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Dead Leg (Quadriceps Contusion)
A dead leg or charley horse is a bruise or contusion caused by a sharp impact with a muscle which is usually crushed against the thigh bone resulting in swelling and sometimes bruising of the thigh muscles.
Symptoms of a thigh contusion
There will be pain at the time of injury and the athlete is likely to have restricted movement in the muscle. Swelling and later bruising may appear over time. Thigh contusions can range in severity from very mild which is hardly noticeable at the time to severe disabling injuries where the athlete is unable to walk. Like muscle strains, contusions are grade 1, 2 or 3 depending on the severity.
Thigh contusion explained
Although a dead leg or charlie horse can often seem a minor injury it is important the correct diagnosis is made. If you try to exercise on a bad intramuscular injury you can prevent healing or even cause permanent damage. If heat or massage is applied too early myositis Ossificans or bone forming within the muscle. Contusions are either intramuscular or intermuscular.
Intramuscular which is a tearing of the muscle within the sheath that surrounds it. This means that the initial bleeding may stop early within hours because of increased pressure within the muscle however the fluid is unable to escape as the muscle sheath prevents it. The result is considerable loss of function and pain which can take days or weeks to recover. You are not likely to see any bruising come out with this type - especially in the early stages.
Intermuscular which is a tearing of the muscle and part of the sheath surrounding it. This means that the initial bleeding will take longer to stop especially if you do not ice it. However recovery is often faster than intramuscular as the blood and fluids can flow away from the site of injury. You are more likely to see bruising come out with this one.
After two to three days check if the swelling has not gone then you probably have an intramuscular injury. If the bleeding has spread and caused bruising away from the site of the injury then you probably have an intermuscular injury. If you are more able to contract the muscle you probably have an intermuscular injury.
Classification of contusions
Grade 1 contusions will feel tightness in the thigh, the patient may walk with a limp. There is unlikely to be much swelling. Trying to straighten the knee against resistance probably won't produce much pain and the patient will still have nearly a full range of motion when stretching the muscle.
Grade 2 the patient is unlikely to be able to walk properly. There will be occasional sudden twinges of pain during activity, possible swelling and straightening the leg against resistance reproduces pain. Pressing in over the site of injury will be painful and the patient will be unable to fully bend the knee.
Grade 3 contusions mean the patient will be unable to walk with the aid of crutches. They will be in severe pain and significant swelling will appear immediately. Contracting the muscle may produce a visible bulge or gap in the muscle. Expect to be out of competition for 3 to twelve weeks.
Grade 1 treatment
Apply cold therapy and compression immediately. Use a compression bandage or heat retainer until you feel no pain. See a sports injury professional. Gentle quadriceps stretching exercises should begin as soon as pain allows after the first 24 hours.
Use sports massage techniques to speed up recovery once the acute phase has definitely passed. Using massage too soon can cause severe damage including Myositis Ossificans. Use of ultrasound and electrical stimulation may also be beneficial. Although the athlete is likely to be back to normal training within a few days it is a good idea to develop stretching and strengthening exercises to ensure there is no long term effect on performance.
Grade 2 treatment
Ice, compress, elevate, use crutches for 3 to 5 days. See a sports injury professional. A professional practitioner can use sports massage techniques to speed up recovery only after the acute phase when recommended by your physio. Electrotherapy and a full rehabilitation program is even more important for a grade 2 thigh contusion.
Grade 3 treatment
Apply R.I.C.E. (Rest, Ice, Compress, Elevate.) and seek medical attention immediately. Avoid walking and use crutches if necessary. Recovery time will be much longer and initially simply rest and applying cold therapy is the best form of treatment. Ice can be applied for 15 minutes every hour for the first 24 to 48 hours reducing frequency as symptoms improve.
After the acute phase a professional therapist can use sports massage techniques to speed up recovery but only in the later stages. Do not massage in the acute painful stage or this may cause severe damage including myositis ossificans. A full rehabilitation program is required to try and get the athlete back to competitive fitness. In particularly severe cases a surgeon may operate.
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