Muscle Contusion (Bruise)

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A muscle is surrounded by an outer sheath that allows it to move smoothly over the surrounding tissues as it contracts. Inside the outer sheath are bundles of muscle fibers known as fascicles, which are further made of myofibrils. These myofibrils are composed of millions of microscopic units called sarcomeres that are responsible for muscle contraction.

In the sarcomere, muscle proteins called myosins pull against thin ropes of a protein called actin when they are stimulated by nerves. When this occurs, the sarcomeres shorten, resulting in a contraction. When the myosin proteins relax, the sarcomeres lengthen back to their original position and so does the muscle. Overall, the combination of muscle contraction and relaxation is coordinated through the nervous system. This is what allows athletes to run, kick, throw, and even walk and breathe

A muscle contusion (also known as a bruised muscle) is a certain type of soft tissue injury. Muscle contusions are highly common whether in sports or occupational laborers. In fact, they are one of the most leading sports-related muscle injuries after strains. Bruises are normally minor and heal rapidly without requiring any complicated changes in your activity level. In rare cases, muscle contusions can become severe enough to cause deep tissue damage.

Recovery from a severe contusion may take several weeks prior to the damage made. Muscle contusions are often the result of a direct blow to the body. However, some patients bruise easily and may get bruises from relatively minor bumps or bangs. They may notice skin discoloration or have tenderness without even remembering an injury.

Causes & Symptoms

When a muscle contusion injury occurs, a portion of the muscle ruptures. This causes a disruption of the small blood vessels called capillaries and bleeding into the muscle tissue. At that point, the bleeding forms a grand collection of blood within and around the muscle tissue called a hematoma. After the injury, there is a gradual increase in inflammation over the next several days prior to the muscle contusion. As the muscle tissue begins to heal, many athletes report a formation of scar tissue. The early movement seems to help prevent scar formation. In addition, the amount of scar is very closely related to the severity of the initial injury, where more severe muscle tearing causes more significant scar formation.

The most common symptom of muscle contusion is pain. The pain is usually localized to the affected area. In addition to pain, symptoms that may be associated with a bruised muscle include:

  • Swelling
  • Skin discoloration
  • Pain that worsens in days following the contusion
  • Reduced range of motion
  • A knot in the affected area

Similar to muscle strains, muscle contusions are classified into three separate categories, such as the following:

  • Grade 1 muscle contusion – A grade 1 bruise is the least severe. It is the result of a minor rupture of the capillaries and is accompanied by mild pain, some swelling, and stiffness. There is normally very little loss of function as a result of a first-degree muscle contusion.
  • Grade 2 muscle contusion – A second graded muscle contusion is the result of a moderate rupture of the capillaries and increased bleeding. There is also increased swelling and pain associated with a second-degree bruise and a moderate loss of movement at the injury site.
  • Grade 3 muscle contusion – A grade 3 bruise is the most severe of the other two degrees. A third-degree muscle contusion is the result of a major rupture of the capillaries and will result in massive swelling, severe pain, and instability around the injury site.

Who gets a Muscle Contusion?

Playing sports and participating in other physical activities increases the risk of getting your muscle bruised. Here are other risk factors that increase the chances of muscle contusions:

  • Age – Adults older than the age of 50 are more susceptible to experiencing muscle contusions due to decreased muscle mass (osteoarthritis).
  • Health conditions – Having a bleeding disorder from liver disease, vitamin K deficiency, or a genetic disorder are all risk factors for a bruised muscle.
  • Weaker muscle – Many people tend to bruise very easily because of having weaker muscles. One person can withstand a direct blow with a minor bruise while the other has a much higher chance of a grade 2 muscle contusion due to weaker muscle.
  • Platelet disorder – Having a platelet disorder including fewer platelets or platelets that do not function properly are causes that can lead to muscle contusions.
  • Medications – Taking anticoagulant or antiplatelet drugs can increase your risk of getting your muscle bruised easier.

How Does it Affect You? How Serious is it?

Deep tissue damage from a severe muscle contusion can lead to complications without any medical treatment. Two of the most common complications include:


Compartment syndrome

In some cases, rapid bleeding may cause extremely painful swelling within the muscle group of your arm, leg, foot, or buttock. A build-up of pressure from fluids several hours after a contusion injury can disrupt blood flow and prevent nourishment from reaching the muscle group. Compartment syndrome may require immediate surgical treatment in order to quickly drain the excess fluids.

Myositis ossificans

Younger athletes who try to rehabilitate a severe contusion too rapidly can sometimes develop myositis ossificans. This is a serious condition in which the bruised muscle grows bone instead of new muscle cells. Symptoms may include mild to severe pain that does not go away and swelling at the injury site. Abnormal bone formations can also reduce your flexibility. In addition, performing vigorous stretching exercises can make the condition much worse.

