# Reframing Ankle Sprain Management: The Role of Thermography in Ligament Injury Monitoring

## TL;DR

This study explores how infrared thermography can track ankle sprain recovery by measuring temperature changes over time.

## Contribution

The study introduces a novel use of thermography to monitor physiological recovery in ankle sprains, providing objective thermal thresholds for return-to-play decisions.

## Key findings

- A significant increase in temperature asymmetry was observed immediately after ankle sprains.
- Thermal asymmetry decreased significantly between 21.5 and 28.5 days post-injury.
- Temperature asymmetry showed a consistent weekly decline during the return-to-play process.

## Abstract

Background: Ankle sprains are one of the most frequent ligament injuries in elite sports. Despite their high incidence, current rehabilitation approaches are often based on time-based criteria and neglect the physiological status of the injured tissues. Infrared thermography (IRT) is a non-invasive tool useful for detecting temperature asymmetries related to inflammation and tissue dysfunction. This study aimed to analyze the temporal evolution of ankle temperature asymmetry during return-to-play (RTP). Methods: A retrospective observational study of 26 ankle injuries analyzed with thermography that met the inclusion criteria. Thermograms were processed with a software to calculate temperature asymmetry in the ankle region of interest (ankleROI). Statistical analyses included paired and one-sample t-tests, as well as linear regression models, to assess temporal changes throughout the RTP process. Results: A significant hyperthermic response was observed immediately after injury (Δ = +0.594 °C; p < 0.001, Cohen’s d = 0.918). The first significant asymmetry reduction occurred between 21.5 and 28.5 days post-injury (Δ = −0.488 °C; p = 0.004), with a consistent weekly decrease of −0.109 °C (95% CI [−0.143, −0.078]). These findings indicate a progressive decrease in decrement on thermal asymmetry over approximately four weeks of RTP. Conclusions: IRT demonstrates potential as a physiological monitoring tool during the RTP process after ankle sprains. The observed pattern of temperature recovery provides objective reference thresholds that could complement existing functional and clinical criteria.