Sports Medicine Muscle Injuries

Muscle Contusion (Bruise)

Athletes in contact sports have many opportunities to get a muscle contusion (bruise). Contusions are second only to strains as a leading cause of sports injuries.

Most contusions are minor and heal quickly, without taking the athlete away from the game. Severe contusions, however, can cause deep tissue damage and lead to complications that may prevent an athlete from being able to play sports for months.

Causes

Contusions occur when a direct blow or repeated blows by a blunt object strike part of the body, crushing underlying muscle fibers and connective tissue without breaking the skin. A contusion can result from falling or jamming the body against a hard surface.

Symptoms

Contusions cause swelling and pain and can limit joint range of motion near the injury. Torn blood vessels may cause bluish discoloration. The injured muscle may feel weak and stiff.

Sometimes a pool of blood collects within damaged tissue, forming a lump over the injury (hematoma). If tissue damage is extensive, you may also have a broken bone, dislocated joint, sprain, torn muscle, or other injuries. Contusions to the abdomen may damage internal organs.

Physical Examination

See your doctor right away for complete diagnosis. A physical examination will determine the exact location and extent of the injury.

Diagnostic imaging tools may be used to better visualize inside the injured area of your body. These tools include x-rays, ultrasound, magnetic resonance imaging (MRI) scans, or computerized tomography (CT) scans. For some injuries, your doctor may also need to check for nerve injury.

Treatment

To control pain, bleeding, and inflammation, keep the muscle in a gentle stretch position and use the RICE protocol:

• Protect the injured area from further harm by stopping play. You may also use a protective device (i.e., crutches, sling).
• Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly on the skin.
• Lightly wrap the injured area in a soft bandage or ace wrap.
• Raise the injured area to a level above the heart.

Most athletes with contusions get better quickly with simple treatment measures. Your doctor may give you nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, or other medications for pain relief. Do not massage the injured area.

During the first 24 to 48 hours after injury (acute phase), you will probably need to continue using rest, ice, compression bandages, and elevation of the injured area to control bleeding, swelling, and pain. While the injured muscle heals, be sure to keep exercising the uninjured parts of your body to maintain your overall level of fitness. If there is a large hematoma that does not go away within several days, your doctor may drain it surgically to expedite healing.

Rehabilitation

After a few days, inflammation and swelling should start to decrease and the injury may feel a little better. At this time, your doctor may tell you to apply gentle heat to the injury and start the rehabilitation process. Remember to increase your activity level gradually.

Depending upon the extent of your injuries, returning to your normal sports activity may take several weeks or longer. If you put too much stress on the injured area before it has healed enough, excessive scar tissue may develop and cause more problems.

In the first phase of rehabilitation, your doctor may prescribe gentle stretching exercises that begin to restore range of motion to the injured area.

Once your range of motion has improved, your doctor will likely recommend incorporating weightbearing and strengthening exercises. When you have normal, pain-free range of motion, your doctor may let you return to non-contact sports.

Return to Play

You may be able to return to contact sports when you get back your full strength, motion, and endurance. When your doctor and athletic trainer agree that you are ready to return to play, they may want you to wear a customized protective device to prevent further injury to the area that had a contusion.

Depending upon your sport, you may get special padding made of firm or semi-firm materials. The padding spreads out the force of impact when direct blows from blunt objects strike your body.

Complications

Getting prompt medical treatment and following your doctor’s advice about rehabilitation can help you avoid serious medical complications that occasionally result from deep muscle contusions. Two of the more common complications are compartment syndrome and myositis ossificans.

Compartment Syndrome

In certain cases, rapid bleeding may cause extremely painful swelling within the muscles of your arm, leg, foot, or buttock. Build-up of pressure from fluids several hours after a contusion can disrupt blood flow and prevent nourishment from reaching the muscle group. Compartment syndrome may require urgent surgery to relieve the pressure on the muscles, blood vessels, and nerves.

Myositis Ossificans

Young athletes who try to rehabilitate a severe contusion too quickly sometimes develop myositis ossificans. This is a condition in which bone forms in the injured muscle.

Symptoms may include mild to severe pain that does not go away and swelling at the site of the injury. Abnormal bone formation can also reduce your flexibility. Vigorous stretching exercises may make the condition worse.

Rest, ice, compression, and elevation to reduce inflammation will usually help. Gentle stretching exercises may improve flexibility. Surgery is rarely required.

Muscle Cramp

A muscle cramp is an involuntary contraction of a muscle that occurs suddenly and does not relax. If you have ever experienced a charley horse, you probably still remember the sudden, tight and intense pain caused by a muscle locked in spasm.

Cramps can affect any muscle under your voluntary control (skeletal muscle). They can involve part or all of a muscle, or several muscles in a group.

