What you may be feeling
Although there is potential for the muscle fibres to tear from the impact, contusions do not generally result in structural damage to the muscle tissue. This is generally why sporting participants can continue playing even after suffering a high-grade contusion.
The injury commonly results in a diffuse, dull pain, with associated bruising, swelling and is sore to touch. Additionally, contusions affect the muscle function in both strength and flexibility. Range of motion of the affected area is therefore often restricted, such as a contusion to the front of the thigh resulting in reduced ability to bend the knee.
Pain occurs in the muscle the harder it has to contract and harder it has to work. Pain can also me the case when the muscle is stretched. This is generally more noticeable after cessation of physical activity once the body has “cooled down” such as after a game or the next morning. Injury to the lower limb can also result in pain in weight bearing activities such as walking and running.
What’s Really Going On Inside?
Muscle contusions (otherwise known as a “cork”) are defined as an acute direct muscle injury caused by
blunt trauma to the tissue with associated hematoma. Hematoma is the accumulation of blood due to the damaged integrity of the surrounding blood vessels, which in turn can cause the bruising one may see after the injury has occurred. The hematoma can be localised or wide-spread throughout the muscle, the latter of which presenting with diffuse bruising. Wide-spread bleeding/bruising is commonly due to tearing of the sheath surrounding the muscle bundle, which allows for the blood to spread throughout the muscle belly. Localised bruising is due to the muscle sheath remaining intact, however these forms of contusions can take longer to get better.
Contusions are most commonly a result from a direct blow and common in the sporting community such as a from an opponent’s knee colliding into a thigh in a contact sport, or a player connecting with a ball or stick. The severity can vary and injuries are generally graded as mild, moderate or severe depending on the amount of contact force and how contracted the muscle is at the point of impact. The most common location for this to occur is in the quadriceps, the muscles on the front/side of the thigh.
Acute Management Advice
Management can be split into 3 phases. The acute phase (24-72 hours), the resolution phase and the sport-specific or functional phase.
The Acute Phase
The acute phase for management of a muscle contusion is basic acute injury management. This comprises of the first 24-72 hours and applying the “PRICE” Protocol, which stands for Protect, Rest, Ice, Compression, Elevation.
Protect: The purpose of this first step is to protect the injured tissue from further damage. This may not be as crucial as compared with other injuries, however if severe enough, you may need crutches if having difficulty with walking (e.g. painful limp). Certain taping techniques may also feel supportive.
Rest: A period of “relative” rest is essential. This does not mean keeping the affected area immobilised for the next 2 days. Once able, it is important to get the limb moving, however this does not mean exerting under force. This may mean simply mean moving the limb from a rested position e.g. bending and straightening your knee after a contusion to the thigh. Weight-bearing should commence as tolerated but only do as much as what feels comfortable and do not push through the pain.
Ice: The purpose of ice is to reduce pain and prevent secondary tissue damage. Ice can be applied with the purpose of helping to reduce blood flow, pain, muscle spasm and muscle inhibition. To get significant pain relief, it is important to reduce the body temperature enough to slow down the messages being sent between the injured tissue and the pain centres in the brain, which produce a pain response.
Applying crushed ice will be most effective in reducing local tissue temperature than frozen vegetables or gel packs, however all can be helpful so use what is accessible to you at the time. Keep the ice on for 10-20 times and apply 2-3 times throughout the day. Aim to apply the ice with the muscle on pain-free stretch to further help limit blood flow. As temperature drops, the speed of these signals slows and with less signals, the can be less pain. Cease icing immediately if there are any signs of adverse effects such as increased pain, swelling or skin irritation. Be wary of ice burns!
Compression: Applying a compression bandage, tubigrip or even at least somewhere compression garments such as “skins” can helped reduce swelling, pain and aid circulation. The area should feel compressed but not uncomfortable or painful. Glad-wrap can be an adequate temporary substitute. This can be worn throughout the day and if uncomfortable, removed at night for when sleeping as swelling can be better controlled when lying down.
Elevation: The purpose of elevation is to reduce swelling and aid circulation. Try to elevate the injured area for 10-20 minutes at a time.
How A Physio Can Help
As you progress from the phase of acute injury management, you will enter the resolution stage where you want to promote movement and begin to improve muscle function. Initially, the area may be stiff, inflexible and painful. This is where heat packs and/or hot showers can come in handy as the can temporarily improve muscle extensibility and increase pain-free range of motion to facilitate movement. Applying a heat pack for 5-10 minutes of having a hot shower before commencing range of motion and muscle strengthening exercises can be helpful for this. Movement will help promote circulation, clear cellular debris in the area and prevent uneven distribution of scar tissue build up. It will also help facilitate muscle tissue remodelling and increase range of motion. This can be achieved by active range of motion where the muscles are simply engaged to provide movement. Static muscle contractions can also be commenced to begin building the strength of the injured muscle. The physiotherapist can provide you with the right exercises to start work on your strength and range of motion. Additionally, they can provide the right soft tissue therapy and taping techniques to further facilitate your rehabilitation.
Ongoing rehabilitation will see you progress into the Sports-Specific/Functional-Specific Phase where you want to begin progressive resistance exercise to build the strength of the injured muscle and eventually move into more functional and sport specific exercise and drills. This includes progressing from static muscle contractions to dynamic exercises, which the physio can instruct on. Additional stretching may be integrated into your rehab progress to improve your flexibility quicker. Progression into this phase will depend on a variety of factors including the severity of the contusion and the quality of the management in the lead up to this point.
Muscles have good blood delivery and therefore receive good nutrients, which facilitate timely and reliable healing. Contusions generally take 2-3 weeks depending on the graded severity of the injury. Approximately: Mild – 13 days, Moderate – 19 days, Severe – 21 days.
Contusions can also lead to complications such as active bleeding, acute compartment syndrome or large hematomas (Big bruises). A relatively common complication which occurs in roughly 10% of cases within the sporting population is a condition called “Myositis Ossificans”. This occurs with recurrent contusions or excessive prolonged bleeding, which causes the tissue to calcify and harden. This can lead to significant tenderness, hardening on palpation and significant range of motion loss. This needs to be management with sufficient rest and gentle rehabilitation.