Rehabilitation program for a dead leg, charley horse or quadriceps contusion. A contusion is caused by a direct blow to the muscle and should be treated differently to a muscle strain.
Aims of rehabilitation
We recommend seeking professional advice before starting any rehabilitation program. The aim of rehabilitation of a thigh contusion is to control the initial pain and swelling, maintain and improve flexibility, restore muscle strength and gradually return to full fitness.
Reducing pain and swelling
Immediate first aid is to apply ice, compression and elevate the limb if possible. Cold therapy and compression can be applied for 10 to 15 minutes every hour for the first 24 to 48 hours depending on severity reducing frequency as symptoms reduce. Ice should not be applied directly to the skin but wrap in a wet tea towel or use a commercially available cold wrap to avoid ice burns.
Wear a compression bandage all the time to help reduce swelling and give support until pain has gone. Rest from activity. This may only be for a day or two for a grade one contusion but grade two contusion may require 3 to 5 days rest and a grade three a week or more.Use crutches if necessary. A grade 3 contusion may require use of crutches for a week.
It is very important to apply cold and compression to a contusion. Applying heat or deep massage in the acute stage may cause further injury or lead to myositis ossificans which is a bony growth within the muscle.
Improving mobility and flexibility
Gentle stretching if it is not painful - hold for 30 secs, repeat 5 times daily. This may be started after the initial acute stage - usually 48 hours. From day four (no earlier - and it may be longer in severe injuries) apply heat (hot water bottle, hot baths, see a specialist for ultrasound).
After the acute stage apply gentle sports massage techniques. For a grade two or three contusion, sports massage should be avoided until the acute stage is complete. Heat treatment and massage can cause serious muscle damage if performed on an acute contusion.
Restoring muscle strength
For a grade one contusion, strengthening exercises may be performed as soon as they can be done without pain. Start with the easier exercises on a daily basis and progress as soon as you feel comfortable onto the more difficult exercises which should be done three times a week.
For a grade two contusion, it may be a week before strengthening is possible and a grade three even longer. All strengthening sessions should start with a gentle warm up and stretch and finish with a good stretch. Strengthening should continue for weeks after you feel the injury has healed.
If the athlete is unable to continue with normal training, then swimming or cycling can be done instead, or if this is not possible work on the upper body strength. It is important to continue a training routine of some description.
Return to full fitness
This is a gradual process. For a grade one contusion normal training may be resumed with a few days. It is important to maintain a stretching and strengthening program alongside training to ensure full strengthening and mobility of the muscle.
Gentle jogging may be started and built up until the athlete can run comfortably for 40 minutes. Speedwork should be introduced gradually for example: 10 x 60m at 50% of top speed, next session might be 10 x 60m at 70% top speed and so on.
Example rehabilitation program
Below are examples of how the above fit into a rehabilitation program for a grade 1,2 and 3 contusion.
- Rest, Ice, Compress and Elevate (R.I.C.E.) immediately.Use a compression bandage or heat retainer until no pain is felt.
- Gentle quadriceps stretching - hold for 30 secs, repeat 5 times daily.
- Leg extension exercises - 4 sets of 10 repetitions 3 times a week.
- Gradually build up the weight to strengthen the quads.
- Ease down your training for a week or two but no need to stop unless there is pain.
- Ice, compress, elevate, use crutches for 3 to 5 days.
- From day three, pain free static quadriceps exercises (contract quads and hold for 10 secs in the sitting position).
- Improve mobility by bending and straightening the leg (as long as it is not painful).
- Apply heat (hot water bottle, hot baths, see a specialist for ultrasound).
- When pain allows do straight leg raises (4 sets of 10 reps 3 times a week)
- From day 7 do leg extensions (4 sets of 10 reps three times a week).
- Swimming 2 to 3 times a week.
- Cycling 2 to 3 times a week.
- Begin stretching (hold stretches for 30 secs, 5 times a day).
- From day 14 start to jog and slowly get back into your sports activities.
- Week 1: You should seek medical attention immediately. R.I.C.E. (Rest, Ice, Compress, Elevate.) Use crutches.
- Week 2: Pain free static contractions ( if it hurts don't do it). Heat with hot water bottle, hot bath or ultrasound. Straight leg raises if pain allows. Use no weight and do 4 sets of 10 reps every day.
- Week 3: All of the above plus straight leg raises with weights. 4 sets of 10 reps 3 times a week.
- Week 4: Pain free leg extension exercises, 4 sets of 10 reps 3 times a week. Swimming 2 or 3 times a week. Cycling 2 or 3 times a week. Start stretching exercises, hold for 30 secs, 5 times a day.
- Week 5: Start jogging. Start squats, 4 sets of 6 to 8 reps 2 days a week. Gradually build up to sports specific exercises.
Although a contusion may not appear to be a serious injury, the effects can be long lasting if rehabilitation is not taken seriously.