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Muscle bruises, or contusions, are caused by a direct blow to the body or from a fall against a hard surface. They are the second most common sports injury. Most bruises are minor and can be treated with the RICE method: rest, ice, compression, and elevation. However, severe bruises can cause deep tissue damage and may take several months to heal. Bruises are graded into three categories: first, second, and third degree, depending on their severity. Treatment for severe bruises may include anti-inflammatory medications and physical therapy.
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What You'll Learn
Rest, ice, compression and elevation (RICE)
RICE is an acronym for a type of treatment that involves rest, ice, compression, and elevation. It is often recommended by doctors for mild to moderate soft tissue injuries, such as bruises, sprains, and strains, which are commonly sports-related.
Rest: Avoiding use of the injured area is essential to allow the body time to heal. Stop, change, or take a break from any activity that may be causing pain or soreness.
Ice: Applying ice packs or cold compresses, such as bags of frozen vegetables, to the injured area helps to minimise swelling and pain by slowing down blood flow to the area. It is important to wrap the ice in a cloth or towel and not apply it directly to the skin. Ice should be applied for 10 to 20 minutes, several times a day, especially within the first 3 days of injury.
Compression: Wrapping the injured area with an elastic bandage provides support, helps control swelling, and reduces inflammation. It is important to wrap the bandage firmly but not too tightly, as this can cause more swelling. Compression is effective for up to 1 week, and it is recommended to talk to a doctor if longer use is required.
Elevation: Keeping the injured area raised above the level of the heart helps to reduce swelling and associated pain and discomfort. This is done by propping up the injured limb with pillows or other supports to achieve the correct elevation. Experts recommend elevating the area for 2-3 hours a day.
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Nonsteroidal anti-inflammatory drugs
NSAIDs are available as nonprescription and prescription-strength medications. Some common nonprescription NSAIDs include:
- Aspirin (Bayer®, St. Joseph®)
- Ibuprofen (Motrin®, Advil®)
- Naproxen sodium (Aleve®)
On the other hand, prescription-strength NSAIDs include:
- Celecoxib (Celebrex®)
- Diclofenac (Voltaren®)
- Fenoprofen (Nalfon®)
- Indomethacin (Indocin®)
- Ketorolac (Toradol®)
It is important to note that NSAIDs can cause serious, and sometimes life-threatening, side effects and may interact with other medications. Therefore, they should always be used with caution, for the shortest time possible, and at the lowest effective dose. It is recommended to consult a doctor or pharmacist before taking NSAIDs to ensure they are safe for you. Additionally, if you experience any side effects, it is important to stop taking the medication and seek medical advice.
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Light activity and heat
Light activity is important for two reasons: it promotes blood circulation and activates the lymphatic system, which is vital for clearing the body of waste products that accumulate after a muscle bruise. However, it's important to increase your activity level gradually. Returning to your normal sports activity may take several weeks or longer, and if you put too much stress on the injured area before it has healed, too much scar tissue may develop. In the first phase of rehabilitation, your doctor may prescribe gentle stretching exercises to restore your range of motion. Once your flexibility and range of motion have returned to normal, you can move on to more active rehabilitation techniques like strength work and balance drills.
Heat is very effective in stimulating blood flow to bruised muscle tissues. After 48 hours, you can start applying heat to the bruise in the form of a heat pack, ray lamp, or hot water bottle. You can also try soaking in a hot bath to ease pain and loosen up your muscles.
It's important to note that light activity and heat will not remove scar tissue and other damaged tissue. If you have a moderate to severe muscle contusion, you may need physical therapy to break down this tissue.
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Massage
After the initial healing period, massage can be beneficial in breaking down scar tissue and promoting healing. It is important to start with light strokes and gradually increase the pressure, concentrating on the direct point of the bruise. The injured area may be tender, so it is crucial to listen to your body and not push through any intense pain.
Remedial massage or myotherapy can be particularly useful in the early stages of recovery. This type of massage focuses on working the muscles above and below the injury site to relax and release any protective spasms. Manual lymphatic drainage is another technique that can help drain the area if there is significant fluid leakage from the blood vessels.
Gentle stretching should be incorporated alongside massage to help regain your range of motion and realign bruised muscle fibers. It is important to work on increasing the flexibility of the injured area as well as the surrounding muscle groups. As your flexibility and range of motion improve, you can gradually incorporate more active rehabilitation techniques, such as strength work and balance drills.
It is important to note that massage may not be suitable for severe bruises or hematomas. If the bruise is very large or there is a possibility of other injuries, it is crucial to seek medical attention.
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Imaging tests
Your healthcare provider will first physically examine the injury, asking about symptoms and how it occurred. They may apply slight pressure to the injured muscle and test the range of motion of nearby joints. If they suspect a severe muscle contusion or other complications, they may recommend imaging tests to get a closer look at the muscles, joints, and bones.
One common imaging test is magnetic resonance imaging (MRI), which uses strong magnetic frequencies to create detailed images of the inside of the body, particularly the soft tissues. MRI scans can help detect tears, strains, or other damage to muscles, tendons, and ligaments. Another imaging test is the computed tomography (CT) scan, which takes X-ray images from various angles to provide a more comprehensive view of the body's interior than standard X-rays. CT scans are useful for diagnosing problems with bones or muscles.
Ultrasound imaging, also known as sonography, uses sound waves to visualize the inside of the body and is excellent for capturing images of soft tissues, including muscles and ligaments. It is particularly effective at detecting swelling and inflammation near joints and muscles. For a closer look at the bones, your healthcare provider may recommend a DEXA scan or X-rays, especially if they suspect a bone bruise, fracture, or myositis ossificans, which is when bone forms inside a muscle after a severe injury.
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Frequently asked questions
A muscle contusion, or bruise, is an injury that occurs during vigorous activities such as sports. They are caused by a direct blow to the muscle, like being hit by an object, or from a fall against a hard surface.
Most bruises respond to rest, ice, compression and elevation (RICE) for 24 to 48 hours. Your doctor may also recommend anti-inflammatory medicines to reduce pain and inflammation. In rare cases, surgery may be required to drain a large hematoma.
Symptoms of a muscle contusion include pain, swelling, skin discolouration and restricted movement. Bruises are graded into three categories: first, second and third-degree, depending on their severity.
