In this article we will look more closely at what a thigh contusion actually is, what you should be aware of and what you should do after you have had one.
What is a thigh contusion, really?
A thigh contusion is known as a contusion injury or a crush injury to the muscle. This injury can occur in any muscle, but a thigh contusion refers to an injury to the muscles at the front of the thigh. The muscle is crushed against the bone underneath and damage occurs to the muscle tissue. Some of the muscle fibres are torn apart in a similar way to a strain. Depending on the forces involved, we can get different degrees of muscle damage and we usually distinguish between two different variants.
Variant 1 is called an intramuscular thigh contusion / contusion injury, and here only the muscle fibres are damaged as a result of a hard blow. The connective tissue that encapsulates the muscle (epimysium) is intact and the collection of blood (haematoma) that occurs after the muscle injury is confined to the inside of the muscle.
Variant 2 is called an intermuscular thigh contusion / contusion injury, and here the connective tissue around the muscles is also damaged, not just the muscle fibres. This means the haematoma can seep out from the muscle into the surrounding muscles.
Variant 2 looks the most dramatic, as it often causes large colour changes because of more widespread bleeding. Variant 1, where the haematoma is confined to the inside of the muscle, often causes more pain and greater loss of function. This is because a large pressure builds up inside the muscle, and this can carry a greater risk of long-term consequences. You can therefore almost be reassured if bleeding under the skin appears in the hours or days after you got the thigh contusion.
Why is it important to take them seriously?
Most thigh contusions settle well and you can return to, for example, playing football after days to weeks. In some cases, however, a thigh contusion can lead to complications that can keep you out of action for a longer period.
Thigh contusions are often not treated for what they are, namely muscle injuries. There is a structural injury to the muscle, as with a strain, and this needs time to heal, in addition to the need to gradually rebuild the capacity of the muscle tissue. Imagine that a strain corresponds to a sheet of paper that you tear, while a thigh contusion represents a sheet of paper that you make a hole in the middle of. If you return too early to hard activity, the muscle is more exposed to further injury.
In some cases a thigh contusion can also develop into two different serious conditions if the injury is extensive enough, or if it is not treated properly. These conditions are admittedly relatively rare, but serious.
In some cases the pressure that arises after an intramuscular thigh contusion can lead to acute compartment syndrome. This is a condition that occurs because circulation is impaired as a result of high pressure. If the pressure is high enough and lasts long enough, there is a risk that muscle and nerve tissue die as a result of lack of oxygen. Acute compartment syndrome must be operated on quickly to prevent serious damage.
The other condition that can occur after a thigh contusion is called myositis ossificans. This is a condition in which bone tissue forms inside the muscle after trauma, and it can be seen as a reaction to failed healing of the damaged muscle tissue. It is the body's attempt to create stability in the area. If the thigh contusion leads to myositis ossificans, you can expect a much longer rehabilitation period.
What should you do after a thigh contusion?
Because the injury is not always visible (intramuscular), it can be difficult to assess the severity, but how far you are able to bend the knee can give us a good indicator, where a greater ability to bend the knee suggests a shorter rehabilitation period.
In the early phase after the thigh contusion the goals are pain relief, minimising swelling and improving mobility. You can largely follow the principles from PEACE & LOVE, which we have written about here. In short, it is important to protect the injured area and you can apply compression to limit bleeding. In addition, it can help to lock the knee in as acute an angle as you tolerate. This helps limit the bleeding and will prevent further loss of mobility.
Once you have gained control of pain and swelling, it is important to gradually prepare the muscle tissue for loading again. We want the ability to bend the knee to return to normal, and then we start with light strength training of the injured muscles. After that it is about gradually exposing the muscles to more and more stress, back towards the stress they are normally exposed to – for example playing football. The way back to this should be as pain-free as possible.
You have nothing to gain by rushing back after a thigh contusion, so allow yourself a couple of days to see how the symptoms change. If you suspect a greater degree of injury, we recommend that you see a physiotherapist for help assessing the severity, and for help drawing up a plan to get back to what you want to do.
Our practitioners have good experience with assessment and rehabilitation after thigh contusions.
References
- Kary JM. Diagnosis and management of quadriceps strains and contusions. Curr Rev Musculoskelet Med. 2010 Jul 30;3(1-4):26-31. doi: 10.1007/s12178-010-9064-5. PMID: 21063497; PMCID: PMC2941577.
- Aronen JG, Garrick JG, Chronister RD, McDevitt ER. Quadriceps contusions: clinical results of immediate immobilization in 120 degrees of knee flexion. Clin J Sport Med. 2006 Sep;16(5):383-7. doi: 10.1097/01.jsm.0000244605.34283.94. PMID: 17016112.
- How MI, Lee PK, Wei TS, Chong CT. Delayed presentation of compartment syndrome of the thigh secondary to quadriceps trauma and vascular injury in a soccer athlete. Int J Surg Case Rep. 2015;11:56-58. doi: 10.1016/j.ijscr.2015.04.003. Epub 2015 Apr 8. PMID: 25931302; PMCID: PMC4446675.
- Devilbiss Z, Hess M, Ho GWK. Myositis Ossificans in Sport: A Review. Curr Sports Med Rep. 2018 Sep;17(9):290-295. doi: 10.1249/JSR.0000000000000515. PMID: 30204632.
- https://www.physio-network.com/blog/case-study-myositis-ossificans-deadlegs-arent-just-for-the-playground/