The most commonly affected muscle groups are:

• Back of lower leg/calf (gastrocnemius)
• Back of thigh (hamstrings)
• Front of thigh (quadriceps)
• Cramps in the feet, hands, arms, abdomen, and along the rib cage are also very common.

Causes

Although the exact cause of muscle cramps is unknown (idiopathic), some researchers believe inadequate stretching and muscle fatigue leads to abnormalities in the mechanisms that control muscle contraction. Other factors may also be involved, including poor conditioning, exercising or working in intense heat, dehydration and depletion of salt and minerals (electrolytes).

Inadequate Stretching and Muscle Fatigue

Muscles are bundles of fibers that contract and expand to produce movement. A regular program of stretching lengthens muscle fibers so they can contract and tighten more vigorously when you exercise. When your body is poorly conditioned, you are more likely to experience muscle fatigue, which can alter spinal neural reflex activity. Overexertion depletes a muscle’s oxygen supply, leading to build up of waste product and spasm. When a cramp begins, the spinal cord stimulates the muscle to keep contracting.

Heat, Dehydration, and Electrolyte Depletion

Muscle cramps are more likely when you exercise in hot weather because sweat drains your body’s fluids, salt and minerals (i.e., potassium, magnesium and calcium). Loss of these nutrients may also cause a muscle to spasm.

Risk Factors

Some people are predisposed to muscle cramps and get them regularly with any physical exertion. Those at greatest risk for cramps and other ailments related to excess heat include infants and young children, and people over age 65. Other factors that put people at greater risk for muscle cramp include:

• Being ill or overweight
• Overexerting during work or exercise
• Taking certain medications

Muscle cramps are very common among endurance athletes, such as marathon runners and triathletes, and older people who perform strenuous physical activities.

Athletes are more likely to get cramps in the preseason when the body is not conditioned and therefore more subject to fatigue. Cramps often develop near the end of intense or prolonged exercise, or 4 to 6 hours later.

Older people are more susceptible to muscle cramps due to normal muscle loss (atrophy) that begins in the mid-40s and accelerates with inactivity. As you age, your muscles cannot work as hard or as quickly as they used to. The body also loses some of its sense of thirst and its ability to sense and respond to changes in temperature.

Symptoms

Muscle cramps range in intensity from a slight tic to agonizing pain. A cramping muscle may feel hard to the touch and/or appear visibly distorted or twitch beneath the skin. A cramp can last a few seconds to 15 minutes or longer. It might recur multiple times before it goes away.

When to see your doctor

Although most muscle cramps are benign, sometimes they can indicate a serious medical condition. See your doctor if cramps are severe, happen frequently, respond poorly to simple treatments, or are not related to obvious causes like strenuous exercise. You could have problems with circulation, nerves, metabolism, hormones, medications, or nutrition.

Muscle cramps may be a part of many conditions that range from minor to severe, such as Lou Gehrig’s disease (amyotrophic lateral sclerosis), spinal nerve irritation or compression (radiculopathy), hardening of the arteries, narrowing of the spinal canal (stenosis), thyroid disease, chronic infections, and cirrhosis of the liver.

Treatment

• Cramps usually go away on their own without seeing a doctor.
• Stop doing whatever activity triggered the cramp.
• Gently stretch and massage the cramping muscle, holding it in stretched position until the cramp stops.
• Apply heat to tense/tight muscles, or cold to sore/tender muscles.

Prevention

To avoid future cramps, work toward better overall fitness. Do regular flexibility exercises before and after you work out to stretch muscle groups most prone to cramping.

Warm up

Always warm up before stretching. Good examples of warm-up activities are slowly running in place or walking briskly for a few minutes, and stretching. Hold each stretch briefly, then release. Never stretch to the point of pain.

Calf Muscle Stretch

Lean forward against a wall with one leg in front of the other. Straighten your back leg and press your heel into the floor. Your front knee is bent. Hold for 15 to 30 seconds. You should feel this stretch in your calf and down toward your heel.

• Do: Keep both heels flat on the floor. Point the toes of your back foot toward the heel of your front foot.

Hamstring Muscle Stretch

Sit up tall with both legs extended straight in front of you. Your feet are neutral — not pointed or flexed. Place your palms on the floor and slide your hands toward your ankles. Hold for 30 seconds.

You should feel this stretch at the back of your thighs and behind your knees.

• Do: Keep your chest open and back long. Reach from your hips. Stop sliding your palms forward when you feel the stretch.
• Do not: Round your back or try to bring your nose to your knees. Do not lock your knees.

Quadriceps Muscle Stretch

Hold on to a wall or the back of a chair for balance. Lift one foot and bring your heel up toward your buttocks. Grasp your ankle with your hand and pull your heel closer to your body. Hold the stretch for 30 seconds.

You should feel this stretch in the front of your thigh.

• Do: Keep your knees close together. Stop bringing your heel closer when you feel the stretch.
• Do not: Arch or twist your back.