Leg > Bone Bruises

What are Muscle Bruises?

A bruise is one of the most common sports injuries. Typically, it is a collection of blood under the skin that heals quickly when treated with R.I.C.E (Rest, Ice, Compression, Elevation) and pain medication. However, sometimes a bruise can be a sign of deeper trauma. If left untreated, some large bruises may even wind up causing permanent muscle damage. According to Matthew D. Maddox, D.O., team physician for the Phoenix Coyotes, bruises can be divided into several categories. Understanding the symptoms and basic treatment of each type of bruise will help you know when your bruises are serious enough to need a physician’s care.

   Extramuscular Bruises — The most common type of bruise is a collection of blood just below the skin, which appears rapidly after a collision or trauma. Extramuscular bruises can be large and serious looking, but they usually heal quickly with standard R.I.C.E. (Rest, Ice, Compression, Elevation) treatment.

   Intramuscular Bruises — Some trauma can cause an area of blood to collect inside a muscle, which may interfere with a muscle’s function and restrict your ability to move.

   Intermuscular Bruises — Blood can also collect between layers of muscle without actually spreading into the muscle itself. Intermuscular bruises can also limit your movement.

   Deep Bruises — This term refers to any bruise that results in a significant amount of blood collecting in and around muscle tissue. More blood collecting in the muscle tissue causes greater pain. Severe deep bruises can be any combination of extra, intra, and intermuscular bruises. Blood may collect from directly under the skin, into the underlying muscle tissues, and throughout the space between muscle.

After a direct contact or a twisting injury, such as an ACL tear, an athlete may have a bruise on the bone itself. “You can get swelling and injury to the bone without actually breaking the bone,” says Dr. Maddox. Though bone bruises usually heal on their own, a small percentage can cause joint problems or fractures. The more concentrated a bone bruise is, the more of a problem it causes. “It is like if you took a hammer and struck one tiny spot versus hitting a big, broad area – more force is distributed over a wider area,” says Dr. Maddox.

Muscle According to Dr. Maddox, deep bruises occur most often in the thighs and arms during contact sports like soccer, rugby, and martial arts where athletes do not wear thigh or arm pads. Football and hockey players also frequently suffer deep bruises, despite the use of protective equipment. Bone Another type of bone bruise occurs when the covering of the bone, called the periosteum, is injured. The periosteum is a special connective tissue covering all the bones in the body that possesses the ability to form new bone tissue. Periosteum bone bruises are often seen in football players after repetitive hits to the shoulder. Right below the shoulder pad, multiple tackles and collisions can damage the upper arm bone’s periosteum, causing a condition commonly called blocker’s bone. A bone bruise to the periosteum in the upper arm may cause bony build-up in the shoulder and a bone-spur may grow, which restricts movement.

For all types of bruises, athletes should treat any bruised areas with R.I.C.E. (Rest, Ice, Compression, and Elevation) immediately after an injury. You should ice a bruise for about 15 minutes at a time, two or three times a day. Ice constricts blood vessels, which slows blood flow into the area and speeds healing time. In the rare event that a bruise, particularly a bone bruise, is not visible, you should still apply R.I.C.E. treatment to the area in pain. The bruised area should be elevated above the heart level. It should not be used for weight-bearing activity. Gentle compression should be applied using a wrap of neoprene or athletic tape. Anti-inflammatories or painkillers can be used to help comfort your pain. R.I.C.E. treatment for 24 hours should start to reduce the swelling and pain associated with a bruise. If symptoms worsen in 24 hours, your bruise may be a sign of deeper trauma, such as a stress fracture, and a physician should examine it. Proper treatment of bruises is the best way to prevent a minor injury from becoming dangerous. If a bruise is left untreated, blood may continue to enter an injured area. This can cause devastating complications for athletes.

If a bruise spreads from the below the skin surface into muscle tissue, athletes are at risk of developing bone tissue build-up in their muscles. This condition, called myositis ossificans, occurs when excess blood flows into muscle tissue after an injury. Instead of healing as scar tissue, the healing process ossifies the blood, turning it into bone tissue. This greatly restricts movement. Ice and compression typically prevent myositis, but deeper and larger bruises are more at risk of developing myositis. Before a large bruise becomes too stiff, you should have it evaluated by a physician. According to Dr. Maddox, you should have a physician check your bruise if:

   you are having trouble bending your knees, elbows, or other joints further than 90 degrees

   the pain is getting worse or staying the same after 24 hours of R.I.C.E. treatment

   weight-bearing activity is difficult

Physicians can more easily help you prevent myositis if you seek treatment before bone tissue starts to form.

If you take too much pain medication, you are more prone to suffering compartment syndrome. According to Dr. Maddox, a high dose of anti-inflammatory medications like aspirin or Advil makes the platelets that coagulate your blood less sticky. If you suffer a bruise, it may continue to bleed, causing a build-up of blood in the thigh or arm. If the blood exerts enough pressure, you can develop a compartment syndrome, which is a rare emergency situation requiring a surgeon to open up the bruised area to relieve the pressure. To prevent compartment syndrome, you must immediately recognize these symptoms:

   increasing pain

   skin pallor, a noticeable loss of color

   inability to feel a pulse in the arteries of the bruised extremities

   a tingling sensation in the fingers and toes that increases despite treatment with ice and compression – tingling may be a sign that you are losing circulation and need to see a physician immediately.

“There is only so much space in your arm,” says Dr. Maddox. “If it is all filling up with blood, it puts pressure on the nerves and vessels in there, and it is just like putting a tourniquet around your limb.” In extreme situations, this can put you at risk for losing a limb.