May – the month when athletic champions are crowned, summer training programs ignite, and our collective spirit turns toward movement – is also National Physical Fitness and Sports Month. As we spotlight peak performance and injury prevention, one tool continues to gain ground in the world of sports medicine: ultrasound imaging.
Ultrasound imaging, long valued as a point-of-care diagnostic tool providing real-time evaluation of a variety of neuromusculoskeletal structures, has rapidly become an important component of the assessment and care of athletes in a variety of fitness and sports settings. Not only is ultrasound imaging used as a diagnostic tool to evaluate soft tissue injuries, but it has become increasingly important in the hands of sports medicine specialists for identifying risk factors for sports injuries before symptoms arise. This is where the conversation gets interesting!
A Season in the Life of a Tendon
A recent study by Savage et al (Inter J Physiother, 2024) used high-resolution ultrasound imaging to examine changes in tendon and bone health among Division I female volleyball athletes across their competitive season. The study examined body regions most injured in competitive volleyball players, including shoulders, knees, ankles, and feet, which have soft tissues that are under the most stress from the cumulative demands of repetitive jumping, landing, and hitting.
The findings? Over 90% of the athletes had preseason tendon or bony abnormalities despite most not reporting significant symptoms. Tendon cross-sectional area changed significantly over the course of the competitive season, particularly the Achilles and patellar tendons.
Significantly more athletes ended the season with sonographic abnormalities in four or more body regions than when they began the season.
What does this mean? These Division I athletes had sonographic signatures of soft tissue strain and adaptation related to the physical demands of the competitive volleyball season. While many of these athletes remained asymptomatic or mildly symptomatic, most were able to finish the competitive season.
However, recent study by Cushman et al (Orthop J Sports Med, 2024) found that baseline sonographic tendon abnormalities in athletes are predictive of future injury.
Ultrasound as a Performance Barometer
So, what are we looking at when we point the transducer? Tendon thickening? Focal hypoechoic zones? Calcaneal enthesophytes? Perhaps. But more broadly, we are capturing a physiological fingerprint of sport-specific loading. In this context, ultrasound imaging is more than just a diagnostic tool, it becomes a training and screening tool by:
- Detecting early soft tissue changes before symptoms develop
- Guiding load management strategies during the competitive season
- Tracking recovery and response to training and interventions
- Providing real-time comparison between limbs and soft tissues over time
These are just some examples of the value of ultrasound imaging in fitness and athletic settings, but this conversation echoes a growing trend in the sports medicine world: pairing point-of-care ultrasound imaging with athlete monitoring is an innovative application to better train and manage athletes before an injury sends them to the training room or sports medicine clinic.
Don’t Diagnose in a Vacuum
Of course, not every tendon or bony abnormality seen on ultrasound imaging is teetering toward meaningful damage or an injury. As with all imaging modalities, ultrasound must be interpreted alongside the clinical examination, sport-specific demands, body composition variables, prior injuries, and functional status. That’s what makes the sports medicine specialist’s job so interesting! Being valuable stewards of this safe and cost-effective point-of-care technology means that ultrasound imaging can be used to amplify our clinical reasoning.
Let’s Keep the Conversation Going
As we celebrate athleticism this month, consider how ultrasound imaging can play a larger role in your sports medicine practice or training program by asking:
- Can preseason scanning inform an athlete’s training program and load adjustments?
- Can ultrasound imaging identify athletes at risk for developing an injury?
- What stories are hidden beneath the surface – Are there other innovative applications of ultrasound imaging that can benefit fitness and sports enthusiasts?
- How have you used ultrasound imaging to guide decisions about fitness programs or to the training and care of an athlete?
What have you seen? I would love to hear your comments and insights about how you are integrating ultrasound imaging into the science of movement! Comment or connect with me on LinkedIn (www.linkedin.com/in/nathan-savage-wssu) or X (@DrNathanJSavage).
Dr. Nathan J. Savage, PhD, DPT, RMSK, is an Associate Professor of Physical Therapy with expertise in neuromusculoskeletal ultrasound. His research focuses on integrating imaging into clinical decision-making for injury prevention, rehabilitation, and sports performance.
This posting has been edited for length and clarity. The opinions expressed in this posting are the author’s own and do not necessarily reflect the view of their employer or the American Institute of Ultrasound in Medicine.