Sports Medicine
Sports Injury Prevention & Rehabilitation

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Quadriceps Contusion

(Also known as Corked Thigh, Quadriceps Bruise, Corky, Quadriceps Haematoma, Charley Horse, Dead Leg)
What is a quadriceps contusion?
The large muscle group at the front of your thigh is called the quadriceps. The quadriceps is responsible for straightening the knee during activity and has a rich blood supply. Following a direct impact to the quadriceps, damage to the muscle fibers, connective tissue and small blood vessels of the quadriceps may occur. This results in a 'bruise' to the quadriceps and is known as a quadriceps contusion.
Quadriceps contusions can range from minor contusions resulting in minimal pain and allowing ongoing activity, to severe contusions resulting in significant pain and loss of function.

Causes of a quadriceps contusion

Quadriceps contusions occur following a direct impact to the quadriceps muscle from an object or person. This most commonly occurs due to a collision with another player during contact sports such as football or rugby, or from an impact from a ball in sports such as hockey or baseball.

Signs and symptoms of a quadriceps contusion

Patients with a quadriceps contusion usually feel a sudden pain in the quadriceps muscle at the time of injury. In minor quadriceps contusions, pain may be minimal allowing continued activity. In more severe cases, patients may experience severe pain, muscle spasm, weakness and an inability to continue activity. Patients with a severe quadriceps contusion may also be unable to walk without a limp.
Patients with a quadriceps contusion usually experience pain during activities such as squatting, going up and down stairs, running, jumping, hopping, lunging or kicking. It is also common for patients to experience pain or stiffness after these activities with rest, especially upon waking in the morning. Swelling, tenderness and bruising may also be present in the quadriceps muscle, along with an inability to bend the knee as far as usual while keeping the hip straight.
In severe cases, a visible increase in size of the quadriceps muscle may be detected due to bleeding and swelling. In these cases patients may be unable to sleep due to pain. Occasionally the swelling and bruising may track down to the knee joint or lower leg.

Diagnosis of a quadriceps contusion
A thorough subjective and objective examination from a physical therapist is usually sufficient to diagnose a quadriceps contusion. Further investigations such as an MRI scan or Ultrasound may be required, in rare cases, to confirm diagnosis.

Treatment for a quadriceps contusion
Most patients with a quadriceps contusion heal well with appropriate physical therapy. The success rate of treatment is largely dictated by patient compliance. One of the key components is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. Activities which place large amounts of stress through the quadriceps should be minimized, these include: running, jumping, squatting, lunging, hopping and kicking. Rest from aggravating activities ensures the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms. Ignoring symptoms, or adopting a 'no pain, no gain' attitude is likely to lead to the problem becoming chronic and can lead to further complications (such as Myositis Ossificans).
Immediate, appropriate treatment in patients with a quadriceps contusion is essential to ensure a speedy recovery.
Diligently following RICE in the initial phase of injury (first 72 hours) will greatly assist in improving recovery time in patients with a quadriceps contusion. This involves rest from aggravating activities, regular icing, the use of a compression bandage, and keeping the injured leg elevated above the level of your heart. The use of crutches when walking may be necessary to protect the quadriceps muscle from further damage and to hasten the healing process. Care should be taken not to exercise or stretch into pain as this may lead to further bleeding. The use of heat, massage and the consumption of alcohol in the initial stages should also be avoided.
A graduated pain free flexibility and strength program guided by a physical therapist is essential to recondition the quadriceps muscle and reduce the likelihood of injury aggravation following a quadriceps contusion. A graduated return to running program is also required in the final stages of rehabilitation to recondition the quadriceps for running in a safe and effective manner.

Prognosis of a quadriceps contusion
With appropriate management, patients with minor quadriceps contusions can usually recover in one to three weeks. With larger contusions, recovery may take four to eight weeks or longer depending on the severity of injury. In rare cases, patients with a quadriceps contusion can sometimes develop myositis ossificans (i.e. bony growth in the contusion). This condition is more common in severe quadriceps contusions (especially those that are managed inappropriately) and may prolong recovery by weeks to months.

Physical therapy for a quadriceps contusion
Physical therapy for patients with a quadriceps contusion is vital to hasten the healing process and ensure an optimal outcome. Treatment may comprise:
  • soft tissue massage (after the initial 72 hour period)
  • electrotherapy (e.g. ultrasound)
  • joint mobilization
  • stretches
  • anti-inflammatory advice
  • the use of crutches
  • applying a compression bandage
  • the use of protective padding to the quadriceps to prevent re-injury
  • ice or heat treatment
  • exercises to improve strength and flexibility (particularly of the quadriceps)
  • education
  • activity modification advice
  • establishment of an appropriate return to activity or sport plan

Other intervention for a quadriceps contusion

Despite appropriate physical therapy management, some patients with a quadriceps contusion do not improve adequately. When this occurs, your treating physical therapist or doctor can advise on the best course of management. This may include investigations such as an Xray (to assess for myositis ossificans), ultrasound, CT scan or MRI, pharmaceutical intervention, or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition.