, Tengvar M, Saartok T, Thorstensson A. Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med. 2008;36:1799–804.
Schneider-Kolsky ME, Hoving JL, Warren P, Connell DA. A comparison between clinical assessment and magnetic resonance imaging of acute hamstring injuries. Am J Sports Med. 2006;34:1008–15.
Connell DA, Schneider-Kolsky ME, Hoving JL, et al. Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. AJR Am J Roentgenol. 2004;183:975–84.
Cohen SB, Towers JD, Zoga A, et al. Hamstring injuries in professional football players: magnetic resonance imaging correlation with return to play. Sports Health. 2011;3:423–30.
Gibbs NJ, Cross TM, Cameron M, Houang MT. The accuracy of MRI in predicting recovery and recurrence of acute grade one hamstring muscle strains within the same season in Australian Rules football players. J Sci Med Sport. 2004;7:248–58.
Kerkhoffs GM, van Es N, Wieldraaijer T, Sierevelt IN, Ekstrand J, van Dijk CN. Diagnosis and prognosis of acute hamstring injuries in athletes. Knee Surg Sports Traumatol Arthrosc. 2013;21:500–9. Important literature review for the identification of relevant diagnostic and prognostic features of acute hamstring injuries, including clinical and imaging assessments.
Koulouris G, Connell DA, Brukner P, Schneider-Kolsky M. Magnetic resonance imaging parameters for assessing risk of recurrent hamstring injuries in elite athletes. Am J Sports Med. 2007;35:1500–6.
Verrall GM, Slavotinek JP, Barnes PG, Fon GT, Esterman A. Assessment of physical examination and magnetic resonance imaging findings of hamstring injury as predictors for recurrent injury. J Orthop Sports Phys Ther. 2006;36:215–24.
Cross TM, Gibbs N, Houang MT, Cameron M. Acute quadriceps muscle strains: magnetic resonance imaging features and prognosis. Am J Sports Med. 2004;32:710–9.
Lee JC, Mitchell AW, Healy JC. Imaging of muscle injury in the elite athlete. Br J Radiol. 2012;85:1173–85.
Garrett Jr WE. Muscle strain injuries: clinical and basic aspects. Med Sci Sports Exerc. 1990;22:436–43.
Askling CM, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during slow-speed stretching: clinical, magnetic resonance imaging, and recovery characteristics. Am J Sports Med. 2007;35:1716–24.
Garrett Jr WE, Califf JC, Bassett 3rd FH. Histochemical correlates of hamstring injuries. Am J Sports Med. 1984;12:98–103.
Slocum DB, James SL. Biomechanics of running. JAMA. 1968;205:721–8.
Croisier JL, Ganteaume S, Binet J, Genty M, Ferret JM. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med. 2008;36:1469–75.
el-Khoury GY, Daniel WW, Kathol MH. Acute and chronic avulsive injuries. Radiol Clin North Am. 1997;35:747–66.
O’Donoghue DO. Treatment of injuries to athletes. Philadelphia: WB Saunders; 1962.
Hayashi D, Hamilton B, Guermazi A, de Villiers R, Crema MD, Roemer FW. Traumatic injuries of thigh and calf muscles in athletes: role and clinical relevance of MR imaging and ultrasound. Insights Imag. 2012;3:591–601.
Koulouris G, Connell D. Hamstring muscle complex: an imaging review. Radiographics. 2005;25:571–86.
Slavotinek JP, Verrall GM, Fon GT. Hamstring injury in athletes: using MR imaging measurements to compare extent of muscle injury with amount of time lost from competition. AJR Am J Roentgenol. 2002;179:1621–8.
Comin J, Malliaras P, Baquie P, Barbour T, Connell D. Return to competitive play after hamstring injuries involving disruption of the central tendon. Am J Sports Med. 2013;41:111–5. First study demonstrating the relevance of central tendon involvement in muscle strain regarding the time of recovery of athletes.
Deutsch AL, Mink JH. Magnetic resonance imaging of musculoskeletal injuries. Radiol Clin North Am. 1989;27:983–1002.
