Overview
Athletes in all contact sports have many opportunities to get a muscle contusion (bruise). Contusions are second only to strains as a leading cause of sports injuries.
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Most contusions are minor and heal quickly, without taking the athlete needing to be removed from the game. But, severe contusions can cause deep tissue damage and can lead to complications and/or keep the athlete out of sports for months
These contusions are graded 1, 2, or 3 depending on the severity:
- Grade 1 (mild): A grade 1 muscle contusion produces mild bruising, little pain and no swelling at the site of impact. The knee moves normally or very close to normally. Athletes have some mild soreness when pressure is applied to the area of injury.
- Grade 2 (moderate): This injury is slightly deep than a grade 1 contusion and produces mild pain and a little swelling. Athletes with a grade 2 quadriceps injury can only bend the knee part of the way and may walk with a slight limp. Pressure on the area of injury causes some pain.
- Grade 3 (severe): Severe muscle contusions are very painful and are accompanied by noticeable swelling. Individuals with this type of injury usually develop obvious bruising at the sight of injury. A severe quadriceps contusion may result in a significant loss of motion in the knee and cause an obvious limp. Athletes have pain with pressure at the site of injury and the surrounding area.
How it occurs ?
Muscle contusions occur when an individual receives one or more direct blows, to the body part, falls or jams of a body part against a hard surface. In essence, the muscles are compressed and crushed between the object or person delivering the blow and the underlying bone.
When these soft tissues are damaged, blood from the ruptured capillaries leaks out under the skin and pools, causing the area to swell and form a red or purplish mark that can be sore and tender to touch. The symptoms associated with bruises are pain, swelling and restricted movement.
Who Bruises?
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Anyone can get a bruise, although people involved in contact sports are most at risk. But why do some people bruise more easily than others?
The severity of a bruise can depend on a number of things: like how tough a person's skin tissue is; the general health of the underlying muscles and soft tissue; medications you may be on; or your age. Age can be a major contributor because as we get older our blood vessels tend to become more fragile.
Symptoms
- Pain resulting from a severe blow to the leg.
- You might get swelling or bruising (see below).
- Restricted movement is not uncommon.
- If the swelling has not gone then you probably have an intra muscular injury.
- If the bleeding has spread and caused bruising away from the site of the injury then you probably have an inter muscular injury.
- If you are more able to contract the muscle you probably have an inter muscular injury.
Can you feel a deformation in the muscle or a gap?
It is important you make the correct diagnosis because if you try to exercise on a complete rupture, or a bad intra muscular injury you can inhibit healing, make things worse or cause permanent disability. If you apply heat and massage in the early stages then you could get Myositis Ossificans (or bone forming within the muscle), then you are in trouble.
What does it feel like?
- You might have tightness in the back of the lower leg.
- You may be able to walk properly.
- You probably won't have much swelling.
- Trying to push up onto your toes probably won't produce much pain.
- You should have nearly a full range of motion.
Treatment
Contusions cause swelling and pain and limit joint range of motion near the injury. Torn blood vessels may cause bluish discoloration. The injured muscle may feel weak and stiff.
To control pain, bleeding, and inflammation, keep the muscle in a gentle stretch position and use the RICE formula:
- Rest: Protect the injured area from further harm by stopping play. You may also use a protective device (i.e., crutches, sling).
- Ice: Apply ice wrapped in a clean cloth. (Remove ice after 20 minutes.)
- Compression: Lightly wrap the injured area in a soft bandage or ace wrap.
- Elevation: Raise it to a level above the heart.
During the first 24 to 48 hours after injury (acute phase), you will probably need to continue using rest, ice, compression bandages, and elevation of the injured area to control bleeding, swelling, and pain. While the injured part heals, be sure to keep exercising the uninjured parts of your body to maintain your overall level of fitness.
If there is a large hematoma that does not go away within several days, in some cases the doctor may drain it surgically to speed healing.
Rehabilitation
After a few days, inflammation should start to go down and the injury may feel a little better. At this time, the doctor may tell you to apply gentle heat to the injury and start the rehabilitation process. Remember to increase your activity level gradually.
Depending upon the extent of your injuries, returning to your normal sports activity may take several weeks or longer. If you put too much stress on the injured area before it has healed enough, excessive scar tissue may develop and cause more problems.
In the first phase of rehabilitation, your doctor may prescribe gentle stretching exercises that begin to restore range of motion to the injured area.
Later, when the doctor says range of motion has improved enough, he or she may prescribe weightbearing and strengthening exercises.
When you have normal, pain-free range of motion, the doctor may let you return to non-contact sports.
Complications
Getting prompt medical treatment and following your doctor's advice about rehabilitation can help you avoid serious medical complications that occasionally result from deep muscle contusions. Two complications include compartment syndrome and myositis ossificans.
Compartment Syndrome
In certain cases, rapid bleeding may cause extremely painful swelling within the muscle group of your arm, leg, foot, or buttock. Build-up of pressure from fluids several hours after a contusion injury can disrupt blood flow and prevent nourishment from reaching the muscle group. Compartment syndrome may require urgent surgery to drain the excess fluids.
Myositis Ossificans
Young athletes who try to rehabilitate a severe contusion too quickly sometimes develop myositis ossificans. This is a condition in which the bruised muscle grows bone instead of new muscle cells.
Symptoms may include mild to severe pain that does not go away and swelling at the injury site. Abnormal bone formations can also reduce your flexibility. Vigorous stretching exercises may make the condition worse.
Rest, ice, compression and elevation to reduce inflammation will usually help. Gentle stretching exercises may improve flexibility. Surgery is rarely required.
Return to Play
You may be able to return to contact sports when you get back your full strength, motion, and endurance. When the doctor says you are ready to return to play, he or she may want you to wear a customized protective device to prevent further injury to the area that had a contusion.
Depending upon your sport, you may get special padding made of firm or semi-firm materials. The padding spreads out the force of impact when direct blows from blunt objects strike your body.
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