In technical terms, an injury that results from a direct blow to the thigh is called a thigh contusion, but it is also colloquially referred to as a dead leg or a “corkie”. It is the outer part of the muscle that is most often injured. Thigh contusions are amongst the most common acute thigh injuries across all contact sports.

Symptoms

The injured athlete will often describe a direct blow to the thigh. Many find that they get the injury during a game, but that it doesn’t become a problem until later once the muscle has cooled down after the match. Pain is the most common symptom, but swelling and limited range of motion can also occur. Sometimes it is also possible to feel a dip in the muscle.

Causes

All muscles are surrounded by a sheath, and the muscle and the sheath are collectively called a compartment. Recovery time will vary depending on if this sheath is injured or not.

Tearing of the sheath – intermuscular injury

Some of the muscle fibres will tear following a thigh contusion. This leads to internal bleeding. If the surrounding sheath is damaged, the blood can flow out and spread. This reduces the pressure in the thigh, which often leads to less pain and less movement limitation. This type of injury is known as an intermuscular injury and often result in discolouration and bruising.

Undamaged sheath – intramuscular injury

If the sheath around the compartment remains intact with injury, blood cannot flow out and spread. Pressure will then increase as the muscle swells inside its compartment. This is often more painful than if the sheath was injured. It also restricts movement to a greater extent. If there is increasing pain in the injured area it may need urgent medical attention to relieve the pressure in the compartment before muscle damage becomes permanent.

Diagnosis

A diagnosis is made based on the symptoms and the way in which the injury occurred. It is important to clarify the severity of the injury. This can be described as mild, moderate, or serious. In elite sport it is often possible to see video replays of injuries occurring to assess the mechanism of injury.

Treatment

The time it takes before the athlete can return to sport may vary from a few days to several weeks.

The first 24 hours from the time of injury is the most crucial period for treatment of a thigh contusion. Early treatment can make a big difference to the time to return to sport.

The athlete should immediately be removed from activity and treated according to the RICE principle (Rest, Ice, Compression, Elevation). Crutches might be helpful if putting weight on the leg causes pain.

Avoiding heat, massage and alcohol in the first 72 hours is important, as they will increase the bleeding in the muscle.

Treatment is divided into 4 stages:

1. Controlling the bleeding (the most important element)
2. Building up full, painless range of motion
3. Functional rehabilitation
4. Gradually returning to sport

Keeping the thigh in a position with the knee bent as much as possible without causing pain can be an effective method to limit bleeding. A compression bandage can be applied to bind the thigh and lower leg together, keeping the knee in a fixed position.

Pain killers can be effective in the first few days, but anti-inflammatories (NSAIDs) such as Nurofen, Voltaren and Naprosyn should be avoided for the first 24 hours. The reason for this is that they can have a blood thinning effect that can increase the amount of bleeding, resulting in more pain and further decreased range of motion.

Following a short period of immobilisation, the athlete should begin with gentle mobilisation exercises. For example, cycling (pain-free) using an exercise bike. After this, the athlete should begin with active mobility exercises and gradual strength training.

Skilled physiotherapists can assist with sport-specific rehabilitation at this point.  Luke Blunden, Peta Johnston and Simon Lewis are all highly experienced clinicians who can direct your return to sport.

Return to sport

The prognosis following a thigh contusion injury is good. With intermuscular injuries, most athletes will be able to return to sport within a few days, but if the injury is severe it might take up to 2-3 weeks. The time for a return to sport is longer with intramuscular injuries, but very few athletes will develop any long lasting problems.

References: https://fittoplay.org/sports/football/