“I have what? Myositis ossificans”? I thought it was just a bruise.

I am sure all of you have suffered a whack to your thigh while playing soccer. If you haven’t you probably didn’t compete hard enough or couldn’t tackle a ham sandwich. Needless to say, most soccer players have received a hit to the thigh muscle. The majority of times you can continue to play and sometimes the pain is so great that you need to come off the park. The catch in the scenario is that if it is not looked after properly it can become a serious problem and possibly cause permanent disability.

The hit into the thigh usually occurs on the large muscle called the quadriceps. The quadriceps is the largest group of muscles in the body and they have a very large blood supply. (That is why one can die from a fractured femur, the large bone in the thigh, if the blood loss is too great). The impact on the muscle causes damage to the blood vessels, muscle fibers and the connective tissue surrounding the thigh.

Some people describe the injury like a ‘dead leg’. Others say they have suffered a ‘charley-horse’. The medically correct say you have suffered a muscle contusion. The range of disability is from not having any affect on the player whatsoever to being totally disabled and not being able to move the knee (since the quadriceps main job is to straighten the knee).

In very severe cases, especially when the injury is not managed correctly the tissue regenerates as bone instead of muscle. The end result is that there is a bone mass in the muscle belly. The bone mass can be as small as a dime or as large as a CD. It is usually palpable and very painful. The range of motion of the knee becomes very limited and movement is restricted. The bone mass is occasionally reabsorbed, but many times the athlete is left with a small remnant in the muscle belly.

WHY DOES THE ABNORMALITY OCCUR?

The answer is: no one really knows. However, many factors come into play and most medical practitioners believe that a combination of the following contribute to the problem:

  • Contusions that are severe
  • Contusions resulting in a large loss of movement immediately
  • Contusions that are not managed properly at the onset (see protocol below)
  • Re-injury to the contusion (within a short period of time of the first impact)
  • Athletes that do not rest sufficiently following the contusion
  • Athletes who do not use ice to reduce the amount of bleeding following the contusion
  • Athletes who receive massage or ultrasound too early following the contusion
  • Athletes who exercise into pain too early following the contusion
  • Athletes who continue to play through the injury
  • Athletes who return to play too early following the contusion.

PROPER TREATMENT OF A THIGH BRUISE TO REDUCE TIME LOSS FROM SPORTS

To reduce the amount of time the player may lose due to a thigh bruise or “charley-horse” the following steps should be followed:

  • Try to bend the knee as much as possible WITHOUT pain.
  • Apply ice on the entire injured site for at least ten minutes and not more than twenty minutes. Remember not to apply the ice directly on the skin and have a moist cloth between the ice and the skin. Try and repeat the icing at least once an hour. Try and continue with the ice regime for the first 48 -72 hours. Then contrast baths (one minute heat and thirty seconds ice, repeated 4-6 times) is highly recommended.
  • Compress the thigh with a tensor when it is not being iced.
  • Try and move the knee within the PAINFREE range just prior to icing and after icing so that the range of motion isn’t lost.
  • Typically the knee will swell at night and the knee will be very painful and stiff in the morning. To avoid this a little trick of the trade is to bend the knee to the PAINFREE limit, and then put a tensor around both the thigh and lower leg so that the knee cannot straighten in the night. Remember do not put it on tightly or the athlete will wake up with elephantitis, where the thigh will feel OK but the ankle will be ten times the size of normal.

RETURN TO PLAY GUIDELINES

The key for most coaches and players is to know when to return to playing/training. To be 100% certain, always check with a qualified sports rehabilitation specialist, like a sports physiotherapist. Some simple tests the athlete needs to be able to do PAINFREE before returning to play are:

  • Squat fully
  • Jump and land correctly
  • Travel up and down stairs
  • Lunge
  • Kick a ball
  • Hopping
  • Sprint

If the athlete cannot do the aforementioned functional tests they should not be allowed back on the field.

Begin to get worried about myositis ossificans if the knee remains swollen, pain persists past the 72 hours and is NOT subsiding, night pain awakes the athlete, and a visible lump begins to be felt or seen in the muscle belly.

Further investigations will need to be done to confirm the diagnosis. These investigations can include X-ray at the three week mark, MRI, or diagnostic ultrasound. Definitely being followed by a sports physiotherapist at this point is a must.

References
www.PhysioAdvisor.com

Marc Rizzardo – Marc is the co-owner/operator of Metrotown Orthopedic and Sports Physiotherapy and is also a member of the SportMedBC Board of Directors. He holds a Post Graduate Diploma in Sports Physiotherapy and has been a long time soccer coach at the university, provincial and national levels. Marc was the Chief Therapist for the Canadian Olympic Committee at the 2010 Olympics in Vancouver where he worked closely with Chief Medical Officer, Dr. Bob McCormack, to oversee the Canadian Medical Team. Marc has also been the Chief Therapist at the 2007 Pan American Games in Rio de Janiero and the Lead Therapist for the Canadian Womens’ soccer team at the 2008 Beijing Olympics. He has been appointed Chief Therapist for Canada at the London Olympic Games 2012.