Revolution Sports Injuries Clinic: 2013

Wednesday, 17 April 2013

Quadriceps contusions - Just a bruise?

10:31

Quadriceps contusions – Just a bruise?

This article is going to talk about Quadriceps contusions. This is an extremely common injury with a high occurrence in contact sports such as rugby or American football, but is also common in sports where the ball travels at high speeds causing a contusion. Contusions are often referred to as ‘just a bruise’, however no treatment or incorrect treatment can severely delay a return to sport.

How it occurs?

Direct blows to the anterior thigh from another player or a ball are usually the main mechanisms of injury. Trauma to the muscle will cause localised bleeding due to primary damage to myofibrils, fascia and blood vessels. The contusion may be either intramuscular; which is where the bleed is confined to the muscle compartment; or intermuscular where the fascia surrounding the muscle is broken and blood escapes into other compartments of the thigh.

What are the symptoms?

Quadriceps contusions are classified as Mild, Moderate and Severe. A mild contusion is usually tender to touch, sore after cooling down or the next morning and may restrict full range of knee movement by 5-20%. A severe contusion will have obvious bruising, the rapid onset of swelling and bleeding may not be able to be controlled. There will be difficulty weight bearing on that leg, a loss of quadriceps strength and a sever loss of movement of around 50%. A moderate contusion will sit between the two grades.

Treatment
The treatment can be divided into four stages:

Stage 1- Control the Haemorrhage.
The most important period in the treatment of a thigh contusion is in the first 24hours following injury. This is done through Rest, Ice, Compression and elevation (RICE). Soft tissue therapy should not be used at this stage but some gentle stretching should be started. Depending on severity this stage of treatment can last between 48hrs-3days.

Stage 2- restoration of pain free range of motion.
After 24-48 hours, it is important to see an injury specialist such as Sports Therapist or Physiotherapist who can correctly diagnose the injured muscles and begin a rehabilitation program. Usually some gentle soft tissue work will be initiated, stretches increase, and static muscle contractions started. Usually gentle exercises such as pool walking or static bike will be indicated by the therapist.

Stage 3 – Functional rehabilitation.
Stretches are maintained through this stage and concentric and eccentric exercises introduced. There is gradual increase of repetitions, speed and resistance of these exercises.

Stage 4 – Gradual return to sport.
All rehab becomes sport specific i.e. kicking, jumping and multi-directional activities. A full training session should be completed pain free before a return to sport. Some soft tissue therapy may be necessary to relieve any quadriceps myofascial tension.

What are the risks following a thigh contusion?

After a moderate to severe contusion some complications may occur. Intramuscular hematoma may result in high pressure within the muscle compartment; this can lead to a diagnosis of compartment syndrome. This is usually manageable with conservative treatment and surgery is not usually implicated.

Occasionally after a contusion the hematoma can calcify, this means small bits of bone can develop within the quad muscles. This is known as myositis ossificans. The more severe the contusion the more likely the development of myositis ossificans, the risk of this is also increased with inappropriate treatment of the injury. Once this problem has developed there is little that can be done to increase the absorption rate of the bits of bone from the muscle, this can lead to increased pain with activity, in the morning and can often cause night pain.

Visit our clinic website at www.revolutionsportsinjuries.co.uk