Thermography and Return to Play Decisions
Dr. William A. Sands

Inflammation is a consistent indicator of injury and ongoing healing. Thermal imaging is
used for the characterization of inflammation. Thermal imaging can be used to monitor
the location, status, and progress of an injury by comparisons of the size of the injured
area and its temperature.

• Injuries foster a number of decisions that suffer from uncertainty, yet may require firm commitment, vigilance, and follow-through to resolve the injury. Uncertainty arises from variations in diagnoses, healing capacities, pain tolerance, effectiveness of healing modalities and medications, and
psychological support (1,3,6,8,9). Those who treat athletic injuries, coaches, athletes, and parents are often faced with return to play decisions that are wrought with pitfalls due to the lack of pertinent information regarding the athlete’s current injury state, his/her current performance status, and the risks and benefits of returning to activity. However, thermography technology may reduce the uncertainty.

Thermography involves the use of a special camera that can detect a portion of the
electromagnetic spectrum that lies just below the region of visible light–infrared light. Infrared light is the product of heat; all objects show heat, unless the object is at the temperature of absolute zero.

People are terrific heat sources. The heat that people produce is variable depending on the region of the body, metabolism, and other factors. One of the greatest sources of heat is that due to inflammation. Inflammation is derived from the same word as “flame” and accompanies all types of pain and injury. Inflammation is detectable as a heat source in the injured athlete, particularly when the temperature of the inflamed area is higher than that of the surrounding skin.

One of the interesting properties of inflammation and the detection of the heat produced by inflamed tissues is that even deep tissues often show a “signature” of heat in the overlying skin. In athletic injury, inflammation is usually reasonably close to the skin surface and easily detectable by thermal imaging equipment (2,4,5,10,11,12).

Thermal imaging has been used for injury and disease detection, malingering, and other
characteristics (2,4,5,7,10,11). Recent experience has shown that thermal imaging can be
used to assess the status and change of active inflammation that can reduce the
uncertainty regarding return to play decisions. Pain and inflammation have always been
coincident; thermal imaging can assess the presence of inflammation and thus provide
information about the progress of injury healing.

Monitoring the healing and recovery from injury with thermal imaging can help determine
whether an athlete’s injury has ceased the active inflammation period. Clearly, if
inflammation is still present, return to play should be postponed, further medical
consultation is needed, and increased vigilance and caution are merited. Injuries that have
become mostly or completely pain-free have been monitored with thermal imaging and the
injuries have shown a return of inflammation after premature return to play.

In conclusion, thermal imaging can provide a window into the world of injury recovery and
reduce the uncertainty involved in return to play decisions. Thermal imaging equipment
has been dropping in price for years and is available in a variety of camera-types and
configurations. Those concerned with return to play decisions are encouraged to consider
thermal imaging.