Muscle contusions or bruises are often referred to as corks
What is a cork?
A cork is bruising of the muscle usually occurring after blunt trauma. This causes a haematoma (a large bruise) to form. Sometimes, if it has occurred in the superficial muscles (close to the skin’s surface) you can physically see the bruising within a few hours. If the cork (or contusion) has occurred deep in the soft tissue, it can even take a few days or more to see the bruise!
How does it happen?
Usually you get a muscle contusion with contact sports such as rugby when another player’s knee or elbow impacts your body, or in soccer when a player may get kicked in the thigh. The most common places to get a cork is on the quadriceps (thigh) and the arm around the biceps, or buttocks. You could also get a contusion through individual sports such as surfing (e.g. if you land on your board) or in a car accident.
How should you manage a muscle contusion?
If you have any pain with exercise or continuing the sport you were playing you should stop and rest. You should then apply ice (wrapped in a wet cloth) with the muscle on a slight stretch. For example, if you had a cork to the quad (front thigh muscle), you should keep the knee bent under you as you sit on a chair to apply the ice over the cork, and alternatively, if the cork is on your hamstring (back thigh muscle) you sit with the leg straight and apply the ice to the back of the thigh. You could apply the ice for 15 minutes on and 20 minutes off over the next 2-3 hours, then apply one to three times per day over the next 48 hours. In between icing, it is a good idea to apply compression to the affected area (such as a tubi-grip compression bandage) during the day to prevent further swelling.
What can go wrong if poorly managed?
A poorly managed cork can progress into myositis ossificans, where the excess bleeding and swelling calcifies – so essentially bone is forming within the muscle tissue and this will reduce the strength and flexibility of the muscle. It is worth noting that even with good management, it can sometimes occur.
Surgery for myositis ossificans is rarely warranted. If the myositis ossificans is removed before it is “mature,” it will likely return. Therefore, most surgeons wait between 6 and 12 months before even considering removal. Furthermore, there is a chance of return even when removed very late. Generally, myositis ossificans is only removed surgically if it interferes with joint motion or if it is irritating a nerve.
Examples of poor management of a cork:
- someone who doesn’t rest long enough for the cork to heal and causes further bleeding in the area by exercising the muscle.
- excessive alcohol consumption (which encourages further bleeding).
- strong massage or application of heat packs or having hot baths (all of which promotes more bleeding into the damaged muscle)
When to seek further treatment
If you have done all the aforementioned first aid and your pain or function are not showing a good improvement after a few days, it is best to get it looked at by your physiotherapist. Your physio can assess you to make sure there are no other injuries and give you advice on when you can safely return to a graduated exercise program. Your physio can also work out when it is safe to begin other techniques such as massage/stretching etc.