Recommended Treatment & Rehabilitation

During a diagnosis of muscle contusions, your doctor will begin by asking questions about what type of activity triggered your bruised muscle and whether there were other certain symptoms in the muscle at the time of injury. The doctor will then ask about the symptoms, especially any decrease in muscle strength or any difficulty moving. Afterward, he or she will want to know whether you have had a recent fever, weight loss, leg numbness, urinary or bladder problems, or other symptoms that may point to a more severe medical problem.

After noting your symptoms and past medical history, your doctor will examine you, checking for muscle tenderness, spasms, weakness, and decreased muscle movement. If this exam points to a mild or moderate muscle contusion, you may not need any additional testing. However, if the diagnosis suspects a muscle contusion, X-rays or magnetic resonance imaging (MRI) scans may be useful to rule out the condition. If you have back pain, your doctor may order additional tests to check for a urinary tract infection or a problem involving the vertebrae (or backbones), vertebral disks, spinal canal, or spinal cord.

After finishing a diagnosis of muscle strains, a physiotherapist will be able to work with you to develop a specific treatment plan to achieve your recovery goals. These treatment plans may include:

  • Patient education – Your physiotherapist will work with you to help identify and change any external factors causing your pain. The type and amount of exercises you perform, your athletic activities, or your footwear may be discussed. Next, your physiotherapist will recommend improvements to your daily activities and design a personalized exercise program to help ensure a pain-free return to your desired activity level.
  • Range-of-motion exercises – Your muscle contusion may be causing increased tension in your muscle. Your physiotherapist may teach you range-of-motion techniques to restore normal motion in your muscles.
  • Pain management – Your physiotherapist will develop a treatment plan to address ice to the affected area. They may use ultrasound, electrical stimulation, and/or other methods to help control your pain. Your physiotherapist may recommend decreasing some activities that cause pain.
  • Manual therapy – Your physiotherapist may provide hands-on treatments to gently move your muscles and joints. These techniques help improve motion and strength. They often address areas that are difficult to treat on your own.
  • Functional training – Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities. To reduce pain in your muscle, you will need to learn safe, controlled movements. Therefore, your physiotherapist will create a series of activities based on your unique condition to teach you how to move correctly and safely.
  • Muscle-strengthening – Muscle weaknesses or imbalances can contribute to muscle strain. They can also be a result of your injury. Based on your condition, your physiotherapist will design a safe muscle strengthening program for your muscle strain recovery.


Stretching is important for keeping muscles flexible and preventing further muscle contusions. The specific stretches will depend on the injured area. Therefore, here are some examples that you can try at home:

  • Hip flexor stretch – Lie flat on the back and pull the right knee to the chest. Hold it there for 10 to 15 seconds before straightening the leg out again. Repeat with the left leg, feeling a stretch in the upper thigh and hips.
  • Neck stretches – For a strained neck muscle, lean the head forward to try to touch the chin to the chest. Next, lean the head first to the left and then to the right, trying to touch the ear to the shoulder.
  • Hamstring stretch – Stand with the feet hip-width apart, and bend at the waist to lean forward. There should be a mild stretch along the back of the legs.

Alternative & Homeopathic Treatment

Most muscle contusions can be successfully treated homeopathically. The following treatments include:

  • Massage – Therapeutic massage helps loosen tight muscles and increases blood flow to help heal damaged tissues. Applying pressure to the injured muscle tissue also helps remove excess fluid and cellular waste products. Studies have shown that performing a massage immediately following an injury may even speed bruised muscle healing.
  • Pain medication – You can relieve pain with over-the-counter medications like aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), which may also help reduce swelling.
  • Rest – Avoid using your muscle for a few days, especially if movement causes an increase in pain. However, too much rest can cause muscles to become weak.
  • Cold therapy – When you experience a contusion in a muscle, the fibers in the tissue are damaged. This may cause immediate pain, inflammation in the muscle tissue, and swelling in the affected area. You can help combat these symptoms by applying a cold pack to the injury. Continue applying cold several times a day for 20 to 30 minutes at a time. You can try to use gel packs, cold therapy systems, or have cold-water baths for a rapid recovery.
  • Heat therapy – Heat therapy may help relieve pain after the initial swelling has subsided. You can apply therapeutic heat with electric hot pads, warm baths or hot tubs, hot cloths, and hot water bottles. Heat also increases blood flow, which may promote healing. You can alternate hot and cold therapy to help reduce the pain and swelling caused by a muscle contusion.
  • Compression – Compression helps reduce swelling inflammation, which may intensify pain and slow healing. You can use static compression with an elastic bandage to apply consistent pressure and help prevent additional swelling.

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