? In the twentieth episode (in English) of “Thermography: Science, Health and Sport” we introduce Dr. Stefan Mattyasovszky, medical staff of Mainz 05, Germany.

⚽ PD Dr. Stefan Mattyasovszky, medical staff of F.S.V Mainz 05 and clinical director of Galenos Praxis, Germany, brings his experience in both health and performance.

? PD Dr. Stefan Mattyasovszky is specialist in orthopedic and trauma surgery. Expert in Spine Diseases (DWG Spine Surgery Master's Certificate) complement his expertise in spine diseases with thermography to illustrate patient and add value to his diagnosis. His perspective allows us to provide more information in clinical research.

? In this podcast he talks about how to implement thermography in high performance, how to use thermography as a great tool for follow-up injuries during recovery process and how thermography assists them to role-out in spine surgery to discard vessels problems and educate patients through coloured thermograms.

TRANSCRIPTION:

Ismael (I): Hello everyone and welcome to a new episode for our podcast about thermography. Today, I am very happy to introduce you to Dr. Stefan Mattyasovszky. Thank you very much for being with us today.

PD Dr. Stefan Mattyasovszky (S): Yes, thanks too.

(I): So let me briefly introduce him. Dr. Stefan Mattyasovszky is a specialist in Orthopedics, he is German. We are very interested to hear about his testimonial using thermography because he is managing and owns a clinic in Mainz, a city of Germany. But at the same time he is also a specialist and Doctor of the Football team of the Bundesliga, Mainz 05. And just going directly straight forward to the conversation, Dr. Mattyasovszky, I would like to know how you discovered and how was the first time you learned about this technology?

(S): The first time I had contact with thermography was really coincidental. We traveled with friends from Sportsärztezeitung to China, and we were invited to a conference about rehabilitation. And it was a presentation about rehab. And I listened to a presentation about recovery after ACL replacement in the knee, and he had very nice images and he showed images from thermography. And his intention of using thermography was just to control the temperature after the surgery. So not to look for specific diagnostic procedures or diagnosis, he just looked for the temperature and he presented the images to us. And when I listened to his presentation some ideas came up, because dealing with problems in soccer for example, muscle injuries, or other injuries is also a very interesting topic. And so the idea came up to look for a camera and to start working with thermography and to start working to do diagnosis with thermography in other diseases, not only surgeries, but also to work thermography and primary diagnosis.

(I): OK, I understand.

(S): And that was basically the idea. It was over three years ago, so it was before COVID. And so we started in the training camp four years ago to take images before the training and after the training and to get our experience with this technique. So that's how it started.

(I): So it was four years ago, but as far as I know you are using as you mentioned with the football team. But you are using thermography as well with your patients in your praxis. So how is your daily routine? How do you use thermography?

(S): My daily routine has not changed a lot in the last couple of years and basically I examine the patients as I used to examine them the years before. But doing the examination and deciding whether to do an X-ray or MRI, I integrated thermography into my setup, so when I finish examining the patient I do the thermography. And then I decide if I need imaging like X-rays, sonography or MRI or CT scan or whatever. But it's in my daily procedures integrated in the physical examination. So I always have the camera in my room. I have to set up in my room and almost every week I download images and upload them to the software to have a more precise diagnosis with the software.

So I always have the camera in my room. I have to set up in my room and almost every week I download images and upload them to the software to have a more precise diagnosis with the software.

PD Dr. Stefan Mattyasovszky

(I): And regarding the football team. How do you use that with your players?

(S): In the football team we have another camera, a second camera and. Our physiotherapists were taught by you to know how to use the camera, taking the images, having a standardized set up, standardized temperature, standardized standing of the players, standardized distance, standardized temperature in the room. And now, they do it by themselves, so they take the images every day by themselves and on the weekends we travel to the games. We take a look together and talk about images. It's still in an experimental phase in the soccer team. We have to be honest. It's not that we do it routinely for years. We started four years ago. But it took a while for me to get some experience to work with the camera, to work with the software, to have somebody who is working eagerly with these technique not not just taking pictures, taking images. It's all about enthusiasm. And also time, investing time. So you always have to have somebody who is really keen in investing time in this technique and it's all about doing and it's all about getting experience. Somebody who's really interested in this technique needs to do it everyday and repeat it, interpreting, repeating, interpreting. You could not do it. I think it really depends a lot on the enthusiasm of the person who is doing it.

