The correct injury management of a bruised thigh muscle
Introduction
The statement that you can just run off a 'dead leg' is one of the most common myths in injury management.
It's an outdated saying that has been used for years and has no place in the modern game. A true 'dead-leg' can be a serious injury and players often end up in hospital as a result; so it's not something to be taken lightly.
A dead-leg is just another name for a bruised muscle, or a contusion in medical terms. The expression 'dead-leg' comes from the accompanying numbness which often results from muscle contusions, leading to altered skin sensation.
In most contact sports, particularly in football, the front of the thigh is the most common area to sustain a contusion as a result of a direct blow.
The injury commonly referred to in touch-line language as a dead-leg is simply a bruised thigh muscle, which can lead to the formation of a haematoma – or pooling of blood - in and around the affected tissues.
This can be an incredibly painful injury. Because most tackles in football will come from the front, the thigh is a sitting duck for contact injuries. Often, a simple bruising will be nothing serious, but occasionally these thigh contusions – aka dead legs – can result in serious complications.
When a muscle sustains an impact strong enough to result in a contusion some bleeding will occur. The damage caused to the small capillaries leads to the blood tracking around and into the muscle tissues themselves.
This bleeding leads to a collection of blood at the injury site, known as a haematoma, and most muscle contusions normally result in the formation of a haematoma because the force of the direct impact leads to bruising in and around the affected area.
The problem lies in differentiating whether the actual injury is on the peripheral surface of the muscle or if the bruising is contained deep within the muscle itself.
Differentiating between an Intermuscular and Intramuscular Haematoma
With the common type of thigh contusion, the injury is to the periphery of the muscle, and gravity will allow the haematoma to drain away naturally over the next few days via adjacent muscle planes. This is known as an intermuscular haematoma.
The term 'intermuscular' comes from the presence of the bruising on the surface of the tissues in between adjacent muscles; this allows the haematoma to drain away naturally; assisted by gravity. The bruising is usually evident within a few hours of the injury being sustained and generally looks worse than it usually is.
Often the bruising will track further down the leg due to gravity; usually in a nice black, yellow or dark blue colour. The discolouration will often be accompanied by pain and limitation of movement. Attempting to bend the knee will be sore, and walking might be difficult.
This is the usual scenario with intermuscular haematomas. The danger lies when the injury results in the bleeding taking place within the actual tissues of the muscle itself.
This is known as an 'intramuscular haematoma' and results in the blood pooling being trapped within the muscle tissues.
In this case, there is nowhere for the blood / bruising to drain away to since the injury is confined within a restricted space.
This means that any increase in swelling will simply lead to increased internal pressure within the muscle and surgery can often be required to release that pressure.
This is not an injury to mess around with. The clinical presentation of an intramuscular haematoma is one of a warm, swollen thigh muscle with minimal surface bruising evident.
It may be possible to feel the fluid by lightly running a hand across the injured area which will look and feel different to the unaffected leg. The swelling arises from the considerable amount of blood collected in the injured area.
The danger arises when that swelling continues to increase in the few hours immediately after the injury has been sustained and that stage it becomes obvious that we are not dealing with a straight-forward intermuscular hematoma.
Massage and heat treatments are strongly contradicted due to the tissue reaction and any attempt to massage the affected area or apply heat to the injured tissues will simply increase symptoms; potentially leading to emergency surgery.
This follows the principles of immediate management advising that ice should be used to relieve pain and limit swelling as opposed to applying heat since heat will lead to an increase in swelling.
Any attempt to "run-off" an intramuscular haematoma will only lead to further bleeding since an increase in body temperature will lead to increased blood flow in and around the injured tissues.
Complications arising from bruised thigh muscles
Longer-term complications can arise if you attempt to return to play or exercise too quickly after the injury has been sustained. In some cases, bony calcification of the injured tissue as a result of blood remaining pooled in the affected areas can occur and this is known as a 'calcified haematoma'.
In medical terms this is known as 'Myositis Ossificans'; and will easily show on a plain x-ray of the thigh as an obvious distortion in the muscle tissue. It's one of the most common injuries sustained in adult football but can occur in youngsters as well.
Lots of older, retired, professional players have had these over the years and the effects are there to see in terms of limitation of movement and altered contours of the muscles themselves.
Often this stems from repeated attempts to come back to play before the original haematoma has had time to be absorbed and dispersed naturally via the body's healing process.
So although a bruised or contused thigh is a relatively common injury in football, the problems lie with the actual location of the injury; and whether the resultant haematoma is deep or superficial to the muscle tissues.
Summary and conclusion
In conclusion, therefore, severe bruising of the thigh muscles can result in two different presentations:
1. Superficial (intermuscular) haematoma located on the surface area of the muscles > superficial drainage between adjacent muscle planes.
2. Deep (intramuscular) haematoma located within the muscle itself > bleeding within the tissue and unable to clear naturally.
So if the thigh continues to swell, or if it becomes difficult to bend the knee, and/or the injury still feels warm despite regular applications of ice in conjunction with elevation, etc., careful management is required.
The likelihood is that we are dealing with an intramuscular haematoma and further medical opinion is needed. If the symptoms of deep muscle bruising appear to be worsening, this is the kind of 'dead-leg' that you simply just can't "run-off".