Kneeland JP. MR imaging of muscle and tendon injury. Eur J Radiol. 1997;25:198–208.
Douis H, Gillett M, James SL. Imaging in the diagnosis, prognostication, and management of lower limb muscle injury. Semin Musculoskelet Radiol. 2011;15:27–41.
Verrall GM, Slavotinek JP, Barnes PG, Fon GT. Diagnostic and prognostic value of clinical findings in 83 athletes with posterior thigh injury: comparison of clinical findings with magnetic resonance imaging documentation of hamstring muscle strain. Am J Sports Med. 2003;31:969–73.
Pomeranz SJ, Heidt Jr RS. MR imaging in the prognostication of hamstring injury. work in progress. Radiology. 1993;189:897–900.
Silder A, Sherry MA, Sanfilippo J, Tuite MJ, Hetzel SJ, Heiderscheit BC. Clinical and morphological changes following 2 rehabilitation programs for acute hamstring strain injuries: a randomized clinical trial. J Orthop Sports Phys Ther. 2013;43:284–99. Relevant follow-up randomized clinical trial including athletes with hamstring injuries, including clinical and MRI assessments at baseline and follow-up.
Kim HK, Lindquist DM, Serai SD, et al. Magnetic resonance imaging of pediatric muscular disorders: recent advances and clinical applications. Radiol Clin North Am. 2013;51:721–42.
Forbes SC, Walter GA, Rooney WD, et al. Skeletal muscles of ambulant children with Duchenne muscular dystrophy: validation of multicenter study of evaluation with MR imaging and MR spectroscopy. Radiology. 2013;269:198–207.
Maillard SM, Jones R, Owens C, et al. Quantitative assessment of MRI T2 relaxation time of thigh muscles in juvenile dermatomyositis. Rheumatology. 2004;43:603–8.
Arpan I, Forbes SC, Lott DJ, et al. T(2) mapping provides multiple approaches for the characterization of muscle involvement in neuromuscular diseases: a cross-sectional study of lower leg muscles in 5–15-year-old boys with Duchenne muscular dystrophy. NMR Biomed. 2013;26:320–8.
Hsieh TJ, Jaw TS, Chuang HY, Jong YJ, Liu GC, Li CW. Muscle metabolism in Duchenne muscular dystrophy assessed by in vivo proton magnetic resonance spectroscopy. J Comput Assist Tomogr. 2009;33:150–4.
Kim HK, Laor T, Horn PS, Racadio JM, Wong B, Dardzinski BJ. T2 mapping in Duchenne muscular dystrophy: distribution of disease activity and correlation with clinical assessments. Radiology. 2010;255:899–908.
Kim HK, Laor T, Horn PS, Wong B. Quantitative assessment of the T2 relaxation time of the gluteus muscles in children with Duchenne muscular dystrophy: a comparative study before and after steroid treatment. Korean J Radiol. 2010;11:304–11.
Lodi R, Muntoni F, Taylor J, et al. Correlative MR imaging and 31P-MR spectroscopy study in sarcoglycan deficient limb girdle muscular dystrophy. Neuromuscul Disord. 1997;7:505–11.
Torriani M, Townsend E, Thomas BJ, Bredella MA, Ghomi RH, Tseng BS. Lower leg muscle involvement in Duchenne muscular dystrophy: an MR imaging and spectroscopy study. Skeletal Radiol. 2012;41:437–45.
Prior BM, Foley JM, Jayaraman RC, Meyer RA. Pixel T2 distribution in functional magnetic resonance images of muscle. J Appl Physiol. 1999;87:2107–14.
Shellock FG, Fleckenstein JL. Muscle physiology and pathophysiology: magnetic resonance imaging evaluation. Semin Musculoskelet Radiol. 2000;4:459–79.
Kinugasa R, Kawakami Y, Fukunaga T. Mapping activation levels of skeletal muscle in healthy volunteers: an MRI study. J Magn Reson Imaging. 2006;24:1420–5.
