Application of musculoskeletal biomechanical imaging technology in sports medicine

The incidence rate of sports injuries among the sports population is about 10% -20%, and the high incidence population is mainly college students majoring in sports teaching/training, professional athletes of sports teams at all levels and amateur sports enthusiasts. According to a report by the State Council, the number of people in China who regularly engage in physical exercise reached 440 million at the end of last year, of which there were about 43.5 million sports injury patients. It is estimated that by 2025, the number of sports injury patients can reach about 55 million.

Hospitals in China that have separate sports medicine departments are mainly traditional well-known orthopedic hospitals, such as Peking University Third Hospital, Beijing Jishuitan Hospital, Shanghai Sixth People's Hospital, Fudan University Affiliated Huashan Hospital, Xiangya Hospital, etc. Most hospitals only establish sports medicine under the orthopedic department.

There are currently about 36000 qualified rehabilitation therapists in China. According to international standards, the number of physical therapists per 100000 population is 2.65, while the average for North America and Europe is 60 per 100000 population, the United States is 62.8 per 100000 population, Germany is 68.7 per 100000 population, and Hong Kong is 36.4 per 100000 population. The development of sports medicine in China is still in its infancy. The rise of national fitness activities inevitably leads to an increase in sports injuries, and the attention to sports medicine continues to rise. Some hospitals have established sports medicine sub disciplines under orthopedics to meet the increasing demand.

In addition to public hospitals, the sports community also seeks rehabilitation services from private medical institutions. In 2020, the number of sports rehabilitation institutions in China reached 370 (with over 600 according to other research data), and the proportion of institutions in first tier and new first tier cities was 82.9%.

Sports medicine, as an important sub field in the orthopedic industry, holds over 10% of the global orthopedic market share. In 2018, the global sports medicine market reached a size of nearly 6 billion US dollars, a year-on-year increase of 8%, higher than the overall growth rate of the orthopedic market (around 5%). It is expected to reach 9.1 billion US dollars by 2024, with an average annual compound growth rate of 6.6%, making it one of the fastest-growing segments in the orthopedic market in the future.

The domestic sports medicine market is thriving, with a market size expected to exceed 5 billion yuan by 2023. The domestic sports medicine market is currently in a stage of rapid development. The market size of sports medicine in China is expected to approach 3 billion yuan in 2019, with a growth rate of over 25%. It is the fastest-growing segment of the orthopedic market in China, and the market size is expected to exceed 5 billion yuan by 2023. In addition to high growth, another major characteristic of sports medicine is import monopoly. In 2018, the domestic market share of sports medicine was less than 10%. The high growth and vast domestic alternative market have raised great expectations for sports medicine. In 2021, Professor Chen Shiyi, a counselor of the Shanghai Municipal People's Government, director of the Institute of Sports Medicine at Fudan University, and affiliated with Huashan Hospital of Fudan University, stated in a media interview that the total market size of sports medicine in China will reach about 200 billion yuan. In the future, there will be development opportunities in areas such as sports injuries, sports rehabilitation, sports promotion of health, and sports prescriptions, as well as in the fields of implant consumables and related medical equipment. With the reform of the national healthcare system, the control of diseases has shifted from "treating diseases" to "preventing diseases". Sports rehabilitation, as a means of treating and defending against diseases that combines medicine and physical fitness, is bound to gradually develop in China and also drive the development of the sports industry.

Sports injuries refer to various losses that occur during the process of physical activity. The occurrence of sports injuries mainly affects the human body's motor system, as well as internal organs, blood vessels, or nervous system. The incidence of sports injuries is closely related to sports events, and the high-risk population is mainly composed of students majoring in physical education teaching/training in universities, professional athletes from various levels of sports teams, and amateur sports enthusiasts; Ball sports, snow sports, and athletics are high-risk sports for sports injuries. For professional athletes, the technical characteristics of sports events, excessive training load during the specialized improvement stage, long-term exercise fatigue, insufficient rest, inadequate preparation activities, external and psychological reasons can all lead to sports injuries [8] [9].

During the process of sports, acute injuries such as joint injuries, ligament injuries, and muscle strains are more likely to occur, while chronic injuries are mostly caused by improper handling of acute injuries, leading to pathological changes in the subtle structure of tissues and gradually accumulating to the corresponding tissue structureDisease occurs, affecting its normal physiological activities and functions. If sports injuries are not dealt with in a timely manner, it will not only affect sports performance, but may even end the sports career prematurely.

Classify by nature of damage

1. Open injury

Open soft tissue injury refers to the rupture of the skin or mucous membrane at the site of injury, with the wound communicating with the outside world and accompanied by the outflow of blood and tissue fluid. Common open soft tissue injuries include abrasions, tears, punctures, and incisions.

