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.
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
Contusions occur when a direct blow or repeated blows
from a blunt object strike part of the body, crushing
underlying muscle fibers and connective tissue without
breaking the skin. A contusion can result from falling
or jamming the body against a hard surface.
Sometimes a pool of blood collects within damaged tissue,
forming a lump over the injury (hematoma).
In severe cases, swelling and bleeding beneath the skin
may cause shock. If tissue damage is extensive, you may
also have a fractured bone, dislocated joint, sprain,
torn muscle, or other injuries.
Contusions to the abdomen may damage internal organs.
See your doctor right away for complete diagnosis. A physical
examination will determine the exact location and extent
Diagnostic imaging tools may be used to better visualize
inside the injured area of your body. These tools include
ultrasound, magnetic resonance imaging (MRI), or computed
tomography (CT) scans.
For some injuries, your doctor may also need to check
for nerve injury.
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
To control pain, bleeding, and inflammation, keep the
muscle in a gentle stretch position and use the RICE
the injured area from further harm by stopping play.
also use a protective device (i.e., crutches,
Apply ice wrapped in a clean cloth. (Remove ice after
Lightly wrap the injured area in a soft bandage or
Raise it to a level above the heart.
Most athletes with contusions get better quickly without
surgery. Your doctor may give you nonsteroidal anti-inflammatory
drugs (NSAIDs) 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 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.
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
When you have normal, pain-free range of motion, the doctor
may let you return to non-contact sports.
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.
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.
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.
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
Rest, ice, compression and elevation to reduce inflammation
will usually help. Gentle stretching exercises may
improve flexibility. Surgery is rarely required.