(I): I absolutely agree. And based on your experience both in your praxis and the football team, in your opinion Doctor, which will be the most significant pros and cons about thermography?

(S): The most significant pro for me is that, apart from the investment, of course it's a very quick way to get an idea and it's an additional information in your physical examination. It does not replace other diagnostic procedures, it does not replace imaging like MRI or CT scan or X-ray. It's more of an additional tool to have it on your hand. It 's quick. And you get an idea very quickly. For example, when I have a patient who has a spine irradiation to the leg. As a diagnosis, it's very important to exclude vascular problems.I always synthetize the patient. Of course it comes very often from the spine, but you can also have a vascular problem. And what is the quickest way to look for that? Of course you can send them to a specialist to look for vessel disorders, but most of the time it took weeks. So the easiest way to find out is to have this image and there are thermography characteristics that patients have a vascular problem, so you have a very quick diagnosis. It's easy to make and if you have some, how does it call it? Of course you need some time to get familiar with this technique, but it's not that it takes years. Let's say it takes weeks, but you get experience very quickly and it's a lot of fun to discuss in collections if older diagnostic findings that you have and what we did at the beginning, we looked how it correlated to the clinical exam to the clinical findings. How does it correlate to the MRI findings? How does it correlate to the angiological findings and to the neurological findings? We have oue own specialist for neurology and it's really very exciting to see to put together these small parts to have the physical examination. You have the MRI, you have the neurology exams, and then to lose afterwards we look at the thermography images, so it's somehow blinded because I'm not doing it immediately. Patients coming and taking images, I do not interpret a lot, I just show them the images and we have to upload them into the software. The software is more sensitive and let’s see what happens and let's see what we find in the MRI, what we find in the neurology and then to put it together. And that's how we get a lot of experience with that technique. And of course, when you look back, we will have this last experience. Now when I take the images, it's easier to interpret. Of course, you have to be careful, but now after doing hundreds of thermograms it is easier to interpret the thermography images. I will not say that I would because I had experience now I would never do a MRI anymore, because you still need it to have a precise diagnosis. For example, disc herniations, spine stenosis and so on. I can say now we're gonna take the images at least I suspect that it could be vascular, it could be neurological, it could be just not bearing weight on the leg, it could be inflammatory and so on. So you get a sense for the thermography.

Of course, you have to be careful, but now after doing hundreds of thermograms it is easier to interpret the thermography images. I will not say that I would because I had experience now I would never do a MRI anymore, because you still need it to have a precise diagnosis.

PD Dr. Mattyasovszky

(I): And regarding limitations?

(S): I want more contrast, right? One of the limitations is that it is still very subjective. So it really depends on experience. I would say if you start doing thermography at the beginning and have not seen anything else. It takes time, it's not possible to do the thermography and to say OK, this player for example has a muscle injury and the other one has just a neurological problem and the other one is just weakness or tiredness. I think it's not possible at the beginning. When you start doing thermography, you cannot be precise and make the right diagnosis. Of course it's a learning curve, but it's the same with any other technique that you saw doing at the beginning, and I would not say that there are anydisadvantages. I mean, of course you need a camera, you need the software. But it does not hurt, it's not invasive. So patients can see their images immediately? Patients love images because they're colored. Orthopedics, as well, we love images and there is not a real disadvantage of this technique.

So patients can see their images immediately? Patients love images because they're colored. Orthopedics, as well, we love images and there is not a real disadvantage of this technique.

PD Dr. Stefan Mattyasovszky

(I): In your experience, may I ask you if you remember any specific cases, mostly from your athletes, your players, where thermography has really helped you out from ruling out a problem, helping recovery, or preventing an injury.

