Bruises & Contusions

What is a Bruise/Contusion?

A bruise and a contusion are both terms used to describe an injury to the soft tissues underneath the skin, where blood vessels are damaged, leading to localized bleeding and discoloration of the skin.

• Bruise: A bruise is a common term used to describe the skin discoloration that occurs due to small blood vessels (capillaries) being damaged or broken, causing blood to leak into the surrounding tissues. Initially, a bruise may appear red or purple, and over time, it may change colour to blue, green, yellow, and eventually fade away as the body reabsorbs the leaked blood.

• Contusion: A contusion is the medical term for a bruise. It is used interchangeably with the term "bruise" and refers to the same injury, where capillaries are damaged, leading to bleeding beneath the skin.

Sports injuries that can cause a contusion/bruise include: 

• Direct Impact: Contusions commonly occur in contact sports where athletes may experience direct blows or collisions with other players, equipment, or hard surfaces.

• Falls: Falling during sports activities, such as skateboarding, skiing, or snowboarding, can result in contusions due to the impact on specific body parts.

• Repetitive Actions: Certain sports involve repetitive motions that can lead to contusions over time. For example, long-distance runners may experience contusions on their feet due to the repetitive impact on hard surfaces.

• Overuse Injuries: In some cases, overuse of a particular muscle group can cause a contusion. This is more common in sports that require repetitive, forceful movements, such as tennis or golf.

• High grade muscle strains: when a majority of the muscle fibres in a muscle tear there is a chance that a small blood vessel also gets damaged and causes increased bleeding in the area. Also due to the injury in the initial stages of healing swelling must occur to promote regeneration, and with this increased swelling bruising can present.

How can physiotherapy help treat a contusion/bruise? 

Physiotherapy can play a crucial role in the management and rehabilitation of contusions. The primary goals of physiotherapy for contusions include reducing pain and swelling, promoting healing, restoring function, and preventing complications such as muscle stiffness or joint immobility. Here are some ways physiotherapy can help: 

• R.I.C.E. Protocol: In the initial stages of a contusion, physiotherapists may recommend the R.I.C.E. protocol - Rest, Ice, Compression, and Elevation - to reduce swelling and manage pain. 

• Therapeutic Modalities: Physiotherapists may use various therapeutic modalities such as ultrasound, electrical stimulation, and cold or heat therapy to aid in pain relief, improve blood circulation, and accelerate healing. 

• Massage and Manual Therapy: Gentle massage around the contusion area can promote blood flow, reduce swelling, and prevent the formation of scar tissue. Massage wouldn’t be applied directly over the contusion as it may cause more bruising.  

• Range of Motion Exercises: Once the acute phase has passed, the physiotherapist may prescribe specific exercises to improve joint range of motion and prevent stiffness. 

• Strengthening Exercises: Gradual strengthening exercises help restore muscle function and stability around the affected area. 

• Proprioception Training: Balance and proprioception exercises can be included to enhance joint stability and prevent future injuries. 

• Bracing and Taping: In some cases, taping or bracing the injured area can provide support and aid in the recovery process.

Physiotherapy Management of Bruises & Contusions

A contusion injury, commonly known as a bruise, occurs when small blood vessels near the surface of the skin rupture due to trauma. This trauma can be caused by a variety of things, such as a blow, impact, or sudden twisting of the body. The force of the impact causes blood to leak into the surrounding tissues, resulting in discoloration and swelling.

Grading of Contusion Injuries

Contusion injuries are typically graded based on their severity:

1. Grade 1: Mild contusion with minimal tissue damage and no significant loss of function.

2. Grade 2: Moderate contusion with more extensive tissue damage, leading to some loss of function and increased swelling.

3. Grade 3: Severe contusion with significant tissue damage, often accompanied by loss of function and severe swelling.

Stages of Healing

The healing process of a contusion injury typically follows several stages:

1. Immediate response (0-48 hours): Immediately after the injury, there is swelling and inflammation as the body's immune system responds to the trauma. This stage is characterized by pain, swelling, and redness around the affected area.

2. Subacute phase (2-21 days): In this phase, the body begins to repair the damaged tissues. New blood vessels form to bring in nutrients and oxygen, and white blood cells remove debris from the injury site. The bruise may change color as the body metabolizes the trapped blood.

3. Remodeling phase (3 weeks to several months): During this phase, the damaged tissues continue to heal and remodel. Collagen fibers are laid down to strengthen the injured area, and the bruise gradually fades as the trapped blood is reabsorbed by the body.

Physiotherapy for contusions/bruises

Physiotherapy treatment for contusion injuries aims to promote healing, reduce pain and swelling, restore range of motion, and prevent complications such as stiffness or muscle weakness. Treatment may include:

• Rest and protection: Initially, rest and immobilization may be necessary to prevent further injury and allow the body to heal.

• Ice therapy: Applying ice to the affected area can help reduce pain and swelling by constricting blood vessels.

• Compression: Using compression bandages or garments can help reduce swelling and provide support to the injured area.

• Elevation: Elevating the injured limb above the level of the heart can help reduce swelling by promoting drainage of excess fluid.

• Physiotherapy exercises: Once the acute phase has passed, gentle stretching and strengthening exercises can help restore mobility and function to the injured area.

• Modalities: Therapeutic modalities such as ultrasound, electrical stimulation, or massage may be used to promote healing and reduce pain.

It's important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan for a contusion injury.