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.
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.
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.
Regardless of how bad the injury is the PRICE principles of protection, rest, ice, compression and elevation should be applied as soon as possible. Apply a cold therapy and compression wrap immediately. Ice can be applied every two hours for 10 minutes for the first 72 hours for more severe contusions. This will help stop any internal bleeding and reduce pain and swelling. Wear a compression bandage or thigh support to protect the injury and help reduce swelling. Elevating the limb allows swelling and tissue fluids to drain away from the area.
A professional therapist can apply 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.
Read more on treatment and rehabilitation.
Gentle quadriceps stretching exercises should begin as soon as pain allows after the first 24 hours. The emphasis should be on rest and healing rather than attempting to exercise to soon. However, once exercises can safely be done pain free it is important to restore the muscle to its full mobility and strength. Exercises to develop strength include squats, lunges and leg extension machines. Start with very light weights and build up reps before attempting heavier sets.
Read more on exercises.