If you’ve ever accidentally hit your thigh against the edge of a table, or had a more serious injury after an event like a car accident, your skin has probably turned into a rainbow of troubled colors. The discoloration of crushed blood vessels is what is commonly known as a “bruise”, and are medically called contusions. Whatever the size and amalgamation of blues, reds, purples, yellows, browns and greens, a bruise is your body’s obvious way of showing that your tissues are injured.
This resources is meant to help you understand:
What causes a contusion?
A contusion usually results from direct or repetitive blows striking any specific part of your body. They can also come from hitting your body against an object, or falling to the ground. When either of these actions occurs, the muscle fibers and capillaries (small blood vessels) are crushed, and blood leaks out of the injured cells to the surrounding skin and causes discoloration. The skin does not break when a contusion forms.
A bruise’s development depends on the severity of the trauma. A small action like getting skin caught in a zipper or jamming your shin against a table may trigger a bruise quickly (around a few minutes to an hour), as the injury would be close to the skin’s surface. More forceful traumas, such a fall or being hit by a baseball bat, may take a while to see discoloration, taking a few hours or maybe even days. Bruises can also occur far from the injury; it is not uncommon to see bruising in your ankle if you hurt your hip or knee or get surgery, or even have a bruise on your hand if you injure your shoulder. This is due to gravity carrying the escaped blood to the lowest point of the limb, aka your hand and foot in these circumstances. Severe contusions on the abdomen and back may also injure your internal organs.
How big your bruise becomes depends on both the cause and the amount of force due to your injury. The larger the object and more force put on your skin, the bigger the potential contusion.
When the contusion starts healing, other colors may start appearing. Healing contusions may start to develop into green as the hemoglobin converts into other chemicals. As hemoglobin nears its final breakdown process, the bruise then starts turning yellow. The body will eventually absorb the last of the damaged tissue, transfiguring back to its normal fleshy coloring.
Most bruises are multicolored, due to different areas of the affected tissues being injured at different intensities, and damaged by different forces. The worst damage is signaled by the purple and black areas.
How do health care professionals diagnose the problem?
A bruise is very easy to diagnose as they are very visible and obvious on your skin. Your doctor may palpate (feel) around the contused area to see if any hardness is developing to see if any possible complications are forming (which will be mentioned further into the article).
Usually, most bruises won’t need to be examined too thoroughly as small ones will heal on their own. However, in more severe cases and those that result from a bigger injury where the extent of the damage is questioned, an ultrasound, magnetic resonance image (MRI), computed tomography (CT) scan or X-Ray may be needed. Such tests can help determine if the area has caused a significant tear, damage to an internal organ, or if your bone was possibly fractured.
In cases where extensive bruising occurs in an unexpected way (for example, getting a large bruise but only minimally injuring your area) or happens more easily than it should be happening, your doctor may suggest further testing to investigate if you may have a condition that makes bruising more likely, such as hereditary blood diseases like hemophilia. Medications like blood thinners can also contribute to contusions forming. Your health care professional may inquire about any general health conditions or medications in order to properly confirm your problems and see if there are any underlying reasons as to why your bruises are abnormal.
What will my doctor do when I see them?
When you’re able to see your doctor about your contusion, they will usually recommend simply assisting your bruise with the RICE method (rest, ice, compression and elevation). However, in more severe cases where you’ve lost mobility in your limbs or are dealing with significant amounts of pain, they may suggest painkillers, which can be over-the-counter or may be prescribed if your pain is that intense. Your doctor may also suggest a more comprehensive examination if the status of the tissue or bone is in question, thus you may be recommended for an ultrasound, X-ray, CT or MRI to inspect the aforementioned areas. Such tests may be suggested to also make sure that your nerves aren’t damaged.
The earlier you can see your physical therapist, the more they’ll be able to help you with your contusion’s rehabilitation. During the initial stages of healing, the RICE method is still essential.
Hicksville PT’s physical therapists will tell you how much rest you need and the amount of activities you can continue doing while nursing your healing contusion. Resting in the case of a contusion doesn’t necessarily mean you can’t do anything, but to decrease the amount of activity you’re used to, or at least lessen the amount of activity that irritates your injured muscle. Some gentle stretching and movement will usually help encourage the fluid and damaged tissue to transport itself out of the bruised area and assist the formation of healing scars to align in the proper directions. Your specialist will work with you and assign the stretching and strengthening exercises you need at your stage of healing. If your injury is fresh, the first exercises probably won’t ask you to do much; you may only be asked to slowly and gently move the muscle into its full range of motion, if possible, and to work isometrically to tighten the muscle by squeezing and tightening it without moving your actual joint. More intense contusions, however, may require complete rest and minimal movement for a small amount of time. If your contusion is severe, minimal movement will allow for recovery while ensuring you won’t feel any further pain.
If your injury is speedily recovering, your physical therapist may start to recommend more aggressive stretching, called dynamic stretching. Dynamic stretching is used to prepare your muscles to get used to the repetitiveness into your daily routine, as well as get you used to aggressive movements that sports incur. This type of stretching involves moving your limbs repetitively with controlled speed to reach their end range of motion, so your muscles can fully be stretched. When reaching the end stages of recovery, your strengthening will become more aggressive. Your exercises may include squatting, jumping, or moving your limbs and torso quickly and aggressively in order to prepare the contused muscles to again return to everyday life and for the intensity of sport.
