Ultrasound and MRI: what imaging shows in archers

Three ways of looking inside

Studies of the archer's body use three kinds of imaging. Ultrasound reads the echo of sound waves through a probe held against the skin and shows tendons, attachments and muscle thickness in real time, so it depends heavily on whoever holds the probe; magnetic resonance imaging reconstructs slices of the body and measures the area of a muscle; X-rays and CT show mainly bone. This page brings together thirteen studies that use them on archers' bodies, nearly all on a handful of people.

An image describes a tissue, not whether it hurts or will hurt: in the only study of the entheses of elite archers, the authors note that many athletes with marked changes had no symptoms. This page describes the instruments and the measurements taken on groups of athletes, and recommends no examination to anyone.

Entheses and shoulder tendons

Entheses are the points where tendons and ligaments attach to bone. In the 2025 Turkish study a rheumatologist who did not know which sport each person played examined ten sites on each side in 87 athletes from seven sports and in 49 sedentary people. The findings feed two scores: what the authors call "inflammation" adds up less echogenic tissue, thickening and Doppler signal, while "damage" adds up erosions, enthesophytes and calcifications. These are names of scores, not diagnoses: in the 12 archers the upper-limb inflammation score had a median of 3 against 0 in sedentary people, and damage 1 against 0.

The most useful part is the map: the supraspinatus, the medial epicondyle and the triceps insertion change, while the lateral epicondyle, the subscapularis and the lower limb look the same as in sedentary people. With a single reader nobody knows how far a second would have agreed, and the study does not measure agreement; it is also a preprint in a venue with questionable editorial standards, so the entry on entheses in the arm stays at "reported".

In 58 Korean archers in 2021, ultrasound found long-head biceps tendinosis in 22.4% and subacromial bursitis in 10.3%, while 40 of the 58 reported shoulder pain. The entry on common but mild shoulder pain keeps the finding as context, not as the cause of the pain. In the 16 wheelchair archers of 2016 there were 2.29 changes per shoulder in the bow arm and 2.35 in the string arm, with everyday shoulder pain no different from that of wheelchair table tennis players. They had used a wheelchair for almost twenty-four years, and the instrument cannot separate shooting from everything else loading the same shoulders, as their entry says.

Muscle thickness and cross-sections

Ultrasound also measures muscle thickness, where technique matters as much as the result. In 15 young elite Israeli archers in 2025 a physiotherapist froze the image at the end of exhalation and averaged two measurements for each muscle. No significant difference emerged between the two sides, but in individual athletes the gap reached 19% for the back muscles and 47% for the abdominals, and without a comparison group nobody knows how common that is: the entry on side-to-side differences stays "contested".

With MRI, the 2017 Japanese study measured the cross-sectional area of four trunk muscles in 352 athletes, 88 of them archers, divided by height squared: among adult men the archers have the smallest psoas of the five sports, and among boys aged 16 to 18 the wrestlers have larger values in all four muscles. The age bands, however, are different groups rather than young people followed over time, which is the limit of the entry on trunk muscles.

Bone, heart and arteries

For the bones of today's archers there is one measurement, and not from a bone density scan: a Malaysian group used a sonometer to measure the speed of sound in the radius and tibia of 11 teenage archers, 11 badminton players and 11 non-sporting peers, and found no difference. The sample size was calculated on muscle power, and the entry on young people's bones is "contradicted" rather than "refuted". The heart and arteries were examined with Doppler ultrasound in seven Japanese university archers: scaled to body surface area, their aorta was the smallest of the six sports, and their radial artery second only to that of the weightlifters (entry).

Bones from the past are examined by eye. Anthropologists in Szeged compared the muscle attachments of 49 tenth-century skeletons buried with bows and arrows and of 32 men buried without weapons: the enlargements sat in much the same places, with no statistical tests, and those marks on the bones are not enough to identify an archer.

Imaging in the shooting posture

In 1976 six Japanese orthopaedic surgeons took side-view X-rays of the elbow at full draw: in the experienced archers the radius and ulna were parallel, in the beginners they crossed, but there was one radiograph per group. In 2021, CT myelography of the neck of a high school kyudo student, with the head turned as if towards the target, showed the cervical cord compressed, less than with the neck flexed (entry). In 2013 a CT scan of a Korean Olympic archer, lying down with head and arm placed as at full draw, showed the space between the clavicle and the first rib much narrower than on the other side, which was left in a neutral position (the authors note that in healthy people, with the arm raised and turned outwards, that distance shrinks by almost half). In the CT myelography and the CT scan the archer is lying down without a bow, and in all three studies the images cover one or two people: they show what can happen in that position, not how often.

Samples chosen because of symptoms share the same limit. In 1971 only the 30 kyudo practitioners with the worst complaints out of 122 were X-rayed, and the four elbows with osteochondromatosis say nothing about frequency. In 1992 an X-ray of a fifteen-year-old kyudo archer, taken after months of pain around the shoulder blade, showed a fracture line in the first rib: it is a single case, and its entry stays at "reported". In an eleven-year-old archer the first shoulder X-rays were read as normal, and only on a second look did the doctors notice the growth plate still open at the base of the coracoid (entry): an image also depends on what the person reading it is looking for.

Looking without instruments

The scapular dyskinesis test uses no imaging: the examiner watches the shoulder blade while the athlete raises and lowers the arms, and rates the movement as normal or as mildly or obviously altered. Among 100 Indian archers, the string arm was rated normal in 30% of the more experienced against 58% of beginners, but pain was not measured and the journal has questionable editorial standards (entry).

What to check

• who reads the images, whether they know the athlete's group, and whether a second reader measured agreement;
• the definitions: a score called "inflammation" is still a sum of visual signs;
• whether there is a comparison with athletes under similar load, whether pain was measured separately, and whether the sample was chosen for its symptoms;
• whether the shooting posture is real or reconstructed lying down, without a bow;
• whether the design is cross-sectional: a single snapshot cannot say whether a change comes before a problem or remains an adaptation to load.

How design and sample are weighed is explained in How we read a study; the findings in chronological order are in the lines on injuries and on the shoulder, and in the article on injuries.

@misc{campagna2026_enresearchmethodsultrasoundmriarchers,
  author = {Campagna, Matteo},
  title = {Ultrasound and MRI: what imaging shows in archers},
  year = {2026},
  howpublished = {Research, matteocampagna.com},
  url = {https://matteocampagna.com/en/research/methods/ultrasound-mri-archers},
  note = {accessed 2026-10-16}
}