Managing contusions common in contact sport

A contusion of the ankle is a blunt, compressive injury to the ankle or foot that does not involve a break in the skin. Contusions cause damage to the skin and underlying soft tissue. Blood seeps out of damaged small blood vessels and collects in the surrounding tissue, forming black-and-blue marks beneath the skin.

After injury, gravity may pull blood downward so the discolouring may extend some distance from the contusion area. Over a period of days, the black and blue marks beneath the skin will change to green and yellow and eventually fade. The affected area may become swollen and painful. A direct blow from a blunt object is the most common cause of limb contusion.

This injury is classified as mild, moderate, or severe. If the contusion is superficial, it involves only the skin and tissue immediately below the skin. If deep, the muscle and bone may also be involved. Blood can accumulate and form a hematoma within the muscle, initiating an inflammatory response that can result in swelling and further tissue injury.

Contusions of the thigh are common injuries sustained by sportspersons (e.g., football, soccer and field hockey players). The knee is highly prone to contusions. The lower leg is prone to contusions because it is often exposed to direct blows, which can include running into or tripping over a piece of furniture or other obstacle. Contusions directly over the shinbone are more likely to be severe because there is little room for swelling in this part of the leg.

Ankle contusions are common but not usually serious. Contusions of the foot may be caused from a direct blow to the foot.  The individual with a knee contusion may complain of restricted movement of the knee. Cuts are commonly associated with knee contusions. This injury is diagnosed by physical appearance on examination. Tests are usually not needed for this diagnosis. With severe contusions, plain x-rays may be taken to rule out bone fracture.

Mild contusions do not need medical attention. Ice should be applied to the injury within the first 24 to 48 hours. Elevating the affected limb also helps to relieve discomfort. The affected limb should be rested for a few days. A compression bandage may help reduce swelling during the first two to three days.

After 24 to 48 hours, application of heat (e.g., hot packs, hot showers, heating pads, and hot whirlpool bath) may help speed reabsorption of the blood by increasing circulation to the injured area. Heat liniments and ointments work in a similar action by causing local vasodilatation.

Therapeutic ultrasound by a physiotherapist is often used to promote tissue repair by increasing the number of new tissue cells and encouraging protein synthesis involved in healing. Most contusions resolve without disability. Healing times vary with the severity of the injury.

The writer is a physiotherapits at Kenyan Premier League side Mathare United

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