A thigh contusion, also known as a dead leg or charley horse, occurs due to direct trauma or impact to the muscle, crushing it against the bone. A contusion differs from a thigh strain, which involves a tear in one of the quadriceps muscles.
Medically reviewed by Dr Chaminda Goonetilleke, 14th Feb. 2022
Symptoms of a thigh contusion
Experiencing pain when the injury occurs, restricted movement, difficulty running or walking, rapid swelling, and potential bruising signify a thigh strain.
Severity Grades:
- Grade 1: Characterized by thigh muscle tightness, possible limp, minimal swelling, and near-full range of motion.
- Grade 2: Walking difficulty, occasional sudden pain, potential swelling, pain when straightening the knee against resistance, and tenderness at the injury site.
- Grade 3: Inability to walk without crutches, severe pain, immediate significant swelling, and a visible bulge or gap in the thigh muscle when contracted. The recovery period typically ranges between 3 to 12 weeks.
Proper diagnosis and treatment are essential.
Causes & anatomy
Direct impact or trauma to the muscle causes a thigh contusion by crushing the muscle against the underlying bone and triggering internal bleeding within the muscle.
Bundles of muscle fibres make up skeletal muscles, each protected by a sheath called the Epimysium.
Depending on the bleeding’s location—whether it stays within the muscle sheath or expands beyond due to sheath damage—contusions receive classification as either intramuscular or intermuscular.
Intramuscular hematoma
When a thigh contusion results in an intramuscular hematoma, it means there’s bleeding within the muscle enclosed by a sheath. This condition leads to an early halt in bleeding, usually within hours, because of the raised pressure within the muscle.
The muscle sheath’s containment of the fluid makes bruising less likely. As a result, pain and significant loss of function may endure for several days or weeks until recovery occurs.
Intermuscular hematoma
An intermuscular hematoma occurs when both the muscle and part of the surrounding sheath sustain damage. This injury could cause prolonged initial bleeding, especially without ice treatment. Yet, compared to intramuscular hematomas, recovery often progresses faster because blood and fluids can move away from the injury, possibly causing visible bruising.
Persistent swelling after two to three days likely signifies an intramuscular injury, where bleeding stays within the muscle. If bruising expands beyond the injury site, it likely suggests an intermuscular injury, which may come with improved muscle function and movement.
Treatment for thigh contusions
Apply the PRICE principle (protection, rest, ice, compression & elevation) immediately after injury:
Cold therapy: Apply ice and compression every two hours for 10 minutes in the first 72 hours. Wrap ice in a wet tea towel or use a cold therapy wrap. Avoid applying ice directly to the skin to prevent ice burns.
Rest: Rest for at least 24 to 48 hours, longer for more severe injuries.
Thigh supports: Use a compression bandage or thigh support during the acute stage. Later, consider a neoprene heat retainer for support and improved blood flow.
Elevation: Elevate the limb to aid drainage and reduce swelling.
Heat: Apply heat from day four onwards using a hot water bottle, heat pack, or hot bath. Seek professional guidance for ultrasound treatment.
Massage: Only perform massage once the acute phase has passed, as heat treatment and massage can worsen muscle damage in the acute stage.
