If you've played contact Sports, inevitably you may have experienced a "charley horse". No one really knows the origins of this phrase or where it came from but it refers to a cramp, bruise or contusion to the thigh or quadriceps muscle. Some speculate that it came from a lame horse named Charley that pulled the roller to groom the baseball diamond for the Chicago White Sox in the 1890's, but this example does not refer to a thigh injury. Some say it refers to leg cramps or leg stiffness from "Charley's" who were police officers from England who suffered from leg pain from high-volume walking on the job. Others say it is from a baseball player who got a "leg cramp" or a leg injury in a baseball game whose name was Charley. In any event, a Charley Horse in this blog refers to a quad contusion or thigh injury. But what exactly is a quad contusion or Charley Horse? In this blog, I will review:
A quad contusion or “Charley horse” is the result of a deep bruise to the muscles of the thigh. Typically in a contact sport the thigh receives a severe blow or blunt force causing pain and injury to the quadriceps muscle. This contact results in bruising and injury within or outside the muscles of the thigh. This occurs frequently in sports like basketball where a player will receive a blow to the thigh from an opponent's knee. Other examples would be in soccer, rugby or football where players will make contact or tackle with an opponent resulting in a Charley Horse to the thigh. Keep in mind that contusions can happen to any part of the body, but have higher risks with areas that have deeper muscle compartments. Other common areas for contusions are the “hip pointer” contusion, in the upper arm a biceps contusion, or the calf muscle contusion in the lower leg.
Signs and Symptoms:
2. How should I care for my contusion ?
The initial management and treatment of a quad contusion is “PIER”. This is an acronym that stands for pressure, ice, elevation, and rest. It is very important to immediately apply ice to the affected area with pressure via a tensor bandage for at least 20 mins. Elevating the affected area and resting it above the heart is also indicated to encourage drainage of extra fluid away from the extremity to be re-absorbed by the body. Rest should be assumed with the muscle in a lengthened position, as shown in the picture below with the heel pulled close to the bum. Another alternative would be to lay on your stomach with the leg wrapped the same way.
The general rule of thumb for rest, is that if you cannot actively bend your knee past 90 degrees (pictured below) due to pain or tension, then you should not return to activity or back to the game. The reason for this is that the bruising signals to the body to start an inflammation process that will heal the area. This healing process means the muscle is in a vulnerable state, however, and has thus lost the ability to stretch and contract efficiently, as you would when partaking in a sport or activity. I'd like to address the misconception that you should just "run it off" as well. This will unfortunately cause more damage to the muscle and aggravate the contusion, and can lead to further risks which I will touch on later. In summary, light movements should be completed to maintain the current elasticity and blood flow to the muscle, to aid recovery. These movements should not be forcing the muscle to create a painful amount of contraction as you would doing exercise. It is common for a bruised muscle to naturally guard and spasm to protect itself from further tearing, which is something we cannot force past in a stretch, which is why any stretching done must be very gentle and pain-free.
If properly treated and managed a quad contusion will resolve within 2 to 4 weeks. However, within the first 3 days after an injury if it does not improve significantly with PIER, it may require further investigation and follow up with a Sports Medicine Physician, Sports Physiotherapist and/or Certified Athletic Therapist. It is important NOT to apply heat within those first 3 days as well. Only light massaging techniques can be done to assist with the removal of swelling, as it is not recommended to aggressively stretch, roll, or massage the muscle as it begins to heal. Any aggressive stretching/rolling/massaging in an attempt to relieve tension or pain may damage the tissue further, attract more blood to pool to the area, and will impede the healing process further. I will review later how these aggressive techniques can also increase other complications to arise as well.
3. How do I know if/when it is safe to return to activity?
Athletes should be fully weight bearing and be able to walk or run without a limp prior to returning to activity. If an athlete wants to return to play or practice, this should be done only after it is adequately protected through padding or adjustments to their equipment to prevent further injury.
If you have any other questions or seek more information on this type of injury, please see or consult your local sports medicine physician or Sports therapist professional.
4. Risks of further injury to look out for:
Proper management of a quad contusion injury will prevent a condition called myositis ossificans. This is when the muscle tissue turns to bone tissue due to the amount of blood pooling in a contained area. For example, if you have ever broken a bone, and the bone marrow inside leaks through the crack, which is what tells the body to turn to bone in order to heal together again. The same applies to a muscle with blood pooling from a contusion, if the pooling is large enough. This usually occurs from repeat contact to the same area, or from aggressive recovery techniques such as massage/rolling/stretching. If the contusion is not properly protected and is not acutely managed with PIER strategies, this may lead to myositis ossificans or a muscle contracture (abnormal shortening of the muscle).
Another complication of contusions is a condition called compartment syndrome. This usually occurs in the lower leg region, most commonly from trauma. What happens is the fluid that accumulates from the trauma inside a muscle compartment builds to the point that the compartment becomes full. This cuts off blood vessel and nerve supply. Usual signs include numbness and tingling in the toes, coldness in the leg and foot, and muscle weakness is a sign that pressure in the compartment is beginning to build. This can become an emergent situation due to risk of tissue death from lack of oxygen to the tissues.
Overall with proper care and evaluation, most contusions will resolve on their own over time. Complications can be easily avoided with rest and gentle recovery techniques. We have provided some videos below of examples of how to apply compression as part of the PIER method for recovery. Click the link below to view our youtube channel!
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