Sonographically derived tissue characteristics and functional performance adaptation across a competitive season in division I female volleyball athletes

Introduction Diagnostic neuromusculoskeletal ultrasound imaging (USI) is increasingly used in athletic populations to characterize tendon and enthesis structure and to monitor seasonal change; however, the functional significance of sonographic tissue characteristics and their relationship to performance remain unclear. This study examined the association between sonographic tissue characteristics and performance measures in Division I female volleyball athletes. Methods Athletes from a single team underwent pre-season ( N = 16) and post-season ( N = 15) USI examination of bilateral shoulder, anterior knee, posterior ankle, and plantar foot regions, along with standardized performance testing. Continuous sonographic measures included supraspinatus tendon and plantar fascia thickness and patellar and Achilles tendon cross-sectional area; categorical pathology indicators included the presence or absence of tendinopathy and enthesopathy. Performance outcomes included single-leg hop distance and single-leg vertical jump height, double-limb vertical jump, drop jump, broad jump and double broad jump performance, jump-landing movement quality, and closed kinetic chain upper extremity stability. Linear mixed-effects models were used to evaluate associations with performance level and seasonal change. Results Performance measures demonstrated modest, task-dependent seasonal changes. Continuous and categorical sonographic tissue measures were not meaningfully associated with performance level or seasonal performance change. Contextual monitoring variables were not associated with double-limb performance and did not modify seasonal performance adaptation. Changes in corresponding right and left tendon measures were strongly correlated, particularly for Achilles tendon cross-sectional area; however, these structural characteristics showed weak correspondence with functional performance adaptations. Discussion In Division I female volleyball athletes, seasonal performance adaptation was modest, while sonographic tissue characteristics showed limited association with performance. Tissue adaptation demonstrated weak correspondence with functional performance change, suggesting that structural and performance adaptations may follow partially independent trajectories across a competitive season. These findings support interpreting USI findings within a broader clinical and performance context.