There is strength in numbers for muscle injuries: it is time to establish an international collaborative registry

Muscle injuries are not all the same. All clinicians have experienced treating injuries that just won’t heal quickly, even though they seem like they should. We feel increasingly anxious as pressure from the patient and team management mounts. One factor that may delay healing of a ‘muscle strain’ is involvement of intramuscular tendon in the injury; we use this example to discuss how clinicians can cooperate to advance understanding and treatment of muscle injuries. A recent narrative review by Brukner and Connell1 has highlighted that, although athletes often present with the ‘typical’ musculotendinous injury, damage may sometimes extend into the intramuscular tendon. Intramuscular (also described as central)2 refers to the part of the tendon onto which muscle fibres insert (as opposed to the ‘free’ tendon). Brukner and Connell contend this has implications for treatment and prognosis.1 Not everybody agrees. The ‘traditional’ strain injury typically involves the musculotendinous junction, while the newly proposed injury subtype extends into the tendinous tissue. Tendon healing, characterised by a slow metabolic rate due to lower oxygen consumption, is a more time-consuming process than muscle …