From Lindsey Vonn’s dramatic fall in the downhill to the head injury sustained by Chinese snowboarder Liu Jiayu, the events held so far at the 2026 Winter Olympics in Milan-Cortina, Italy, have been marked by incidents that left the audience breathless. Winter sports, which combine extreme speeds, icy surfaces, and variable environmental conditions — minimizing the margin for error and magnifying the consequences of every technical blunder — are by their nature high-risk activities.

In this context, diagnostic imaging plays a fundamental role in assessing the damage suffered by athletes’ and estimating recovery times, as well as in preventing health problems that can arise from intense exercise. The same tools, used appropriately, are also helpful for those who practice physical activity at a recreational level.

Assessing Peripheral Nerve Injury

Immediately after an injury, x-ray and ultrasound are first-line tests to determine the severity and extent of the damage — fractures, muscle or tendon injuries, possible internal effusions — and to decide how to intervene. Later, MRI allows for a more accurate assessment of the situation.

MRI is what lets us make a reliable prediction about the time needed to return to competition, which for athletes competing at the highest levels is particularly important: Keeping them unnecessarily sidelined for a long time is counterproductive to their careers, as is allowing a premature return to activity, exposing them to the risk for further damage, said Marcello Zappia, MD, associate professor of radiology at the University of Molise, Campobasso, Italy. Thanks to MRI we can give the green light, issue a red flag, or, in intermediate situations, provide the athlete with the information needed to decide whether to take the risk or act more cautiously, depending on their needs. Today even people who practice sport in their free time want to reach the highest performance levels their bodies allow, but for those who engage in non-competitive activities, the time needed to return to competition can often be assessed just as well with an ultrasound.”

Once the emergency phase — in which bone and muscle trauma are assessed — has passed, it is also necessary to consider possible injuries to the peripheral nervous system. A fall while skiing or a violent impact during an ice hockey game can, for example, cause damage to the brachial or lumbar nerve plexus, which must be diagnosed and treated appropriately to ensure full recovery of the athlete’s activity, explained Simonetta Gerevini, MD, who directs the neuroradiology department of ASST Papa Giovanni XXIII, Bergamo, Italy. Ultrasound, MRI, x-ray, and CT are the tools to evaluate the situation and decide the best course of action, used appropriately.

Peripheral nervous system injuries can range from compression, with local sensory changes and muscle weakness, to nerve laceration, with loss of sensation and motor function. Depending on severity, recovery may be spontaneous, may require rehabilitation, or may require surgical repair.

“There are also nontraumatic sport-related injuries, for example nerve compression caused by pressure from an overly developed muscle, or consequences of repeated microtrauma over time,” Gerevini explained. Amateur athletes are at higher risk for peripheral nerve damage than the high-level competitive athletes because they have less control over their movements and are more likely to perform incorrect motions. Furthermore, amateur athletes often lack the opportunity to dedicate themselves full-time to an intensive rehabilitation program, and their recovery times are longer.

Cardiovascular Risk Prevention

In the cardiovascular field, diagnostic imaging has a primarily preventive function: it allows early identification of silent pathologies that can emerge during physical exertion and interventions to reduce the risk for acute events during sports.

“MRI can be decisive in this regard, but it is not appropriate to use it as a screening test,” said Francesco Secchi, MD, associate professor of radiology at the University of Milan, Milan, Italy. It is a tool we resort to when signs raise suspicion of a risk condition: abnormalities on an ECG during exercise, shortness of breath, fatigue. MRI can distinguish structural changes of the heart that occur as adaptations to intense exercise from pathological changes associated with altered cardiac function, such as dilated cardiomyopathy. CT is useful for studying the course of the coronary arteries and identifying congenital anomalies or stenoses. Warning signs that may suggest this type of problem are chest pain during exertion and, again, abnormalities on the exercise ECG.

Athletes who compete at the elite level undergo at least an annual exercise ECG. Amateur athletes often neglect these tests; however, it would be useful to have them when physical activity is intense. For an opinion, it’s best to consult a sports medicine physician or a cardiologist.

Zappia, Gerevini, and Secchi declared having no conflicts of interest related to the topics discussed.

This story has been translated from Univadis Italy, part of the Medscape Professional Network.