Case Study: Bone bruise in a rugby player

Introduction

Rugby is an intermittent and high-intensity sport with a significant demand for strength and endurance, often involving a high risk of injuries due to the loads and collisions that occur, among other factors. In this article, we describe a case study on monitoring a bone edema injury suffered by a player from the German rugby team. Through two thermographic assessments and a video provided by the player, we will examine the details of the injury, its progression, and how thermography can provide objective data on the return to competition.

The Case of Jarrod Saul

The injury in question occurred during a lineout in a match on January 14, 2018. After the jump, he landed on his right heel inappropriately. Subsequent medical tests revealed details about the extent of the injury: a ligament injury in his right ankle and a bone contusion on the outer face of his calcaneus. After the injury, two thermographic assessments were conducted:

• First Assessment – January 22, 2018 (8 days after the injury): The first assessment with thermography was conducted using ThermoHuman software. Significant hyperthermic asymmetries were detected in the right foot: 2.25ºC in the ankle (frontal view) and 0.93ºC in the outer right heel.
• Second Assessment – February 7, 2018 (24 days after the injury): On this occasion, ThermoHuman software showed results with a significant improvement compared to the first assessment. Asymmetries in the ankle and heel decreased to practically symmetrical values, correlating with the positive evolution of the injury and the disappearance of associated discomfort.

Analysis of the Injury’s Progression

The video where Jarrod’s injury occurs, although recorded from a screen, is an essential tool for documenting the injury and its progress. The outer right heel, where the impact was centered, showed a significant elevation in the first thermographic assessment (0.93ºC). However, in just two weeks, this inflammation drastically reduced to almost symmetrical values (-0.02ºC).

As seen in studies such as Castonguay and Dover (2023) or Haluzan et al. (2015), bone tissue reacts significantly when damaged, especially in cases of bone fracture.

Representation of the evolution of bone fractures described by Castonguay y Dover (2023). Adapted by ThermoHuman

This case study, however, highlights a relevant difference: even though similar hyperthermic asymmetry values are observed in a bone fracture just one week after the injury (0.93ºC), the bone hematoma shows a recovery to symmetrical values in less time (barely 3 weeks after the injury). On the other hand, in fractures, it is common to maintain hyperthermia above 1ºC even 5 weeks after the fracture, as demonstrated in another case study of a stress fracture in a footbal player).

It is another example of the value that thermography and ThermoHuman software can bring to monitoring an injury from a physiological and functional perspective.

Conclusion

Jarrod Saul’s case is a valuable example of the importance of precise and detailed monitoring of a bone contusion injury in a rugby player. We can conclude the following:

• Through the use of different assessments (in this case, medical and thermographic), videos, and progression charts, we can observe how a bone contusion in the outer heel recovered in just three weeks.
• Based on these results, it appears that there is a difference between fracture and bone edema injuries, both reacting similarly in the initial weeks (more than 0.9ºC of hyperthermia), but with a much faster recovery to baseline values in the case of bone edema.
• This case study highlights the need to apply technology in sports injuries, which can enhance athletes’ recovery and ensure their return to the field using objective data.
• Without pain or injury, the trend is to maintain thermal balance between bilateral areas.
• Once the injury occurs, the thermal profile shows a hypothermic or hyperthermic response depending on the type of injury, which can help support the injury diagnosis.
• Thermal asymmetries are a robust method for determining health status, supporting diagnosis, monitoring injury recovery, and making return-to-competition decisions with objective data.

References

Castonguay, T., & Dover, G. (2023). Infrared Thermography-A Novel Tool for Monitoring Fracture Healing: A Critically Appraised Topic With Evidence-Based Recommendations for Clinical Practice. Journal of sport rehabilitation, 32(7), 834–839. https://doi.org/10.1123/jsr.2022-0390

Haluzan, D., Davila, S., Antabak, A., Dobric, I., Stipic, J., Augustin, G., Ehrenfreund, T., & Prlic, I. (2015). Thermal changes during healing of distal radius fractures-Preliminary findings. Injury, 46 Suppl 6, S103–S106. https://doi.org/10.1016/j.injury.2015.10.046