Contusion of the Lower Leg (Shin & Calf)

A calf contusion is caused by a direct impact or trauma to a muscle and can range from mild to severe.

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Symptoms of a calf contusion

Symptoms of a Calf contusion include:

• Instant pain following a direct blow or impact.
• Pain may vary in severity from a niggle to severe, disabling pain.
• For a bad contusion, you will have loss of function and be unable to walk or run properly.
• The area will be tender to touch and you may have pain when stretching the muscles.
• Bruising may appear but this is not always the case. This will depend if the bleeding is contained within the muscle sheath or not.

What is a contusion?

A contusion is an injury to a muscle caused by direct impact or trauma.

This can be from a piece of equipment such as a baseball or hockey stick, or from direct impact to an opponents knee in contact sports.

It is unlike a calf strain which occurs with no external contact.

The muscle gets crushed against the bone. This results in bleeding within the muscle. There are two types of muscle contusion.

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Intermuscular contusions

Muscles are made up of a bunches of muscle fibres which are surrounded by a muscle sheath.

If the muscle sheath (fascia) is also damage and bleeding can spread throughout the muscle then you are likely to see bruising develop. This is known as an Intermuscular contusion.

Intramuscular contusions

If the blood is contained within the sheath then it cannot disperse so easily. Although you are likely to have swelling and restricted movement, visible bruising will not occur.

Structure of skeletal muscle

Complications of calf contusions

If you fail to treat a contusion properly then it may develop into something far more serious.

Myositis ossificans

If you do not apply ice, fail to rest, or massage the calf muscles too soon, then you run the risk of Myositis ossificans. This is where bone growth occurs within the muscle and can be very difficult to treat.

Myositis ossificans occurs because the muscle is crushed against the bone. As a result, your body mistakenly sends new bone repair cells to the site of injury. If left, a small lump of bone can form within the calf muscle.

• More on Myositis ossificans

Treatment for a Calf contusion

As soon as possible apply the PRICE principles (rest, ice, compression, and elevation).

Cold therapy/ice

Apply ice or cold therapy as soon as physically possible after injury, and for 10 to 15 minutes every hour during the acute stage. This is usually the first 24 to 48 hours depending on how bad the injury is.

Ice should not be applied directly to the skin as ice burns can occur. Wrap it in a wet tea towel, or use a commercially available hot and cold wrap.

Compression

Wear a compression bandage or support. This will help reduce bleeding and swelling. Elevating the limb will help bruising and tissue fluids drain away from the site of injury.

Massage

Sports massage can be used, but only after the acute stage has passed to ensure bleeding has stopped). This is a minimum of 3 days. Massage can help relax the muscles and disperse waste products from surrounding tissues.

However, if massage is applied to a muscle too soon after a contusion then myositis ossificans may occur.

• More on Calf massage

Rehabilitation & exercises

When comfortable to do so, begin gentle stretching exercises for the calf muscles.

The length of time you need to wait before beginning strengthening exercises will depend on how severe your contusion is.

• Read more on Calf contusion rehabilitation

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