• Robin R Varghese, PT.

Can physiotherapy help contusions? Are you wondering what to do or whom to go to? We can handle it!!


Contusions are one of the most common muscle injuries besides muscle-strains.

  • A contusion is the most common acute injury and are common in contact sport such as football, rugby and basketball.

  • Contusions are caused by external forces like a direct blow from an opponent's knee.

  • Muscle contusions are classified as acute direct muscle injuries .

  • It is common with muscles that lie next to the bone, which has limited space for movement when exposed to a direct blunt blow.

  • The most frequently injured muscles are the exposed rectus femoris and the intermediate vastus.

Clinical Presentation

  • In the start, there are negligible symptoms, but after 24 hours this will lead to hematoma formation within the muscle causing:

  • pain

  • swelling

  • stiffness and

  • impairment of functional excursion of the muscle.


What exactly happens within?

  • Microscopic rupture and damage to muscle cell

  • Macroscopic defects in muscle bellies

  • Infiltrative bleeding

  • Inflammation

  • Crushed muscle tissue resulting in dysfunction

  • Repair depends on the balance between remodeling and scar formation

  • Unresolved bleeding deep in the muscle tissue which can lead to a serious condition known as myositis ossificans

  • Diffuse or circumscribed bleeding that displaces or compresses muscle fibers causing pain and loss of motion.

Are contusions accompanied by structural damages?

  • Muscle fibers are not torn by longitudinal distraction. Therefore, contusions are not necessarily accompanied by a structural damage of muscle tissue and thus, even with more severe contusions the athletes can often continue playing for a long time.

Classification

  • Mild- Mild restriction of movement, with normal gait,no stiffness,

  • Moderate-Moderate restriction of movement, with mild antalgic gait, minimum stiffness

  • Severe- Severe restriction of movement, with severe antalgic gait, severe stiffness


How is it diagnosed?

  • Diagnostic Ultrasound

  • MRI and

  • Physical tests like firmness measurement, circumference measurement, Active Range Of Motion(AROM),Strength test, Brush-Swipe and tap test, etc are the methods used to diagnose contusions.

Medical Management

Use of NSAIDs

  • NSAIDs can be useful short term for decreasing pain, but their long-term effect on muscle healing is not known .

  • Long-term use of NSAIDs for contusions is usually not necessary and is discouraged.

  • NSAIDs have been promoted for prevention of myositis ossificans after severe quadriceps contusions.

Use of Surgery

Surgical excision is recommended in case of Myositis Ossificans.


Physical Therapy Management

Goals

The goal is to:

Avoid hematoma,

Relieve pain,

Improve ROM, strength and flexibility.


1. Avoid activities that loads the muscle excessively

In case of Quadriceps contusion ,It is recommended the injured leg be placed in a hinged knee brace at 120° of knee flexion or using elastic compression wrap in a position of flexion for the first 24 h post-injury to limit hematoma formation. This needs to be done as soon as possible after injury.

2. Cryokinetics- This is achieved by Rest, ice and compression. Compression limits the hemorrhage for the first 24 to 48 hours and avoids muscle stiffness. Ice application can be followed by progressive, active exercises.

3. Soft tissue massage around the periphery of the contusion. This leads to a better fluid resolution.

4. Electrotherapy in order to reduce the pain.

5. Taping to relieve pain and swelling

6. Active and passive quadriceps muscle stretching with emphasis on knee flexion. After 24 hours, the brace or wrap should be removed and gentle, active, pain-free range of motion at the knee should be initiated along with stretching and isometric quadriceps strengthening.

7.The active phase of treatment, including functional rehabilitation, can begin when pain-free, active knee flexion of at least 120° is attained.



In Valley Healing Hands, Brownsville, Texas, we provide the best physical therapy treatment for muscle contusions and our therapists are highly skilled to diagnose and address your complaints to your satisfaction. They will guide you through each step of your rehab programme in a personalized way that will suit your requirement.



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