How to best manage a cork!
A muscle contusion, or more commonly referred to as a cork is an accumulation of blood in tissue resulting from a blunt force trauma from an object or another person, commonly seen in sport. Though these injuries can occur in any muscle group, they are particularly common within the quadriceps. We tend to see this type of injury quite often in contact sports such AFL and Rugby, though they also occur in cricket and hockey where a hard ball can strike the player. Contusions can range from minor impacts, resulting in discomfort and not affecting activity, to severe, with significant pain and loss of function.
Symptoms include:
Swelling due to pooling of blood within the tissue
Pain, stiffness and loss of range of motion
Bruising - depending on the depth of the injury. Contusion without bruising may be more painful due to the blood being trapped deeper within the tissue layers.
Tender to the touch
Pain may limit walking ability
What to do in the first 0-72 hours Initial management should focus on reducing further bleeding and swelling:
Rest – cease play, avoiding loading the injured area, eg use crutches.
Ice – to reduce blood flow to the area. It is recommended to ice the affected area in a slightly stretched position (eg. knee bent for quadriceps cork) to maintain the range of motion within that muscle as the blood accumulates
Compression – around the affected limb to reduce swelling.
Elevation - to reduce blood flow and promote drainage of swelling.
What NOT TO DO:
Heat
Alcohol
Running
Massage
It is important that all of the above should be avoided as they will all stimulate increased amount of bleeding resulting in a more severe injury. This may increase the recovery time and delay return to sport.
Ongoing management Following the initial acute recovery, gentle, pain-free range of motion movements and early exercise is recommended to restore function of the affected muscles and joints. If pain, stiffness and a palpable lump can be felt where the cork occurred, additional physiotherapy treatment can help to resolve symptoms and promote recovery.
Potential Complications - Myositis Ossificans is a potential complication which can occur in up to 20% of large haematomas/ corks. It occurs when bony tissue develops within the affected muscle. It is difficult to predict which patients this may develop in with the recovery time being significantly longer than a typical cork. Symptoms can include:
Increasing pain
Range of motion getting progressively worse or more restricted
Tender to palpate the area, although will feel very firm to the touch
Diagnosis
Diagnosis is made predominantly based on the history of the injury and progression of symptoms. X-rays may be able to identify calcification within the tissue from 2-3 weeks post injury.
If you experience a cork during sport which requires additional treatment to help settle symptoms and aid return to play don’t hesitate to book in with one of our physiotherapists on (02) 4861 1223. Additionally, if you notice your cork worsening, or symptoms just not improving after 5-7 days coupled with further loss of motion be sure to contact our clinic for an Acute appointment so we can screen for potential complications such as Myositis Ossificans immediately.