THE USE OF THERMOGRAPHY AND ITS CONTROL VARIABLES: A SYSTEMATIC REVIEW

Muscle injuries are the most frequent cause of physical disability in sports, representing a large percentage of all sports injuries. In high-performance sports in particular, there is great interest in optimizing the process of diagnosis and rehabilitation of muscle injuries in order to reduce the amount of time taken off by athletes due to their injuries. Infrared thermography, or cutaneous thermometry, is a technique used for complementary investigation of pain. It provides thermal imaging with an infrared camera, to measure the surface temperature of the body.

Objective:

To conduct a systematic review of the use of thermography as a functional evaluation for the identification and prevention of muscle injuries, and of the control variables used in its applicability.

Methods:

A systematic review was conducted in the MEDLINE, ResearchGate and Scielo databases, using the search terms: “thermography”, “muscle injury”, “rehabilitation” and “diagnosis”, searching on articles published from 2000 to 2017, in Portuguese, English and Spanish. The eligibility criteria for the studies was the use of thermography as an outcome, and the reporting of standards for evaluating skin temperature variation in athletes.

Results:

Following the systematic review, 94 studies were retrieved. Of these, only 12 met the criteria for inclusion in the study.

Conclusion:

Thermography is a suitable tool for the evaluation and prevention of muscle injuries in athletes, and care should be taken with the control variables during its use. The most efficient variables for capturing the thermographic image appear to be an environment with a temperature of between 18 and 25°C, for 15 minutes for acclimatization, and with the individual placed in a pre-determined position, depending on the body segment being evaluated, without contact with another object. Level of evidence I; Systematic review.

Keywords:
Thermography; Injury; Sport; Rehabilitation; Diagnosis

Bibliographic reference	Sample	Parameters used	Injury	Conclusion
Bandeira et al.⁷7. Bandeira F, Neves EB, Moura MA, Nohama P. A termografia no apoio ao diagnóstico de lesão muscular no esporte. Rev Bras Med Esporte. 2014;20(1):59-64. (2014)	21 rugby athletes	Temperature: between 22 e 23°C	NA	It can be concluded that the thermography can be used as a method of location of muscle injury in athletes, associated with the use of CK. However, it is suggested the option for analysis by visual inspection, as is the case of other imaging exams.
	Male	Humidity: 50%
	Aged between 19 e 31 years	Time to acclimate: 30’
	(mean age 25,06)	Orthostatic position
		Dresses only with underwear.
Lima et al.¹⁰10. Lima RP, Brioschi ML, Teixeira MJ, Neves EB. Análise termográfica de corpo inteiro: indicações para investigação de dores crônicas e diagnóstico complementar de disfunções secundárias. Pan Am J Med Thermol. 2015;2(2)70-7. (2015)	50 subjects	Temperature: 23°C	Chronic pain	The thermographic study of whole body with the acquisition of images following the protocol described in patients with chronic pain allowed the identification and classification of secondary injuries and dysfunctions of great importance in comparison to a thermographic analysis if they were restricted only to the topography of the main complaint.
	Female and male	Humidity: below 60%
	Aged between 20 e 83 years	Time to acclimate: 15’
		Orthostatic position
		Undressed
Brioschi et al.¹²12. Brioschi ML, Cherem AJ, Ruiz RC, Sardá Júnior JJ, Silva FM. O uso da termografia infravermelha na avaliação do retorno ao trabalho em programa de reabilitação ampliado (PRA). Acta Fisiatr. 2009;16(2):87-92. (2009)	62 workers	Temperature: 20°C	LER/DORT	The skin thermography by infrared thermography showed itself as a supplementary method useful and objective to support the expert evaluation of the variables that interfere with the ability to work, since its validity and maximum degree the inability.
	Female and male	Humidity: 55%
	Mean age 32 ± 13 years	Time to acclimate: 15’
		Orthostatic position
		Undressed
Hildebrand et al.¹³13. Hildebrandt C, Raschner C, Ammer K. An overview of recent application of medical infrared thermography in sports medicine in Austria. Sensors (Basel). 2010;10(5):4700-15. (2010)	87 athletes	Temperature: between 21,5 e 22,3°C	Tendinopathy patellar and anterior cruciate ligament injury	The objective of this technique is not to replace the clinical examination, but enhance it. It should be used as a tool of multidisciplinary evaluation by experts from different fields. The extension of specific databases of sport can contribute even more to the detection of high-risk athletes and help them to initiate early intervention.
	Female and male	Humidity: between 35 e 38%
		Time to acclimate: 20’

