The leg extends from the top of the thigh down to the foot. However, the leg is usually referred to as the portion of the lower extremity from the knee to the ankle. The leg has two bones, which are the tibia and the fibula. Both are known as ‘long’ bones. The larger of the two is the tibia, typically called the shinbone. The fibula runs alongside the tibia. A wide range of conditions can affect the legs such as restless leg syndrome, edema, and dead leg.
The thighs contain some of the largest muscles in the human body – the thigh muscles allow the lower body to bend, flex, and rotate. They also bear most of your body’s weight and keep the hips and legs assigned, in addition to providing and assisting with enough balance. Thigh muscles can be grouped based on their function and location, such as:
- Hamstrings – The hamstrings allow you to extend your hip to move your leg behind your body, such as when you walk and put one leg behind you. They also let you flex your knee, for instance, when you are squatting.
- Adductors – Adductors allows you to bring the thighs toward each other, which is called adduction. They help you stay balanced, keep the legs and hips in alignment, and allow rotation through the hips and legs.
- Pectineus – The pectineus enables you to flex and rotate the thigh at the hip joint. It also helps stabilize the pelvis.
- Sartorius – This helps you flex and rotate the thigh from the hip joint. You use it when you cross your legs to rest one ankle on the opposite leg. Other examples include sitting cross-legged on the floor or bending and rotating your leg to look at the bottom of your foot.
- Quadriceps – The quadriceps allow you to flex your hip or extend the knee.
A dead leg (thigh contusion) is an injury to the soft tissue of the upper leg. The most commonly involved muscle is the quadriceps. The muscle contusion may be accompanied by bone contusion (bruise) or even a fracture (broken bone).
Causes & Symptoms
Dead leg contusions can be classified as mild, moderate, and severe. Mild injuries result in mild pain and swelling, but you are able to walk without a limp. You’re also able to bend your knee past 90 degrees and can contract the muscle without significant pain. A moderate muscle contusion results in an increase in bleeding into the muscle tissue and more damage to the actual muscle fibers. The signs and symptoms will be more pronounced including a noticeable limp, more bruising, and swelling, and an inability to flex the knee past 90 degrees without significant pain. With a severe dead leg, the bleeding may actually track down into the knee area and down into the lower leg creating extensive discoloration. Swelling may continue to increase over a 24-hour period resulting in stiffening of the thigh and knee as the effusion increases.
Athletes with severe dead leg may not be able to bend their knee past 45 degrees and may have significant difficulty walking. These athletes may be to be placed on crutches. Lastly, a palpable hematoma may be felt in an athlete with a severe dead leg. When the muscle is palpated, a firm mass may be felt (hematoma) with defined borders. This area will be very tender for an athlete so care should be taken when palpating a deep contusion.
Overall, symptoms associated with dead leg include:
- Pain at the time of injury.
- Difficulty walking.
- Rapid swelling.
- Bruising may or may not appear depending on the severity of the injury.
- Restricted movement and / or inability to run properly.
Who gets a Dead Leg?
A dead leg is most common in contact sports due to player-to-player contact as in the sports of football and basketball. Contusions can also occur in the thigh due to the direct impact of a sports implement as can be seen in sports such as softball, baseball, and lacrosse (including fastball).
Other risk factors linked to dead leg include:
- Age – As a person ages, they become more susceptible to developing a dead leg, thus leading to bruising. Bruises may also take longer to recover in older adults.
- Vitamin deficiencies – People who experience malnutrition could be deficient in vitamin C and may develop a dead leg. In severe cases, people deficient in vitamin K may also bruise more often. This is because their blood does not clot efficiently.
- Obesity – Being overweight or obese can increase the pressure on your thigh, causing intense pain.
How Does it Affect You? How Serious is it?
Severe deep thigh contusions that are left untreated may lead to a few complications, such as the following below:
Myositis ossificans (MO) occurs when bone or bone-like tissue grows where it’s not supposed to. It most commonly happens in your muscle after an injury (for instance, when you get hit hard in the thigh during a soccer game). This complication is typically caused by direct trauma to the muscle, like a knee to the thigh in rugby or landing hard on the ground in a bike accident. If you develop a large contusion and a pool of blood forms a lump over the injury, the bone may grow at the injury site.
Acute compartment syndrome
Acute compartment syndrome occurs when excessive pressure builds up inside an enclosed muscle space in the body. Compartment syndrome usually results from bleeding or swelling after an injury. The dangerously high pressure in compartment syndrome impedes the flow of blood to and from the affected tissues. It can be an emergency, requiring surgery to prevent permanent injury.
