9 May, 2018

Diagnostic Imaging in Sports Medicine: Present and Future

Health and Wellness
Sports Performance
160K

Muscle injuries account for more than 30% of all injuries in sports like soccer. Their significance is therefore enormous in terms of training sessions and lost game time. A correct diagnosis is essential for minimizing the problem, establishing the appropriate prognosis and treatment times and the risk of re-injury.

Imaging techniques – such as ultrasound or MRI – are very helpful in this process. Recently, Dr. Gil Rodas, a specialist physician at FC Barcelona, published an article in Healthmanagement.org magazine, in which he describes the main uses of these techniques, their significance and some new areas of research.

Diagnosis is Crucial

“The most important factor in treating a muscle injury is to make a good diagnosis,” says Rodas. “To do this, it is essential to consider what the patient and the physical examination tell you, but today we are lucky in that we also have tests, such as ultrasound or magnetic resonance imaging, which help us gain more accuracy.”

The challenge is complex, and the classification of muscle injuries is still a matter of debate. In 2017, FC Barcelona’s own medical team, in collaboration with Aspetar Hospital and other European and US centers, proposed a new system which took into account both the injury mechanism and its location, the degree of severity and the number of previous injuries. “We are moving from a very simple classification to one with many layers of information, somewhat similar to what is happening with cancer diagnosis. But we are still in this process,” says Rodas.

As for imaging tests, ultrasound is now the most widely used. “It is an easy and inexpensive system that we can use at any sports club, like a stethoscope for a cardiologist.” Using an ultrasound enables you to follow the healing process, the evolution of the hematoma or to check whether or not the muscle architecture is restored correctly. Right now it is the best tool for regular monitoring.

MRI is more expensive and less suitable for daily practice, but in return it provides a greater degree of accuracy. These imaging tests complement each other and are very useful. However, they have not yet been shown to help in deciding when the right and safe time to return to competition is. That is the next big challenge.

To make this decision, “today we rely on our own clinical evaluation and field tests based on GPS analysis,” says Rodas. “Somehow this data tell us if the vehicle, which has been stationary, is going to reach the same speeds, the same accelerations again.”

The aim is that, in future, imaging tests will also help with this decision. With new technologies, we are moving from merely being able to observe anatomy to being able to study in detail the structure of the muscle and tendon, and even its metabolism and functioning. Although there are still not enough studies, there is hope that new, more powerful MRIs (called ‘3-Tesla’ MRIs) will help by improving image definition. Another type of MRI being studied is elastography, which would allow us to study the muscles in motion, their function and flexibility. Even positron emission tomography (PET) scans, now particularly used in the study of cancer and heart disease, may provide information on muscle metabolism and recovery.

Right now, the main conclusion is that imaging tests improve the diagnosis of muscle lesions, they give a report on the prognosis and enable treatments to be adjusted. With time and research, they will probably also help decide the right time to return to competition.

RELATED NOTES

DO FOOTBALL PLAYER’S MENTAL ABILITIES INFLUENCE THE RISK OF INJURY?

Mental abilities, although not yet fully appreciated, are already considered a relevant part of performance. But their importance could go beyond that: Do they also influence the injury risk, including recurrence, once the player returns to play?

INJURY TYPE IN HANDBALL MAY VARY BY POSITION, CATEGORY AND MATURATION OF PLAYERS

Although several studies have tried to evaluate the characteristics of the risk of injury in handball players, they have been unable to reach sufficiently reliable conclusions. A new study of all the FC Barcelona handball categories has attempted to shed more light on the subject.

HOW PHYSICAL DEMANDS ON FOOTBALL PLAYERS VARY BY THEIR POSITION

Although there are several studies on this topic, many of them have analyzed these demands by looking at just a few variables or using very broad timeframes. A new study completed by physical trainers from F.C. Barcelona has analyzed several of these details more closely.

THE GREAT UNKNOWN OF MUSCLE INJURIES: CONNECTIVE TISSUE IN THE EXTRACELLULAR MATRIX

An article published in The Orthopaedic Journal of Sports Medicine —in which members of the club’s medical services participated— now suggests to consider the detailed structure of the area affected, and treating the extracellular matrix as an essential player in the prognosis of the injury.

WHAT IS LOAD MANAGEMENT REALLY ABOUT?

In this article, Tim Gabbett and his team provide a user-friendly guide for practitioners when describing the general purpose of load management to coaches.

TWO WEEKS ARE ENOUGH TO INCREASE MUSCLE VOLUME AND STRENGTH

For the first time, it has been demonstrated that it does not take months of training to significantly improve both muscle volume and strength; instead, two weeks of an appropriate exercise are enough.

ECCENTRIC EXERCISES: STUDYING “VACCINES” FOR MUSCLES

Training using eccentric exercises is important to prevent possible damage. However, intensive training can also cause muscle damage, so it is critical to be vigilant in order to keep injury risk to an absolute minimum.

THE LEVEL OF RESISTANCE AS A MODERATOR OF THE TRAINING LOAD

Cardiovascular endurance manifests as a moderator of the load result to which the athlete is exposed.

Are the players well positioned in relation to the ball?

Through the use of computer vision we can identify some shortcomings in the body orientation of players in different game situations.

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