Ammer¹⁵15. Ammer K. Temperature changes after manual examination of the cervical spine. Thermology International. 2002;12(4):147-52. (2002)	7 asymptomatic subjects females	Temperature: 24°C	NA	Temperature changes observed immediately after the manual therapy can be caused by manual examination of the cervical spine.
	Aged between 26 and 46 years	Time to acclimate: 15’
		Orthostatic position
Bandeira et al.¹⁶16. Bandeira F, Moura MA, Souza MA, Nohama PA, Neves EB. Pode a termografia auxiliar no diagnóstico de lesões musculares em atletas de futebol? Rev Bras Med Esporte. 2012;18(4):246-51. (2012)	18 athletes	Temperature: 23°C	NA	The results of this study suggest the possibility of use of thermography, in conjunction with the creatine kinase, determine the intensity and location of muscle injuries post-training, once the aforementioned biochemical marker is not able to determine the anatomic location of the muscle injury.
	Male	Time to acclimate: 15’
	Aged between 15 and 17 years	Orthostatic position
Chudecka et al.¹⁷17. Chudecka M, Lubkowska A. Thermal maps of young women and men. Infrared Physics & Technology. 2015;69:81-7. (2015)	200 athletes	Temperature: 25°C	NA	Difficulties in the interpretation of temperature changes in body areas in people with various conditions may be associated with the lack of studies on large populations and representative of healthy individuals.
	Female and male	Humidity: 60%
		Time to acclimate: 20’
		Orthostatic position
Merla et al.¹⁸18. Merla A, Mattei PA, Donato LD, Romani GL. Thermal imaging of cutaneous temperature modifications in runners during graded exercise. Ann Biomed Eng. 2009;38(1):158-63. (2009)	15 athletes	Temperature: between 23 e 24°C	NA	The temperature of the entire previous skin surface of the body was monitored using thermal infrared images during the financial year graduated, producing a specific temporal evolution of cutaneous changes of temperature. The results of this study indicate that, when performing the exercise graduated as heating, the subject must not wear heavy clothing, favoring the vasoconstruição cutaneous vessels by increasing the blood flow to the muscles.
	Female	Humidity: 50 ± 5%
	Mean aged between 25,2 ± 3,1 years	Time to acclimate: 20’
		During the implementation of the program of exercises on the treadmill
Oliveira et al.¹⁹19. Oliveira J, Vardasca R, Pimenta M, Gabriel J, Torres J. Use of infrared thermography for the diagnosis and grading of sprained ankle injuries. Infrared Physics & Technology. 2016;76:530-41. (2016)	19 pacients	Temperature: 21,4 ± 1,3°C	Ankle Sprain	The validation potential of infrared thermography, a secure technology, not harmful, quick and economical, for the classification of lesions of ankle sprain, can be an important indicator of classification of diagnosis in both emergency hospital settings, as well as in amateur and professional sports environments.
	Female and male	Humidity: 37 ± 5,5%
		Time to acclimate: 15’
		Position: Sitting in a chair with his limbs parallel to each other
Salazar-López et al.²⁰20. Salazar-López E, Domínguez E, Ramos VJ, Fuente J, Meins A, Iborra O, Gálvez G, Rodríguez-Artacho MA, Gómez-Milán E. The mental and subjective skin: emotion, empathy, feelings and thermography. Conscious Cogn. 2015;34:149-62. (2015)	120 subjects	Temperature: between 18 e 25°C	NA	Thermography is a useful tool with great potential to address scientific and philosophical questions on subjective experiences, mental states and emotions.
	Female and male	Humidity: 50%
	Aged between 24 e 47 years	Time to acclimate: between 10 e 15’
SILVA et al.²¹21. Silva YA, Santos BH, Andrade PR, Santos HH, Moreira DG, Sillero-Quintana M, Ferreira JJA. Skin temperature changes after exercise and cold water immersion. Sport Sci Health. 2017;13(1):195-202. (2017)	45 subjects	Temperature: between 22 e 24°C	NA	Thermography was more sensitive in the evaluation of exercises with different loads when expressed as a fee relating to the temperature of the forehead. These results support the use of cryoimmersion protocols to minimize the deleterious effects of heavy exercise on muscle function.
	Aged between 18 e 25 years	Humidity: Below 50%
		Time to acclimate: 15’
		Orthostatic position
Zaproudina et al.²²22. Zaproudina N, Ming Z, Hanninen OOP. Plantar infrared thermography measurements and low back pain intensity. J Manipulative Physiol Ther. 2006;29(3):219-23 (2006)	85 subjects	Temperature: between 23 and 25°C	Lowback pain	Temperature measurements may be useful as a test in the evaluation and documentation of thermal abnormalities and sympathetic disorders in patients with lowback pain.
	Female and male	Humidity:
	Aged between 30 e 49 years	Time to acclimate: 15’
		Orthostatic position