Tawara N, Nitta O, Kuruma H, et al. Functional T(2) mapping of the trunkal muscle. Magn Reson Med Sci. 2009;8:81–3.
Tawara N, Nitta O, Kuruma H, Niitsu M, Itoh A. T2 mapping of muscle activity using ultrafast imaging. Magn Reson Med Sci. 2011;10:85–91.
Akima H, Kinugasa R, Kuno S. Recruitment of the thigh muscles during sprint cycling by muscle functional magnetic resonance imaging. Int J Sports Med. 2005;26:245–52.
Baffa AP, Felicio LR, Saad MC, Nogueira-Barbosa MH, Santos AC, Bevilaqua-Grossi D. Quantitative MRI of vastus medialis, vastus lateralis and gluteus medius muscle workload after squat exercise: comparison between squatting with hip adduction and hip abduction. J Hum Kinet. 2012;33:5–14. Nice demonstration of the usefulness of quantitative T2 assessment of muscle recruitment after different exercises applied to the lower limbs.
Fisher MJ, Meyer RA, Adams GR, Foley JM, Potchen EJ. Direct relationship between proton T2 and exercise intensity in skeletal muscle MR images. Invest Radiol. 1990;25:480–5.
Yue G, Alexander AL, Laidlaw DH, Gmitro AF, Unger EC, Enoka RM. Sensitivity of muscle proton spin-spin relaxation time as an index of muscle activation. J Appl Physiol. 1994;77:84–92.
Froeling M, Nederveen AJ, Heijtel DF, et al. Diffusion-tensor MRI reveals the complex muscle architecture of the human forearm. J Magn Reson Imaging. 2012;36:237–48.
Cermak NM, Noseworthy MD, Bourgeois JM, Tarnopolsky MA, Gibala MJ. Diffusion tensor MRI to assess skeletal muscle disruption following eccentric exercise. Muscle Nerve. 2012;46:42–50.
Kan JH, Heemskerk AM, Ding Z, et al. DTI-based muscle fiber tracking of the quadriceps mechanism in lateral patellar dislocation. J Magn Reson Imaging. 2009;29:663–70.
Scheel M, von Roth P, Winkler T, et al. Fiber type characterization in skeletal muscle by diffusion tensor imaging. NMR Biomed. 2013;26:1220–4.
Scheel M, Prokscha T, von Roth P, et al. Diffusion tensor imaging of skeletal muscle - correlation of fractional anisotropy to muscle power. Röfo. 2013;185:857–61.
Taylor DJ. Clinical utility of muscle MR spectroscopy. Semin Musculoskelet Radiol. 2000;4:481–502.
Johansen L, Quistorff B. 31P-MRS characterization of sprint and endurance trained athletes. Int J Sports Med. 2003;24:183–9.
Pesta D, Paschke V, Hoppel F, et al. Different metabolic responses during incremental exercise assessed by localized 31P MRS in sprint and endurance athletes and untrained individuals. Int J Sports Med. 2013;34:669–75.
Koh ES, McNally EG. Ultrasound of skeletal muscle injury. Semin Musculoskelet Radiol. 2007;11:162–73.
Peetrons P. Ultrasound of muscles. Eur Radiol. 2002;12:35–43.
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Conflict of Interest
Andre F. Yamada and Abdalla Y. Skaf declare that they have no conflict of interest.
Michel D. Crema has stock options in Boston Imaging Core Lab.
Ali Guermazi has received consultancy fees from MerckSerono, Genzyme, TissueGene, and OrthoTrophix and has stock options in Boston Imaging Core Lab.
Frank W. Roemer has stock options in Boston Imaging Core Lab.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Muscle Injuries
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Crema, M.D., Yamada, A.F., Guermazi, A. et al. Imaging techniques for muscle injury in sports medicine and clinical relevance. Curr Rev Musculoskelet Med 8, 154–161 (2015). https://doi.org/10.1007/s12178-015-9260-4
- Muscle injury
- Sports medicine
- Trauma injury