Depending on the progress of your injury, your physical therapist may or may not encourage ice. Applying ice is essential if the bruise is fresh within the last 48 hours; ice will assuage any swelling and any secondary injuries pressed on the tissues that surround the main injury. Even if the injury happened more than a few days ago, ice can still be integral to your healing process. However, if the injury transpired more than a few days ago/weeks ago, your specialist may recommend using heat instead. If heat is applied properly, it can also help decrease your pain and assist with your recovery. Combining heating and cooling methods may also help interchangably. Your therapist will give specific advice regarding using such methods and when it is appropriate for your individual injury, and will advise you on the amount of time needed for each session of ice and heat.
If your contusion is in an area that’s easy to compress (such as your calf, forearm or thigh), your therapist will advise you to wrap the area with a compression wrap. Doing so is an integral part of the early stages of recovery, as it can limit excess swelling and prevent your injury from becoming further bruised, as well as contain the area of a possible secondary injury. Some swelling is necessary for the healing process, but too much can damage surrounding cells and stop muscles around the area from functioning properly. If the contusion feels more painful when compressed or is too constricted, remove the wrap and re-wrap it to be a little looser.
In the later stages of a healing contusion, a compression wrap can continue to be useful to limit swelling, but also helps add physical support as you start the rehabilitation process. Your physical therapist may also suggest using tape (both in early and later stages) to add more compression and further limit any swelling or bruising.
If you’re able to, elevating the injured area helps drain swelling related to the injury. Some parts of the body cannot be easily elevated, but if your contused area encompasses any of your limbs, elevation can further help gravity play its part, moving the swelling and bruising towards your heart so the fluids can re-circulate back into your system. When possible and within reasonable limits, try elevating your limb above your heart in order to induce recovery. If the contusion happens on your thigh or calf, lie down on the couch and stack pillows to elevate your legs, or lie on the floor while raising your legs to the couch. Upper extremities are harder to elevant for long periods, but even being able to rest the limb level at heart level will assist in the healing process. When the area is not able to elevate, gravity pulls the swelling downwards into your limb and your body has to rely on your muscles and their actions to get the fluids out. However, since your muscles cannot work as they usually can due to the injured area, natural recovery is slow in comparison. As we’ve said before, gravity is also the reason why bruises may form out of the injured area, such as the knee bruising when the injury was on the hip or the bottom of the thigh facing discoloration when the injury was at the top.
Along with rest, ice/heat, compression and elevation, your Hicksville PT Physical Therapist may use other modes on the contusion to speed up the healing process. Hands-on techniques like massage therapy or hands-on stretching may be tried, and electrical modalities like ultrasound, muscle stimulation, medical laser therapy or interferential current (IFC) may be considered.
If your lower limb or torso is suffering from a severe contusion, you may need crutches to get around. Your physical therapist will suggest them as needed and also teach you how to use them. Generally, if you’re limping when walking without crutches, you may need them, and they or a cane/stick should be continued to be used until the injury heals enough and you’re able to walk without a walking aid.
What kinds of complications can occur from a contusion?
In rare cases, complications may occur as a contusion starts to heal. Seeing complications is more common in severe contusions, as compared to mild contusions, severe ones cause significant muscle fiber damage. Factors that may affect the risk of developing a complication include stretching the injured muscle too aggressively or too early on, not giving the contusion the appropriate time to heal before returning to activities it cannot handle, or massaging the area too aggressively. However, following instructions that your physical therapist gives you in regards to exercising and returning to daily activity will usually help you avoid developing a complication.
One of the complications that can develop in a severe contusion as it’s healing is a hematoma, or a blood clot. A hematoma is a hard lump that can be felt in the muscle fairly early as your body recovers. A hematoma can delay your recovery, but usually will be reabsorbed back into the tissue in due time, and you’ll still be able to fully recover.
Another type of complication that can develop with a severe contusion is myositis ossification. This condition often happens within the quadriceps muscles (known as corked thigh in some parts of the world), but can occur in any severely contused muscle. In this condition, damaged muscle fibers turn into bone, or ossify, and cause a lump in the healing tissue similar to a hematoma. The exact mechanism of the conversion remains unclear. The calcification is separate from a hematoma, as it cannot be felt or does not show up in an X-Ray until at least 4 weeks after the injury has passed. Not controlling your intensity in early rehabilitation and being aggressive in function too quickly possibly induces development of MOs.
Compartment syndrome is another rare complication resulting from a severe contusion, this time in the upper or lower limbs. When a severe contusion occurs, excessive local swelling means blood in the area has nowhere to escape to. The force of extra fluid in the area can put pressure on other local muscles and arteries, causing severe damage and even cut off function to the muscles by cutting off blood supply. Symptoms of this condition occurring after a severe contusion include a sudden, new and excessive pain or ache in the injured area, feeling pins and needles or tingling, difficulty moving the affected body part, and tightness when the area is examined. An acute compartment syndrome is an emergency and requires immediate medical attention. The affected area needs to be decompressed, blood supply restored to the tissues, and must be monitored to ensure that muscle death does not occur.
Bruising happens due to myriad reasons, but the more force and bigger the object the injured area makes contact with, the more severe your damage will probably be. As contusions heal, they go through discoloration that signals what stage of healing they’re in, though bruising can amass a “rainbow” as the areas in the injury may have different levels of damage. Contact Hicksville PT to ensure that your contusion is healing correctly, as receiving early physical therapy advice and treatment can help your contusion heal properly and quickly without any further problems occurring.