Recently, the Munich consensus25 and others28 have proposed alternative muscle grading systems. The Munich grading system classifies injuries as either ‘functional’ (fatigue induced, delayed onset muscle soreness (DOMS), spine related neuromuscular dysfunction or muscle related neuromuscular dysfunction) or ‘structural’ muscle pathology. The ‘functional’ terminology is problematic as clearly a number of the pathological entities which the Munich system describes as ‘functional’ are most likely structural pathology,27 and indeed the consensus comments on MRI changes in these classes.
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