Muscle Contusions

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What is a muscle contusions? 

Muscle contusions are extremely common injuries especially in contact sports and sports that involve collisions for example football, hockey, basketball etc.

Contusions normally occur as a result of a result of a direct blow or repeated blow from an opposition player, contact with equipment including sticks or the ball or by falling or jamming part of your body against a hard surface, crushing underlying muslce fibres and connective tissue without breaking the skin. The direct blow causes local damage to the muscle with bleeding occurring at the site of the blow.  This often results in a blood clot within the muscle belly (haemotoma). The most common place for a contusion to occur is in the thigh (quadriceps) and is known as a 'cork thigh', 'corkie' or 'charlie horse'.

Most contusions are minor and heal quickly without taking you out of the game. But severe contusions can cause deep tissue damage and lead to complications and may keep you out of sports for months.

Muscle contusions can sometimes be mistaken for muscular tears; however they can be easily distinguished by the mechanism of injury. A contusion is the result of a direct blow and a tear normally occurs from an acceleration/deceleration event. Your physiotherapist should also be able to distinguish the difference by the feel of the affected muscle.

How can they be prevented? 

Athletes playing sports that have a high risk of a contusion in specific areas, for example the thigh in football codes, should consider the use of protective equipment such as padding. This however can reduce mobility.

Return to Sport  

You may be able to return to contact sports when you get back your full strength, motion and endurance. You may need to wear a customised 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.

Complications of a Contusion

There are two main complications that may occur following a  contusion these include:

Compartment syndrome

This can occur several hours after a contusion injury. Swelling and bleeding builds up pressure and causes compression of blood vessels and nerves which can disrupt blood flow and prevent nourishment from reaching the muscle group. This can be a serious condition and may require surgery to release the pressure before nerve and blood vessels are damaged.

Myositis Ossificans

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. Although this is most common following more severe muscle contusions, it may also occur in more minor cases. It is suspected if the contusion doesn't resolve in the normal time frame of 1-2 weeks.

How are they managed? 

Management of contusions and haematomas

  • Firstly minimising the bleeding and swelling
  • This is followed by resorption of the blood clot with electrotherapeutic modalities
  • Carefully controlled soft tissue massage
  • Stretching

Most of these injuries are only minor and do not prevent participation in sport. Large contusions can result in a large amount of bleeding, especially if the player continues to play after sustaining the injury.

Heat, alcohol and vigorous massage increase bleeding after a contusion and must be avoided.

Physiotherapy Treatment 

Physiotherapists can provide ways to reduce and minimise swelling and bleeding.

They can perform soft tissue techniques to encourage resorption of the clot.

Your physiotherapist will give you guidance on stretching to restore your range of motion and strengthening for return to sport.