The Role of Ultrasound in Managing Soccer Injuries And Why It Belongs in Every High-Performance Environment

Carlos Jimenez
Apr 18
4 min read

In professional soccer, lower extremity injuries dominate the landscape, particularly during matches where high-speed tackles and collisions are common. Thigh muscle strains lead the list, followed by ankle and knee injuries involving ligaments or tendons. Groin pain and chronic overuse injuries are also frequent among both elite and developing players.

Two soccer players in blue uniforms collide and fall onto the turf during a match, with one player mid-air and upside down after contact. — **Collision Injury During Competitive Soccer Match**

Over the past decade, ultrasound imaging (US) has emerged as a core technology for injury management in sport. Its portability, cost-effectiveness, and ability to provide dynamic, real-time assessment make it uniquely valuable in high-performance environments. It supports rapid decision-making, tracks healing over time, and facilitates guided interventions like injections or dry needling—all without the delay or cost associated with other imaging modalities.

In this post, we explore how ultrasound is applied across common injury sites in soccer and highlight why it should be considered a standard tool in all high-performance sports medicine settings—not just soccer.

Achilles Tendon Injuries in Soccer

Achilles tendon ruptures are among the most devastating injuries for athletes, often requiring 5+ months of recovery. Ultrasound allows for immediate assessment of injury severity, from tendinosis to partial and complete tears. Dynamic imaging helps determine the tendon gap and whether surgical intervention is necessary.

Ultrasound Advantages:

Differentiates partial vs. complete ruptures
Measures tendon gap for surgical decision-making
Tracks post-op healing and detects complications (e.g., intact plantaris tendon mimicking partial tear)

Achilles Tendinosis: Prevention Starts with Imaging

US can also identify subclinical Achilles tendinopathy during preseason screens. Studies show that nearly half of players with abnormal scans go on to develop symptoms, compared to <2% of those with normal scans. This makes ultrasound an incredibly powerful preventive and planning tool.

Medial Gastrocnemius Injuries: Not Every “Pop” Is an Achilles Tear

“Tennis leg”—a myofascial tear of the medial gastrocnemius—can present like an Achilles rupture. Ultrasound quickly distinguishes between the two, guiding clinicians toward a more conservative treatment path with a faster return to sport.

Plantar Fascia Injuries: Better Than MRI for Partial Tears

Ultrasound is the first-line tool for assessing plantar fasciitis and partial fascial tears, particularly when dynamic evaluation is needed. It helps avoid misdiagnoses, guides interventions, and even assesses related conditions like retrocalcaneal bursitis.

Ankle Ligament Injuries: Real-Time Functional Testing

Ultrasound achieves 95%+ diagnostic accuracy for common ankle ligament injuries (e.g., ATFL, CFL), with the added benefit of dynamic testing—allowing clinicians to stress the ligament and directly visualize partial vs. complete tears. MRI is reserved for deeper joint concerns.

Turf Toe and Forefoot Trauma

Injuries to the plantar capsulo-ligamentous complex of the big toe are often subtle but can limit performance. US allows for dynamic assessment of the plantar plate and can detect stress fractures of the metatarsals sooner than radiographs.

An infographic table titled “Point-of-Care Ultrasound: When It Works, When It Doesn’t – Part 1” compares situations where ultrasound is useful versus when MRI or other imaging is recommended. The table includes six body regions: Achilles tendon, plantar fascia, medial gastrocnemius, ankle ligaments, turf toe/forefoot, and knee tendons/bursae. Each row provides concise bullet points outlining ultrasound indications and MRI referral triggers. — **Point-of-Care Ultrasound: When It Works, When It Doesn’t — Part 1**

Knee Injuries: From Elite Athletes to Youth Players

Ultrasound is highly sensitive for quadriceps and patellar tendon injuries and is endorsed by the European Society of Skeletal Radiology as the first-line imaging modality for superficial knee pathologies. It’s also useful in youth soccer, where Osgood-Schlatter and Sinding-Larsen-Johansson diseases are common.

Snapping Hip Syndrome: A Dynamic Problem Needs Dynamic Imaging

Snapping hip, especially extra-articular causes like iliopsoas and iliotibial band snapping, is best diagnosed with dynamic ultrasound. Static imaging often misses subtle snapping, but real-time US captures tendon movement and detects coexisting bursitis or tendinosis.

Muscle Injuries: Rapid Diagnosis and Prognosis

Muscle strains and tears make up nearly one-third of soccer injuries. The Peetrons classification system—based on US—allows clinicians to grade tears in real time. Ultrasound also detects hematomas, fascial injuries, and disruptions at the myotendinous junctions, guiding both return-to-play timelines and prognosis.

Monitoring Healing and Reinjury Risk

Ultrasound is ideal for longitudinal monitoring of injury healing. As hematomas and fiber disruptions resolve, US shows progressive changes in echogenicity and tissue organization. Dynamic imaging reveals ongoing dysfunction even when static images appear normal—essential for avoiding premature return to play.

Goalkeeper’s Thumb and Upper Extremity Injuries

Goalkeepers are prone to UCL tears at the thumb MCP joint (Gamekeeper’s Thumb), which may require surgery if a Stener lesion is present. High-resolution ultrasound is just as accurate as MRI and allows for dynamic testing and detection of other ligament or volar plate injuries in the hand.

An infographic table titled “Point-of-Care Ultrasound: When It Works, When It Doesn’t – Part 2” outlines the clinical scenarios for using ultrasound versus MRI or other imaging. It covers six areas: knee tendons/bursae, hip (snapping hip syndrome), muscle injuries, healing & reinjury monitoring, and goalkeeper’s thumb/hand. Each row lists conditions where ultrasound is effective and cases where MRI is more appropriate. — **Point-of-Care Ultrasound: When It Works, When It Doesn’t — Part 2**

Why Every High-Performance Environment Needs Ultrasound

Whether you’re managing elite soccer players, basketball athletes, rugby professionals, or tactical personnel in military settings, the value of diagnostic ultrasound transcends any single sport. Here’s why:

✅ Immediate Clinical Insights

No waiting on imaging appointments—decisions can be made on the field or in the clinic within minutes.

🎯 Targeted Interventions

US-guided injections, dry needling, or aspirations can be performed with precision, improving outcomes and minimizing complications.

📈 Longitudinal Tracking

Repeatable scans allow clinicians to visualize healing, monitor chronic conditions, and detect reinjury early.

💡 Proactive Injury Prevention

Preseason US can identify athletes at risk for tendon overload, fasciitis, or muscle imbalance—allowing individualized load management.

💼 Cost-Effective and Scalable

Compared to MRI, ultrasound is inexpensive and portable, making it accessible to youth academies, college programs, and elite clubs alike.

Conclusion: A Core Tool for the Future of Sports Medicine

Ultrasound is more than a diagnostic tool—it’s a clinical decision-making asset that blends seamlessly into the high-paced, high-pressure world of modern sports. Whether you’re a team physician, physical therapist, or performance director, integrating US into your environment is not just helpful—it’s essential.

As technology continues to advance, the role of ultrasound will only grow. Those who embrace it early will not only improve outcomes but also stay one step ahead in the care and performance of their athletes.

Reference:

O’Neill, C. P., Gerety, E. L., & Grainger, A. J. (2023). Ultrasound imaging in professional soccer: When is it adequate? Skeletal Radiology, 54(4), 669–681. https://doi.org/10.1007/s00256-023-04551-w