2. Closed injury

Closed soft tissue injury refers to the situation where bleeding is mainly concentrated within the tissue during injury, while the skin or mucosa remains intact and there is no connection between the wound and the outside world. Common closed soft tissue injuries include contusions, muscle and tendon strains, joint sprains, etc. [11]. Closed injuries can be classified into acute and chronic based on the process of pathological changes.

Classify by damage structure

1. Bone damage

The most common bone injuries are fractures and fractures, which are common in long bones such as arms and legs. They mainly include simple/non displaced fractures, displaced fractures, comminuted fractures, compound fractures, fracture dislocations, epiphyseal fractures, stress fractures, and tear fractures.

2. Ligament and joint injuries

The most common joint and ligament injuries come from misuse of the joint or direct trauma, such as ligament sprains, ligament tears, subluxation of the joint, free bodies, osteochondritis dissecans, patellar chondromalacia, and osteoarthritis.

3. Muscle and tendon injuries

Tendons are muscle parts attached to bones, and common injuries include strains, sprains, and tears; The degree of damage can range from mild spasms to severe bleeding and swelling.

4. Skin damage

Skin injuries mainly include abrasions, pain, UV burns, blisters, fungal infections, etc. caused by exercise.

5. Other systemic injuries

There are two types of sports injuries that can cause catastrophic consequences to the entire body system, namely thermal injury and sudden cardiac death. Heat injury mainly includes heat cramps, heat exhaustion, and heatstroke, with their severity increasing in sequence. About half of sudden cardiac death is caused by hypertrophic cardiomyopathy, with an incidence of one in 300000 during exercise [12].

Classify according to the location of the injury

1. Head and neck injuries

Head injuries are more common in contact sports such as ice hockey, baseball, etc; Cervical spine injury is usually caused by lowering the head to force the cervical spine to straighten. Other spinal injuries can lead to fractures, but spinal injuries are the most severe and may result in paralysis.

2.Upper limb injury

Upper limb injuries can occur in the shoulders, elbows, arms, hands, and wrists, such as rotator cuff injuries, elbow fractures, radius/ulna/navicular fractures, finger fractures, etc.

3. Trunk and lower back injuries

This type of injury includes chest injury, abdominal injury, and lower back injury, such as rib fracture, superficial structural contusion or inflammation of the chest wall, persistent abdominal pain, and intervertebral disc injury.

4. Lower limb injuries

Lower limb injuries may occur in the buttocks, thighs, hamstring muscles, knees, ankles, or feet, such as quadriceps injury, anterior cruciate ligament rupture, patellar dislocation, meniscus injury, Achilles tendon rupture, ankle sprain, plantar fasciitis, etc.

The diagnosis of sports injuries is an important basis for prevention, treatment, and post injury rehabilitation exercises. It plays an important role in ensuring the physical health, prevention, and treatment of athletes. The evaluation recommendations for sports injuries in the "Guidelines for Sports Protection" [14] are as follows (SOAP):

1. Subjective informationAthlete's injury history, chief complaints, signs and symptoms, etc

2. Objective informationVisual examination, palpation, and special examinations

Physical examination and diagnosis:The correct judgment is mainly made through palpation, palpation, auscultation, measurement, special tests, neurological examination, vascular examination and other methods, such as echocardiography and electrocardiogram.

Imaging examination and diagnosis:Mainly through electronic means such as taking X-rays, magnetic resonance imaging (MRI), multispectral music, computed tomography (CT), arthroscopy (endoscope), etc.

3. Evaluation：Record related issues such as the type and degree of damage

4. Processing planClearly state the athlete's disposal plan, treatment and rehabilitation plan

Muscle state assessment is a crucial step in the evaluation of soft tissue injuries in sports medicine. At the initial stage of diagnosis and treatment, measuring the biomechanical indicators of the soft tissue at the affected area can evaluate the degree of injury and the severity of the condition; During the rehabilitation process of patient diagnosis and treatment, monitoring their soft tissue biomechanical indicators can evaluate the patient's adaptability to the prescription, the balance of the patient's muscles on both sides, and the patient's recovery status, thereby making adjustments to the treatment and promoting the healing of injuries [15] [16] [17].

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Hou Yu, Zhong Qiuyuan, Yin Wei, Lan Feifei, Lin Ling Application of Shear Wave Biomechanics Imaging in Muscle Hardness Assessment of Chronic Ankle Instability Patients [J]. Imaging Research and Medical Applications, 2021,5 (04): 245-246