We recently had a rugby player visit the clinic complaining of leg pain. The area of pain turned out to be a massive bruise from a couple of days earlier when another player had landed on him. We first assessed him to see whether the muscle was torn, as the bruising was very severe, before beginning treatment of the contusion. Contusion injuries are extremely common in contact sports, especially rugby and combat sports where collisions are frequent.
So, here’s our treatment of a contusion, what to do and what not to do and potential complications if treated incorrectly.
A muscle contusion (there are other types), is usually caused by a direct, blunt force to a muscle, causing damage to the muscle cells and tissues resulting in bleeding of the tissue as blood vessels are damaged. This causes necrosis and haematoma leading to inflammation, necessary for tissue healing. The damage to capillaries allows blood to escape causing the bruising.
Contusions are either intramuscular or intermuscular. Intramusclar contusions are contained within the sheath of the muscle, meaning bleeding stops earlier but this increased pressure causes greater loss of muscle function. You are unlikely to see bruising in the early stages of this injury, but swelling and pain are likely to be present. A bruise may develop later but will be significantly smaller than that of an intermuscular contusion. Intermuscular contusions are caused by tearing of the muscle and/or sheath. The initial bleeding therefore takes longer to stop, with visible bruising, and spreads away from the original injury site.
Initial treatment should aim to minimise haemorrhage and inflammation, therefore reducing pressure and pain at the site of injury. Treat with rest and ice initially and unload the limb if necessary to reduce muscle damage, prevent further bleeding, swelling and pain. Taping can be used from day 1 to encourage removal of fluid and bruising from the injured area.
Contusions generally stabilise and no further bleeding occurs after 24-48 hours. Following this period, therapeutic rehabilitation and treatment can begin. Early mobilisation can significantly reduce recovery time and aid maintenance of muscle strength. Joint and muscle passive range of motion exercises also help to pump fluid from soft tissue and preserve usual tissue movement and that of uninjured muscles.
Light massage, similar to lymphatic drainage techniques, can be used to encourage removal of fluid. Although these techniques must be applied carefully and gently at the correct time in order to prevent further complications.
The maintenance phase of rehabilitation concentrates on restoring full motion and strength gently with isometric exercise and light loading. The addition of some stretching during this phase can aid restoration of function. Following reestablishment of function, a gradually progressive loading programme should commence, beginning with muscle endurance exercises (20+ rep range) prior to progression to heavier strength and power exercises.
Treat your bruise; don’t just leave it to recover. A bruise is a soft tissue injury and must be treated correctly in order to prevent muscle damage, pain and further issues.
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