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How to handle contusions

How to handle contusions

 
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Summary
How contusions develop in the following days and which are the best remedies to take care of them?Some advices of the physiotherapist
 

Contusions can easily affect the muscle tissue, mainly in those sports where physical contact is expected. In football are quite common those that involve the front and the lateral parts of the thigh.

In case of a contusion, there is a crushing or a compression of a muscle by an opponent or another hard surface. It is a little bit more uncommon, but not impossible, that a very violent contusion can result in a damage of muscle fiber. If the damaging strength is applied to a tense muscle, the damage will mainly involve the more superficial fibers, whereas if you apply a very violent force to a loose muscle, it is the deeper fibers that are damaged, because they will be vigorously compressed against the underneath bone tissue.

Contusions always results in a more or less voluminous bleeding, that however is not necessarily visible in the form of a hematoma. 
 
contrasto aereo contusione
It is very easy to go through a blunt-force trauma in air duels
 

HOW DO THEY EVOLVE DURING THE FOLLOWING DAYS?

Generally, except under extreme circumstances, contact does not prevent the player from continuing the match and he clearly feels the pain only after the triple whistle or when who suffers the hit stops. At the beginning, the functional limitation given by the pain is quite modest, but it often accentuate the following day. A hematoma can sometimes form after a direct injury (see picture on the left).

In a normal contusion pain and functional restriction decrease as the days passed.

Usually, they spontaneously solve without any sequence, even if there can be some complications. 
 

ematoma contusione botta

WHAT TO DO?

Also in this case, the acute treatment can be summed up with the acronym R.I.C.E, that is rest, ice, compression and elevation. These simple actions reduce the expansion of the bleeding and simplify the resorption of blood, helping the healing process. In case of a contusion, heat applications, alcohol consumption, physical exercise (if painful) and energetic deep massage are contraindicated.

In case the athlete cannot run the days after the injury, it is good to avoid him training with the team, suggesting him to use an exercise bike or to try to move through water.

Reassure the athlete, because even if the injury is painful, it is not serious.

 

COMPLICATIONS

As already seen, from an anatomic point of view muscles and neurovascular structures of the lower limb are organized in cavities or compartments. If after a very violent impact there is an abrupt increase in the volume of a cavity due to an important hematic loss, there will be a quick increase in the compartment pressure.

This situation is called compartment syndrome and it manifests itself with a sharp pain followed by swelling and insufficiency in sensitivity, and sometimes also temperature and systemic symptoms of discomfort.

The compartment syndrome can be diagnosed by a doctor, who has to measure the pressure intracompartment and to detect a value that should be at least 20 mmHg to be sure there is sign of this syndrome.

If these symptoms appear, it is good to immediately send the player to the first aid, because very elevated pressures for long period of time can cause irreparable damage to the muscle tissue.

The treatment of this injury does not depend on its location. In many cases the solution is surgical, however lately they are trying to deal with the compartment syndrome of the anterior tight in a conservative manner. Outcomes are good if they treat it with pain-free and low intensity exercises, but recovery time is still very long. 
 
trattamento fisioterapico dolori contusioni
Measuring comparmental pressure – the diagnostic process should be conducted by a doctor, who will also decide the right treatment.
 

PRINCIPLES OF PHYSIOTHERAPY TREATMENT

As already stated above, the treatment of a simple contusion is rather linear. During the first 48h the bruised part shall be protected and you have to employ ice, a pressure bandage and the player should rest for a few days, keeping the limb high when possible. In this period it is useful to avoid massaging that area in a vigorous way, however some educated therapists could perform a drainage massage to speed up the resorption process of the hematoma and to relieve the pain.

If the player finds it difficult to run, strict rest shall not be advised, but a load that allows him to keep fit without disturbing the area involved in the injury.

Usually recovery time is very short and only rarely lasts more than a week, if the course is with no complications. 
 
 
Bertolacci, player of AC Milan, shows the acute treatment of a muscle contusion: compression massage and elevation. These two items always go hand in hand with ice packs and an optimal load, therefore pain-free.

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