Ambient temperature used in studies	Number of studies	Bibliographic reference
between 18 e 25°C	1	Salazar-López et al. (2015)²⁰20. Salazar-López E, Domínguez E, Ramos VJ, Fuente J, Meins A, Iborra O, Gálvez G, Rodríguez-Artacho MA, Gómez-Milán E. The mental and subjective skin: emotion, empathy, feelings and thermography. Conscious Cogn. 2015;34:149-62.
20°C	1	Brioschi et al.¹²12. Brioschi ML, Cherem AJ, Ruiz RC, Sardá Júnior JJ, Silva FM. O uso da termografia infravermelha na avaliação do retorno ao trabalho em programa de reabilitação ampliado (PRA). Acta Fisiatr. 2009;16(2):87-92. (2009)
21,4°C	1	Oliveira et al.¹⁹19. Oliveira J, Vardasca R, Pimenta M, Gabriel J, Torres J. Use of infrared thermography for the diagnosis and grading of sprained ankle injuries. Infrared Physics & Technology. 2016;76:530-41. (2016)
Between 21,5 e 22,3°C	1	Hildebrandt et al.¹³13. Hildebrandt C, Raschner C, Ammer K. An overview of recent application of medical infrared thermography in sports medicine in Austria. Sensors (Basel). 2010;10(5):4700-15. (2010)
Between 22 e 23°C	1	Bandeira et al.⁴4. Hallen A, Ekstrand J. Return to play following muscle injuries in professional footballers. J Sports Sci. 2014;32(13):1229-36. (2014)
Between 22 e 24°C	1	Silva et al.²¹21. Silva YA, Santos BH, Andrade PR, Santos HH, Moreira DG, Sillero-Quintana M, Ferreira JJA. Skin temperature changes after exercise and cold water immersion. Sport Sci Health. 2017;13(1):195-202., 2017
23°C	2	Bandeira et al.¹⁹19. Oliveira J, Vardasca R, Pimenta M, Gabriel J, Torres J. Use of infrared thermography for the diagnosis and grading of sprained ankle injuries. Infrared Physics & Technology. 2016;76:530-41. (2012); Lima et al.¹⁰10. Lima RP, Brioschi ML, Teixeira MJ, Neves EB. Análise termográfica de corpo inteiro: indicações para investigação de dores crônicas e diagnóstico complementar de disfunções secundárias. Pan Am J Med Thermol. 2015;2(2)70-7. (2015)
Between 23 e 24°C	1	Merla et al.¹⁸18. Merla A, Mattei PA, Donato LD, Romani GL. Thermal imaging of cutaneous temperature modifications in runners during graded exercise. Ann Biomed Eng. 2009;38(1):158-63. (2009)
Between 23 e 25°C	1	Zaproudina et al.²²22. Zaproudina N, Ming Z, Hanninen OOP. Plantar infrared thermography measurements and low back pain intensity. J Manipulative Physiol Ther. 2006;29(3):219-23 (2006)
24°C	1	Ammer¹⁵15. Ammer K. Temperature changes after manual examination of the cervical spine. Thermology International. 2002;12(4):147-52. (2002)
25°C	1	Chudecka et al.¹⁷17. Chudecka M, Lubkowska A. Thermal maps of young women and men. Infrared Physics & Technology. 2015;69:81-7. (2015)
Relative humidity used in studies
Between 35 e 38%	1	Hildebrandt et al.¹³13. Hildebrandt C, Raschner C, Ammer K. An overview of recent application of medical infrared thermography in sports medicine in Austria. Sensors (Basel). 2010;10(5):4700-15. (2010)
37%	1	Oliveira et al.¹⁹19. Oliveira J, Vardasca R, Pimenta M, Gabriel J, Torres J. Use of infrared thermography for the diagnosis and grading of sprained ankle injuries. Infrared Physics & Technology. 2016;76:530-41. (2016)
