Clinic: Bruising and haematomas

Dr Kim

I've got a haematoma on my leg from falling off and catching my leg on the saddle. It's kinda painful when it gets pressure put on. My doc says not to be surprised if it's still there in a few months... is there anything I can do to make the swelling go away more quickly? Ta very much! Masky

Masky,

From the way you describe the injury, I'm guessing you have a thigh haematoma. Thigh haematomas are common in sport, particularly in contact sports or sports like MTBing where contact with large inanimate natural objects at speed is occasionally inevitable!

A haematoma is a localised collection of blood, as a result of direct trauma to the small blood vessels supplying the area you hit with your saddle. Thigh haematomas occur because the quadriceps muscle is crushed against the femur (thigh bone) on impact.

Haematomas are painful due to (1) damage to the soft tissues and/or muscle as a result of the trauma and (2) the increased pressure caused by having an accumulation of blood in a relatively small area. Haematomas can occur on the sheaths covering muscles or within muscles.

Haematomas can be classified as mild, moderate or severe according to the amount of bruising, swelling, pain and range of movement. The table shows the classification, so you can work out where you sit on the scale.

Unfortunately, the time for immediate care has passed. But for future reference, as with almost all sporting injuries, you can minimise further swelling and inflammation with the application of the well-known R.I.C.E protocol - Rest, Ice, Compression, and Elevation. You should also avoid H.A.R.M - Heat, Alcohol, Running, Massage, as these factors can lead to increased inflammation and bleeding in the injured area.

After this time, you can progress to gentle, gradual pain free stretching of the muscle to help restore the full range of movement. Aggressive forceful stretching should not be used!

The use of non-steroidal anti-inflammatories, such as ibuprofen, provides pain relief and helps reduce inflammation. You can use ibuprofen for 2 to 6 weeks according to the severity of the injury, although you should check with your GP that there is not a reason for you to avoid taking this sort of medication regularly for this period of time.

In the medium term, mild haematomas can be treated with soft tissue massage and stretching, whereas moderate and severe haematomas may benefit from treatment under a physiotherapist.

And in the long term, almost all sportspeople who sustain a haematoma will return to their previous level of sports activity and performance. As a rough guide, you can expect to take a minimum of 2 to 3 weeks, 4 to 6 weeks, or 8 weeks for mild, moderate, and severe haematomas respectively. Occasionally, severe haematomas can lead to a condition called myositis ossificans - in which the healing haematoma forms small bone fragments within layers of the effected muscle. This usually occurs 6 to 7 weeks after the injury and requires more intensive rehabilitation.

Top Tips:

• 1. R.I.C.E - Rest, Ice, Compression, Elevation in the 1st 48hrs
• 2. Avoid H.A.R.M. - Heat, Alcohol, Running, Massage
• 3. Gentle stretching
• 4. Regular anti-inflammatories can be useful for pain relief
• 5. Check out the table to work out how long you need to expect to recover

As a final note, if in the future you find you have recurrent episodes of bruising related to only mild trauma, rather than crashing and burning, then you should see your GP as a small percentage of people have a condition (such as Von Willebrand's) that causes them to bleed more easily.

Table: Severity of Thigh Haematomas

Mild - Average Recovery Time 2-3 weeks

• May be able to continue playing or competing,
• Sore after cooling down or the next day.
• Tender to touch.
• lightly reduced range of movement on stretching.

Moderate - Average Recovery 4-6 weeks (minimum)

• May prevent you from continuing to play or compete.
• Gradual stiffening and swelling.
• Pain.
• Tender to touch.
• May only be able to walk with a limp.
• Range of movement reduced by up to 50%.

Severe - Average Recovery 8 weeks (minimum)

• Rapid onset swelling.
• Obvious bruising.
• Very tender.
• Severe movement loss.
• Unable to walk on leg.

DISCLAIMER: Advice and information is provided via SheCycles.com Clinic on a free of charge basis as a supportive service to women in sport. It should not replace the use of your General Practitioner for medical problems.