Recommended Treatment & Rehabilitation
During a diagnosis of a dead leg, a complete physical examination will determine the exact location and extent of the injury. Your doctor can tell you if they feel a gap within the muscle indicating a possible tear. X-rays of the femur (thigh bone), hip, and / or knee are often taken to rule a fracture or other conditions. Additional tests such as ultrasound, Computed Tomography (CT) scan, or Magnetic Resonance Imaging (MRI) may be required to determine the extent of the injury and to identify any additional injuries.
The results of the physical exam and other diagnostic tests will allow your doctor to determine how severe this injury is; therefore, physiotherapy may be done. Physiotherapy and exercise are typically first-line treatments for relieving, treating, and preventing dead leg symptoms. In treating thigh pain, physiotherapy may:
- Provide symptom relief.
- Promote healing of the underlying cause.
- Prevent recurrences and flare-ups.
A physiotherapist may prescribe a combination of various types of physical, manual, soft tissue mobilization, and / or exercise therapies in treating thigh pain linked to dead leg. Specific exercises depend on the underlying cause of your thigh pain, as well as other factors, such as the patient’s level of pain. The following physiotherapy treatments include:
- Gait training – This includes analysis of walking technique and retraining correct gait patterns. This technique may include video analysis.
- Active assisted range of motion – includes therapist-assisted movement of parts of the lower body, such as the hip and legs. This technique helps facilitate the movement of specific joints or muscles that cause pain.
- Soft tissue mobilization – A soft tissue mobilization will include your physiotherapist using his or her hands or supporting equipment (such as a leg brace) to mobilize the tissues in the lower back, hips, or legs to treat fascia restrictions and decrease muscle tension or spasm.
- Muscle energy technique – is a form of manual therapy that involves the patient performing gentle muscle contractions in conjunction with your physiotherapist moving your painful joints through a specific range of motion. This technique may help reduce pain and restore function.
- Joint manipulation – This is a manual technique in which your therapist applies a quick, thrust force at the end range of motion of a joint to promote pain relief and restore normal movement.
- Nerve mobilization – involves active or passive techniques on a symptomatic nerve when it is placed into and out of tension to facilitate movement and reduce symptoms.
- Function retraining – This includes reintroducing movements, such as lifting, carrying, and bending or squatting. The use of proper technique and healthy movement patterns are incorporated to reduce pain and prevent re-injury.
Overall, what exercise is best for your thigh contusion will depend on where are experiencing pain. Here are some exercise examples for you to try:
Supine adductor stretch
Lie on your back with both knees bent and feet flat on the floor. Next, grab a stretch strap and place it around the ball of the foot of the leg you want to stretch. Straighten the knee toward the ceiling, adjusting the angle as needed if your hamstrings are too tight. Then, let the leg fall out toward the side toward the floor as far as possible, with the inner thigh facing up toward the ceiling. Hold for 30 seconds before repeating 2-3 times a day.
Side-lying hip adduction
Lie on your side with the leg you want to exercise on the bottom. Bend and rotate the top hip and knee so that you can place your foot flat on the ground in front of the knee of the thigh that is still touching the ground. Keep your hips stacked and knee straight as you tense up the inner thigh as you start to lift your lower leg straight up toward the ceiling. Hold for 2-3 seconds before repeating this method 2-3 times a day.
Lateral leg raise
Lie on your side with the hip you want to exercise on top. Bend the bottom knee and hip for stability so that you lift the top leg without wobbling. Keep the upper leg straight and in line with your trunk, then tighten your abs to promote hip stability as you lift the entire leg straight up toward the ceiling. Lift as high as is comfortable before returning to your starting position. Keep the knee and toes pointing straight forward and hip in neutral as you repeat this exercise 2-3 times a day.
Alternative & Homeopathic Treatment
The following below are some homeopathic treatments to help ease your symptoms and find relief on your own:
- Rest – If movement is painful in the early stages of dead leg, rest your legs and stay off them as much as you can until you are able to move without pain.
- Ice – Keep an ice pack on your legs for about 20 minutes every hour over the first 3 days after symptoms begin. Avoid using heat, as it may make swelling worse.
- Compression – Wrap an elastic bandage around your legs or wear compression stockings, which uses pressure to keep swelling down.
- Elevation – Keep your legs raised above the level of your heart for 30 minutes, 3 or 4 times a day, so that gravity can help move fluids out and toward the rest of your body.
- Non-steroidal anti-inflammatory drugs (NSAIDs) – Anti-inflammatory medications such as ibuprofen or naproxen may help ease swelling and pain.
- Turmeric – Turmeric is known to contain anti-inflammatory properties and can help boost your recovery naturally.