What is a Contusion?

There shouldn’t be any confusion about a contusion. In plain English, it’s a bruise. We’ve all had them, especially as children: bumping into the dresser in the bedroom or getting tackled on the soccer pitch, for example. Contusions are very common workplace injuries and sports injuries, almost as common as muscle strains. They can be painful, but generally, they’re not dangerous to our long-term health.

A contusion is an acute direct muscle injury result from blunt trauma to the tissue, accompanied by an accumulation of blood. You may sustain a blow in a sport or you may bump into a fixed object; either way, both your muscle fibres and small blood vessels (capillaries) become injured. Blood from the capillaries leaks out and settles under the skin, although the skin isn’t broken.

The size of the bruise depends on the force involved in the injury, as well as the cause. The greater the force or the larger the object involved, the bigger the contusion.

A contusion also may not be visible immediately; it may take time to develop. It also may not appear directly at the site of the injury, since gravity can send the leaking blood to the lowest portion of your limb; hence, trauma to the knee may result in a contusion near the ankle.

Bruises add a bit of colour to our complexions, albeit not the most attractive sort. The contusion will also change colour over time. Initially, a bruise usually looks red in colour due to the new blood leaking into your tissues. It contains both oxygen and hemoglobin, a protein that is rich in iron.

Shortly afterward, the blood loses its oxygen and your contusion turns a blue or purple colour. As the red blood cells break down, they leak hemoglobin and iron, often turning the contusion a darker purple or a black colour.

Since a contusion doesn’t usually involve muscle tears, you may be able to ignore it and continue on with work or a sporting activity. However, the area may be tender and there may be some swelling and soreness to the touch. Contusions do have an impact upon muscle function, so your range of motion in the area may be limited.

When it comes to how to treat a contusion you’ll want to adopt the PRICE protocol in the first 72 hours following an injury that causes a contusion. PRICE is an acronym standing for protect, rest, ice, compress and elevate and is useful in controlling bleeding, pain and swelling. If the injury occurs during a sporting contest, stop playing immediately to prevent further damage.

The term, rest, is a relative one. You shouldn’t keep the area immobilized – it’s important to get it moving – but you should do so gently without exerting undue force.

Icing should be done on and off for 15 to 20 minutes at a time. The cold reduces pain while preventing additional tissue damage. Be sure to wrap your ice or cold pack in a towel to prevent damage to the skin.

Using a compression bandage can also assist in keeping swelling down and improving circulation, although it is important not to bind the contusion too tightly.

Elevation is also useful for 10 to 20 minutes at a time; it helps to reduce swelling and promote circulation and healing.

Once you get past the 72-hour mark, you’ll want to begin promoting movement and improving the function of your injured muscle. A physiotherapist can be very helpful at this stage in prescribing exercises that increase strength and pain-free range of motion.

These movements will help increase circulation and healing, clear the area of cellular debris and prevent the buildup of scar tissue. A physiotherapist may also employ hands-on techniques to speed recovery, such as massage, or electric modalities, such as ultrasound.

You can expect a contusion to heal in about two to three weeks, depending on the severity of the injury. As you begin to heal, your physiotherapist will eventually introduce resistance exercises and sport-specific exercises that ready you for a return to sport, if that is your goal.

Most contusions are straightforward and heal as expected over time. However, in rare cases, there may be complications, especially with more severe contusions. You’ll want to consult with a physician if these develop.

Your contusion may develop a hematoma, or a blood clot, which feels like a hard lump in your muscle that is evident fairly early on in the recovery process. Generally, it is absorbed back into the tissue.

Once in a while, a contusion leads to deep vein thrombosis, a blood clot that forms deep in the veins. It is a very serious condition, because there is always a risk of a piece of the clot breaking off and travelling to the lungs.

You can help prevent such clots from forming by ensuring that you begin moving the affected area of the body early, regularly and gently.

Luckily, complications are, as noted, rare, and you should be healed and raring to go in a matter of weeks.