Below 50%	1	Silva et al.²¹21. Silva YA, Santos BH, Andrade PR, Santos HH, Moreira DG, Sillero-Quintana M, Ferreira JJA. Skin temperature changes after exercise and cold water immersion. Sport Sci Health. 2017;13(1):195-202. (2017)
50%	3	Bandeira et al.⁴4. Hallen A, Ekstrand J. Return to play following muscle injuries in professional footballers. J Sports Sci. 2014;32(13):1229-36. (2014); Merla et al.¹⁸18. Merla A, Mattei PA, Donato LD, Romani GL. Thermal imaging of cutaneous temperature modifications in runners during graded exercise. Ann Biomed Eng. 2009;38(1):158-63., (2009); Salazar-López et al.²⁰20. Salazar-López E, Domínguez E, Ramos VJ, Fuente J, Meins A, Iborra O, Gálvez G, Rodríguez-Artacho MA, Gómez-Milán E. The mental and subjective skin: emotion, empathy, feelings and thermography. Conscious Cogn. 2015;34:149-62. (2015)
55%	1	Brioschi et al.¹²12. Brioschi ML, Cherem AJ, Ruiz RC, Sardá Júnior JJ, Silva FM. O uso da termografia infravermelha na avaliação do retorno ao trabalho em programa de reabilitação ampliado (PRA). Acta Fisiatr. 2009;16(2):87-92. (2009)
Below 60%	1	Lima et al.¹⁰10. Lima RP, Brioschi ML, Teixeira MJ, Neves EB. Análise termográfica de corpo inteiro: indicações para investigação de dores crônicas e diagnóstico complementar de disfunções secundárias. Pan Am J Med Thermol. 2015;2(2)70-7. (2015)
60%	1	Chudecka et al.¹⁷17. Chudecka M, Lubkowska A. Thermal maps of young women and men. Infrared Physics & Technology. 2015;69:81-7., 2015
Time to acclimate used in studies
between 10 e 15’	1	Salazar-López et al.²⁰20. Salazar-López E, Domínguez E, Ramos VJ, Fuente J, Meins A, Iborra O, Gálvez G, Rodríguez-Artacho MA, Gómez-Milán E. The mental and subjective skin: emotion, empathy, feelings and thermography. Conscious Cogn. 2015;34:149-62. (2015)
15’	7	Ammer¹⁵15. Ammer K. Temperature changes after manual examination of the cervical spine. Thermology International. 2002;12(4):147-52. (2002); Bandeira et al.¹⁹19. Oliveira J, Vardasca R, Pimenta M, Gabriel J, Torres J. Use of infrared thermography for the diagnosis and grading of sprained ankle injuries. Infrared Physics & Technology. 2016;76:530-41. (2012); Brioschi et al¹²12. Brioschi ML, Cherem AJ, Ruiz RC, Sardá Júnior JJ, Silva FM. O uso da termografia infravermelha na avaliação do retorno ao trabalho em programa de reabilitação ampliado (PRA). Acta Fisiatr. 2009;16(2):87-92. (2009); Lima et al.¹⁰10. Lima RP, Brioschi ML, Teixeira MJ, Neves EB. Análise termográfica de corpo inteiro: indicações para investigação de dores crônicas e diagnóstico complementar de disfunções secundárias. Pan Am J Med Thermol. 2015;2(2)70-7. (2015); Oliveira et al.¹⁹19. Oliveira J, Vardasca R, Pimenta M, Gabriel J, Torres J. Use of infrared thermography for the diagnosis and grading of sprained ankle injuries. Infrared Physics & Technology. 2016;76:530-41. (2016); Silva et al.²¹21. Silva YA, Santos BH, Andrade PR, Santos HH, Moreira DG, Sillero-Quintana M, Ferreira JJA. Skin temperature changes after exercise and cold water immersion. Sport Sci Health. 2017;13(1):195-202. (2017); Zaproudina et al.²²22. Zaproudina N, Ming Z, Hanninen OOP. Plantar infrared thermography measurements and low back pain intensity. J Manipulative Physiol Ther. 2006;29(3):219-23 (2006);
