Diseases & Conditions
Muscle Contusion (Bruise)
Athletes in contact sports have many opportunities to get a muscle contusion (bruise). In fact, contusions are the second most common sports injury behind only strains.
Most contusions are minor and heal quickly, without taking the athlete away from the game. Severe contusions, however, can cause deep tissue damage and lead to complications that may prevent an athlete from being able to play sports for months.
Cause
Contusions occur when a direct blow or repeated blows by a blunt object strike part of the body, crushing underlying muscle fibers and connective tissue without breaking the skin.
A contusion can also result from falling or jamming the body against a hard surface.
Symptoms
- Contusions cause swelling and pain and can limit joint range of motion near the injury.
- Torn blood vessels may cause bluish discoloration.
- The injured muscle may feel weak and stiff.
- Sometimes, a pool of blood collects within damaged tissue, forming a lump over the injury (hematoma).
- If tissue damage is extensive, you may also have a broken bone, dislocated joint, sprain, torn muscle, or other injuries.
Contusions to the abdomen or chest may damage internal organs, such as the heart, lungs, liver, kidney, pancreas, and spleen.
Doctor Examination
See your doctor right away for complete diagnosis. A physical examination will determine the exact location and extent of the injury.
Diagnostic imaging tools may be used to better visualize inside the injured area of your body. These tools include X-rays, ultrasound, magnetic resonance imaging (MRI) scans, or computerized tomography (CT) scans.
For some injuries, your doctor may also need to check for nerve injury.
Treatment
To control pain, bleeding, and inflammation, keep the muscle in a gentle stretch position and use the RICE protocol:
- Rest. Protect the injured area from further harm by stopping play. You may also use a protective device (i.e., crutches, sling).
- Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin. Learn more: Heat or Ice for Your Pain?
- Compression. Lightly wrap the injured area in a soft bandage or ace wrap.
- Elevation. Raise the injured area to a level above the heart.
Most athletes with contusions get better quickly with simple treatment measures. Your doctor may give you nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, or other medications for pain relief. Do not massage the injured area.
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 muscle 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, your doctor may drain it to speed up healing.
Rehabilitation
After a few days, inflammation and swelling should start to decrease and the injury may feel a little better. At this time, your doctor may tell you to apply gentle heat to the injury and start the rehabilitation process. Remember to increase your activity level gradually.
Depending on 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, too much 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.
Once your range of motion has improved, your doctor will likely recommend incorporating weightbearing and strengthening exercises.
When you have normal, pain-free range of motion, your doctor may let you return to non-contact sports.
Return to Play
You may be able to return to contact sports when you regain your full strength, motion, and endurance. When your doctor says you are ready to return to play, they may want you to wear a customized protective device to prevent further injury to the bruised area.
Depending on 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
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 of the more common complications are compartment syndrome and myositis ossificans.
Compartment Syndrome
In certain cases, rapid bleeding may cause extremely painful swelling within the muscles of your arm, leg, foot, or buttock. Build-up of pressure from fluids several hours after a contusion can disrupt blood flow and prevent nourishment from reaching the muscle group.
Signs of compartment syndrome include:
- Severe pain, especially when you move the joints next to the muscle
- Numbness
- Poor blood flow (abnormal pulses)
Compartment syndrome is a medical emergency and may require urgent surgery to relieve the pressure on the muscles, blood vessels, and nerves.
Learn more: Compartment Syndrome
Myositis Ossificans
Myositis ossificans is a condition in which bone forms in the injured muscle. It can occur after any significant contusion.
Symptoms may include:
- Mild to severe pain that does not go away
- Swelling at the site of the injury
Abnormal bone formation can also reduce your flexibility. Vigorous stretching exercises may make the condition worse.
What will usually help is to do the following soon after the injury occurs:
- RICE (rest, ice, compression, and elevation) to reduce inflammation.
- Immobilizing the limb (keeping it in one position) with the muscle stretched. For example, a quadriceps (thigh) contusion can be immobilized early on with some knee flexion (bending) to keep the muscle constantly stretched. Immobilizing the knee in flexion (a bent position) for the first 24 hours will minimize the size of the hematoma that can form.
Gentle stretching exercises should start the day after the injury to improve flexibility. Surgery is rarely required.
Last Reviewed
December 2024
Contributed and/or Updated by
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AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.