Advanced Imaging of Sports Injuries: Integrating Radiological Findings with Physiotherapy Assessment and Rehabilitation

Abstract

Background: Sports-related injuries are a significant concern among both recreational and competitive athletes, often leading to pain, reduced physical function, and extended periods away from training or competition. Although advances in musculoskeletal imaging have greatly improved the identification and evaluation of these injuries, clinical care frequently lacks effective coordination between radiological assessment and physiotherapy. This disconnect can limit personalized rehabilitation planning and make evidence-based return-to-sport decisions more challenging. Objective: The purpose of this review is to examine the combined role of advanced radiological imaging and contemporary physiotherapy in the diagnosis, evaluation, rehabilitation, and long-term management of sports injuries. It also explores how integrating structural and quantitative imaging findings with functional physiotherapy assessment can support individualized rehabilitation programmes and improve overall patient outcomes. Main Body: This review summarizes current evidence on advanced imaging techniques used in sports medicine, including magnetic resonance imaging (MRI), quantitative MRI methods such as T2 mapping, T1ρ mapping, diffusion tensor imaging, and ultrashort echo time imaging, musculoskeletal ultrasonography with elastography, computed tomography (CT), dual-energy CT (DECT), three-dimensional imaging, and artificial intelligence (AI)-based image analysis. Their clinical value in detecting, grading, monitoring, and predicting recovery from injuries affecting muscles, tendons, ligaments, cartilage, bone, and peripheral nerves is critically discussed. In addition, the review highlights key physiotherapy assessment approaches, including pain assessment, patient-reported outcome measures, joint range of motion, muscle strength and endurance evaluation, proprioception, balance, postural stability, gait and biomechanical analysis, neuromuscular control, functional performance testing, and return-to-sport assessment. Particular attention is given to the integration of imaging findings with functional rehabilitation outcomes to guide treatment progression, monitor tissue healing, reduce the likelihood of reinjury, and support optimal athletic performance. The review also discusses the growing contribution of radiomics, machine learning, wearable sensor technology, digital rehabilitation platforms, tele-rehabilitation, and multimodal data integration in advancing precision sports medicine. Conclusion: Bringing together advanced radiological imaging and evidence-based physiotherapy offers a more comprehensive approach to sports injury management. Combining structural information with functional assessment enhances diagnostic accuracy, supports individualized rehabilitation planning, enables objective monitoring of recovery, and contributes to safer return-to-sport decisions. Future research should focus on validating standardized imaging-guided rehabilitation protocols and promoting the routine clinical use of quantitative imaging biomarkers to strengthen precision rehabilitation and improve long-term outcomes for athletes.