Sports injury: cork thigh

Corked your leg? "Oh, just walk it off!" your teammate may say. In hindsight, they are probably right after considering the current evidence base.

But what exactly is a corked or dead leg and how can you best manage it?

What is a 'cork'?

The medical term for your pain is a contusion where an external body applies a traumatic blow to your muscle. Contusions are a common injury in sports and without appropriate care may prolong return to high level activity and possibly develop into other conditions such as compartment syndrome or myositis ossificans.

Anatomy of a 'corked' leg

A common area that is 'corked' is the quadriceps muscle, especially during contact sports with no thigh padding such as rugby, soccer and AFL. The quadriceps muscle is located on the anterior compartment of the thigh and is comprised of four sub-muscles: rectus femoris, vastus medialis, vastus lateralis and vastus intermedius.

From the anatomy diagram, it can be justified that the rectus femoris and vastus intermedius are the most frequently injured muscles as they lie next to the bone with limited space for movement when exposed to a blunt force.

How does the trauma cause pain?

A contusion occurs when a compressive force is not dispersed, and the muscle and underlying tissue is squashed into the femur (thigh bone). The myofibrils (muscle fibres) and capillaries within the tissues cannot withstand this stress and rupture. This causes potential bleeding and pain as damage has occurred to the local tissues. From here, the repair of the tissue can be thought of as a race between healing and scar formation. This is important to consider as excess scar tissue will slow down the muscle’s regenerative process and result in incomplete recovery.

Should I keep playing?

There are different grades of contusions - ranging from injuries that prevent further play, to less severe injuries that won't limit the athlete until after completion of play, when the bleeding and swelling has reached a tipping point or created reduced performance.

When tearing the myofibrils through impact, this is through longitudinal distraction and is not necessarily coupled with structural damage of muscle tissue. Therefore, some athletes with severe contusions can continue playing as their muscle is still able to contract whereas other smaller indirect structural injuries can force the player to stop at once.

According to Sports Medicine Australia, with a grade one or two contusion, to keep playing you should:

1. Apply compression - ask your sports trainer or physiotherapist for Tubigrip or compression bandages to strap your thigh. You can add padding to prevent further injury as well.

2. Continue moving - jump on the bike if available or do slow jogs up and down the sideline to ensure the blood does not pool and stiffen up your leg.

3. Avoid heat, alcohol or massage - this is not only painful but will increase blood flow to the area and accelerate the bleeding process while not providing any performance benefit.

However, without in-depth assessment (by a physiotherapist) of palpation, muscle testing, range of motion measuring and other special tests, it is difficult to determine the grade of contusion for personalised treatment, but you can try immediate triage to control the muscular bleeding and minimise the size of the secondary area of injury.

Immediately post-game or as soon as possible, the knee of the contused thigh should be bent painlessly and placed in a knee flexion position of 120 degrees using an elastic wrap. This will limit the hematoma (pooling of blood) by controlling the bleeding. You may use an adjustable range-of-motion brace set at this limit if available. This position should be maintained for the next 24 hours with nonsteroidal anti-inflammatory drugs (NSAIDs) for the first 48 to 72 hours only.

After this period, active pain-free range-of-motion movement should take place several times a day to prevent any scar tissue build-up. Research has shown that cryotherapy has been effective in accelerating the healing process when combined with movement. This consists of ice application, where once the thigh is numb, you can passively stretch the leg. You can try this with our PTP ice stick for recovery.

How do I know when I can return to sport?

Depending on your injury, the return to sport criteria will vary. But here are the essential points to tick off before returning to the field:

1. pain-free knee flexion (bending)

2. both quadriceps are the same size and firmness

3. same level mobility and agility pre-injury

4. wearing, for the remainder of the season, a basic thigh pad modified with a ring-shaped pad to prevent recurrent trauma to the area of the contusion.

If you're in any doubt, please book an appointment with your physiotherapist, or give us a call (3061 7128)!

#corked #corkedleg #deadleg #charleyhorse #walkitoff #physio #brisbanephysio

References

Cooper, Daniel E. (2004). Severe quadriceps muscle contusions in athletes. The American Journal of Sports Medicine, 32(3), 820; author reply 820-820; author reply 821.

Delos, Demetris, Maak, Travis G, & Rodeo, Scott A. (2013). Muscle Injuries in Athletes. Sports Health, 5(4), 346-352.

Kary, Joel M. (2010). Diagnosis and management of quadriceps strains and contusions. Current Reviews in Musculoskeletal Medicine, 3(1), 26-31.

Mueller-Wohlfahrt, Hans-Wilhelm, Haensel, Lutz, Mithoefer, Kai, Ekstrand, Jan, English, Bryan, McNally, Steven, . . . Ueblacker, Peter. (2013). Terminology and classification of muscle injuries in sport: The Munich consensus statement. British Journal of Sports Medicine, 47(6), 342-350.

Singh, Daniel P, Barani Lonbani, Zohreh, Woodruff, Maria A, Parker, Tony J, Steck, Roland, & Peake, Jonathan M. (2017). Effects of Topical Icing on Inflammation, Angiogenesis, Revascularization, and Myofiber Regeneration in Skeletal Muscle Following Contusion Injury. Frontiers in Physiology, 8, 93.

Trojian, Thomas H., MD. (2013). Muscle Contusion (Thigh). Clinics in Sports Medicine, 32(2), 317-324.