Being a sports therapist I see a lot of bruises and they come in many unique shapes and sizes. You get the weird looks but most athletes tend to see them as a sign of achievement and that you’ve earned them – I do anyway!

Each one has its own spectacular story from the dreaded wheel in roller derby to studs in football. However they can be serious and when it comes to dealing with them there tends to be some confusion.

Being a roller derby player and practitioner I get a lot of people asking me about bruises, so I thought I would help clear some things up – hopefully it stops the questions!

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What is a bruise?

A bruise is a general term used when areas are damaged causing blood to leak out into surrounding tissues. The blood gets trapped underneath the skin which leads to the formation of a bruise.
There are many different terms used which is what tends to muddy the waters. They can also commonly be referred to as a contusion or Haematoma.

Contusions are the common form caused by blunt-force trauma. If the blood vessels become damaged under the skin a contusion appears. It is typically identified by the lovely colour spectrum it displays through the healing process from red, black, blue, purple to yellow or green as the leaked blood breaks down and is reabsorbed by the body.

Haematomas often result from the same type of trauma however they tend to be a mass collection of blood pooled at the injury site and are accompanied by more severe pain and swelling. They can occur in any area or organ of the body and depending on the organ they can be life threatening.

How you get them

Sometimes in life everyone will have had a bruise, if not what have you been doing?! They can result from impact, sprains, strains and surgery. No matter the mechanism some people can bruise more easily than others. This can be due to a person’s skin toughness, muscle and tissue health, medication and age. Age can be a major contributor, unfortunately as we get older our blood vessels tend to become more fragile.

Type of bruising

As well as the different names there are also different types of bruising just to make it more complicated, they are:
• Subcutaneous – just beneath the skin
• Intramuscular – in the underlying muscles
• Periosteal – on bones

They can appear anywhere on the body – literally! I commonly display beautiful shades of colour on my hips. Everyone’s bruising is different with a range of shapes and sizes with some areas bleeding more than others such as veins, arteries, soft tissues rather than firmer tissues.

Bone bruising is particularly painful as it causes fibres of the bone to become damaged, if enough is damaged this can lead to a fracture. If you are worried about bone bruising, please get it checked out.bruise

Conditions

You may have also heard of some of the common conditions such as acute compartment syndrome, hip pointer or the weirdly named charley horse.

Acute compartment syndrome happens when the muscles in a confined space get too big for the sheath that surrounds it – usually due to impact. The increase in pressure can restrict blood flow leading to pain and decreased nerve sensation.

A hip pointer occurs following an impact to the outside of your hip – unsurprisingly. The impact causes a contusion and sometimes an avulsion fracture if serious enough. As well as bleeding, swelling can make the joint very painful and restrict movement. Bit of advice, try not to fall on your hips or get them covered.

A charley horse is usually the result of the muscles in your thigh being crushed against your bone. You will probably hear most people shouting ‘dead leg’ whilst resembling some form of walking or dance. Although it can seem pretty minor, if not diagnosed and treated correctly it can cause permanent damage – we’ll talk about this later.

Grading/severity

So now you know what bruising is and the types, let’s discuss timescales and severity.
Bruises can usually heal anytime from a number of days to weeks. It’s also dependent on the area, treatment, complications and severity.Besides the aesthetics and pain, bruising can affect your mobility with some people even needing crutches – please take them seriously

Bruising can be classified into various grades:
• Mild – Little pain and no swelling. Movement is normal, if not almost.
• Moderate – Mild pain and a little swelling. Movement can be restricted with a possible limp.
• Severe – Very painful and noticeable swelling. Can be significant loss of movement causing an obvious limp.

It’s also important to note that they don’t always show up at the site of injury – good old gravity not only drags us down but our bruises too! So be careful, if you think there is an associated injury or the bruising is unexplained please get it checked out.

Treatment

If you don’t already know I’m afraid to tell you that in sports it’s inevitable you will get a bruise at some point and it can really hurt. It’s an old cliché but the best form of treatment is prevention so protect yourself! If you are particularly prone to being knocked over or your legs tend to appeal to the end of someone’s boots or studs I would highly recommend investing in some impact shorts and shin guards – save yourself the pain.

If you do find that you are unable to prevent them there are a range of treatments you can try.
In the initial stages most people will implement the RICE protocol especially if there is associated pain and swelling.

After initial icing (2-3 days) I personally like to start contrast bathing, alternating between ice and heat to contract and relax the blood vessels which essentially creates a pump to move the fluid. When starting to contrast bathe I would recommend starting cold dominant such as 4 mins cold, 1 min hot alternating for 15-20mins and as you improve change the ratio working towards heat dominant.

I also find that Kinesio tape and massage work well to try and drain the fluid. In particularly I have been having great success with Kinesio and most of my teammates now tend to use it for bruising.

There are also a range of ointments on the market which I know people use, however I personally don’t use them so it would be wrong of me to comment on the effectiveness. Alongside these treatments when pain allows it is also helpful to introduce mobility exercises and stretching.

Complications

You remember when I was talking about bruising causing permanent damage earlier right? As well as compartment syndrome which has already been mentioned, if not treated properly it can also lead to a lovely bit of bone forming in your muscles called myositis ossificans. Doesn’t sound very nice does it?! This calcium formation can lead to increased pain, impaired movement and can be difficult to get rid of, so treat bruises properly!

I hope this has helped clear up some of the questions surrounding bruising. Just remember to take them seriously, they are not just simply a bruise. Treat them with respect.

If you do have any questions or experiences you would like to share please feel free to comment.

Amy

Physio Blog - by Amy Brown

As well as skating for Newcastle Roller Girls, Amy is also a sports therapist and has a keen interest in most sports. She has worked in various settings including professional football, women’s premiership rugby, 2012 Olympics and superleague netball. Having undertaken a range of postgraduate training, Amy is also a Kinesio taping practitioner and member of the Society of Sports Therapists.

Alongside providing injury prevention, treatment and rehabilitation within sport she also works in private clinics treating both athletes and the general public.

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