20’	3	Chudecka et al.¹⁷17. Chudecka M, Lubkowska A. Thermal maps of young women and men. Infrared Physics & Technology. 2015;69:81-7. (2015); Hildebrandt et al.¹³13. Hildebrandt C, Raschner C, Ammer K. An overview of recent application of medical infrared thermography in sports medicine in Austria. Sensors (Basel). 2010;10(5):4700-15. (2010); Merla et al.¹⁸18. Merla A, Mattei PA, Donato LD, Romani GL. Thermal imaging of cutaneous temperature modifications in runners during graded exercise. Ann Biomed Eng. 2009;38(1):158-63. (2009)
30’	1	Bandeira et al.⁴4. Hallen A, Ekstrand J. Return to play following muscle injuries in professional footballers. J Sports Sci. 2014;32(13):1229-36. (2014)
Position used in studies
orthostatic position	8	Ammer¹⁵15. Ammer K. Temperature changes after manual examination of the cervical spine. Thermology International. 2002;12(4):147-52., 2002; Bandeira et al.¹⁹19. Oliveira J, Vardasca R, Pimenta M, Gabriel J, Torres J. Use of infrared thermography for the diagnosis and grading of sprained ankle injuries. Infrared Physics & Technology. 2016;76:530-41. (2012); Bandeira et al.⁴4. Hallen A, Ekstrand J. Return to play following muscle injuries in professional footballers. J Sports Sci. 2014;32(13):1229-36. (2014); Brioschi et al¹²12. Brioschi ML, Cherem AJ, Ruiz RC, Sardá Júnior JJ, Silva FM. O uso da termografia infravermelha na avaliação do retorno ao trabalho em programa de reabilitação ampliado (PRA). Acta Fisiatr. 2009;16(2):87-92. (2009); Chudecka et al.¹⁷17. Chudecka M, Lubkowska A. Thermal maps of young women and men. Infrared Physics & Technology. 2015;69:81-7. (2015); Lima et al.¹⁰10. Lima RP, Brioschi ML, Teixeira MJ, Neves EB. Análise termográfica de corpo inteiro: indicações para investigação de dores crônicas e diagnóstico complementar de disfunções secundárias. Pan Am J Med Thermol. 2015;2(2)70-7. (2015); Silva et al.²¹21. Silva YA, Santos BH, Andrade PR, Santos HH, Moreira DG, Sillero-Quintana M, Ferreira JJA. Skin temperature changes after exercise and cold water immersion. Sport Sci Health. 2017;13(1):195-202. (2017); Zaproudina et al.²²22. Zaproudina N, Ming Z, Hanninen OOP. Plantar infrared thermography measurements and low back pain intensity. J Manipulative Physiol Ther. 2006;29(3):219-23 (2006)
During the implementation of the program of exercises on the treadmill	1	Merla et al.¹⁸18. Merla A, Mattei PA, Donato LD, Romani GL. Thermal imaging of cutaneous temperature modifications in runners during graded exercise. Ann Biomed Eng. 2009;38(1):158-63. (2009)
Sitting in a chair with his limbs parallel to each other	1	Oliveira et al.¹⁹19. Oliveira J, Vardasca R, Pimenta M, Gabriel J, Torres J. Use of infrared thermography for the diagnosis and grading of sprained ankle injuries. Infrared Physics & Technology. 2016;76:530-41. (2016)

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[1] Correspondence: Andressa Silva, Escola de Educação Física, Fisioterapia e Terapia Ocupacional (EEFFTO), Universidade Federal de Minas Gerais (UFMG), Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, Brazil. 31270-901. andressa@demello.net.br