(S): I mean now we are in the primary phase to be honest. It's not been so long that we would say that just because of the thermography we take the players out and prevent injury. We have to see or to observe this in a context. Every team has a special set up for prevention. It's different in Mainz 05, in Bayern Munich, in Milano, in Real Madrid. It's different, wherever you go. So you have to integrate it into your team and into your context and I would say it's not that. It's not the only tool that we have to prevent injury. We have the physical examination, we have some other tools that we use in the past. And it's like a puzzle, I mean thermography is a further puzzle in this system to prevent injuries and we cannot say that because of this tool we prevented 10, 20, 30 injuries. We definitely have a tool for a follow-up. We do it at the moment of the injury and almost every day. During recovery and during intervention, we do therapy and we say “OK how does it react?” You're waiting for the time when the suspected case should be healed. For example, after five days they will say, “OK, now it's time to return to activity, return to play, return to competition.” And it's always in correlation with what we find clinically. I will not say we are ready yet. It's still developing. But I feel in a club that our physios who break daily life, they like it and players like it. And we definitely have significant signals. It’s not that we can tell the players something they don't see. We show the players what they can precisely see. And we see that there is still a reaction of the temperature of the skin and something is going on in the deep. And this is something every player understands. And then we started it, did not really know what to do, but now it's really just like usual, sometimes playing. And they say, “hey, come on, can we take another image? What does it look like now?” Yeah, yeah, it's really, they're interested. And because it's quick, you know, lying in MRI takes half an hour. And interpretation of the MRI is quite difficult. Interpretation of thermography is also very challenging because at the end of the day we interpret the temperature of the skin and the body surface, nothing else. It is just, somehow, information on the skin that we get out of the body. And it's not 100%, it's information that begins. The reason for that is exactly the problem that we have. So that's why you have limitations of this technique.

We definitely have a tool for a follow-up. We do it at the moment of the injury and almost every day. During recovery and during intervention, we do therapy and we say “OK how does it react?” You're waiting for the time when the suspected case should be healed.

PD Dr. Stefan Mattyasovszky

(I): My final question is, Dr. Mattyasovszky, regarding the future and I recommend everyone listening to this podcast to read your article published in the Journal of Sports, about your experience and some cases that you publish lately this year. And my question is: what is the future from your point of view of this technology? Which are the main points that we should improve or we should we should through the research to improve the application of this technology?

(S): The most important thing, the most difficult, that we had at the beginning is to have a standardized setup. I think the next step should be for everybody who is using it to have a standardized setup, standardized distance between person and camera, standardized temperature.There is a difference whether we have 20 ºC in the room or 30? How long do the patients have to be without clothes in the room? You know, and this is the first thing if you ask me what should work, is to have a real standardized setup for everybody, just to start. It takes a long time for everybody who's starting. It takes about a year to setup. The second thing that you need to have to be talking about is having meetings, talking about experiences, publishing and to look exactly how certain diseases correlate with the thermography. And basically it can only be done by really good studies. What we do now is to collect data to get our experiences, mainly with muscle injuries, of course, in the soccer team. In the practice I'm not doing just muscle injuries. I'm looking at “How does it react after surgery?” I operate, I'm specialized in spine surgery and I take images of every patient that I operate and also patients that I do not operate. And just to see how they react after having a nerve decompression because you have this surgeon specific thermography images before. And I see what happens in the follow up. And this will be interesting because when I operate on patients and I see “OK I decompress the nerve, how do they react with the temperature?” I can compare it with conservative therapy. How long does it take in conservative therapy to have the same signals or comparative signals if you do not operate? And can I have indirect information about the nerve? And this is what makes it very interesting for me.

(I): Very interesting.

(S): Yeah. And now it's just one example. I mean, it's very easy and there are so many diseases that we could discuss. Disc herniations, spinal stenosis, of course, of the cervical spine or the lumbar spine doesn't matter. We also see specific thermography of the hands of patients who have nerve compression in the neck or in the cervical spine. The specific alterations of the thermography images. And we see what happens after surgery. How long does it take until this gets normal?

(I): And let me ask you, have you discovered so far any differences or outcomes from this cooperation between intervention and conservative treatment?

(S): I mean, of course time is a factor. I can't really say that because when you operate patients... I am maybe showing images of patients that I operated on and you see all the six weeks after surgery in the next presentations or publications. It's quite interesting. When you do not operate on, it takes much longer. So I can't really say what happens when you do conservative therapy and how long does it take to get the same images as you get after surgery. This is what I'm talking about. Therefore, you need some really good studies with a good set up. And with hundreds of patients. And this takes time. It's not easy in daily life, in practice. This is the main problem of science, I think.

(I): …That’s why you are illustrating some advantages with articles such as the one you have published and some cases which are very representative. Because, as you mentioned, it is hard to combine praxis, patients, research and, in addition, to that what you do with the players. But because of that we thank you very much for your time. I think this podcast is especially interesting because of your very interesting experience on both sides. And I really appreciate your time and your testimony. So thank you very much Dr. Mattyasovszky.

(S): Bye bye.

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