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Thigh injuries - pulled hamstring and thigh contusion

Published by Bupa's health information team, healthinfo@bupa.com, April 2008

This article looks at the causes and symptoms of two thigh injuries - hamstring strain and quadriceps thigh contusion - and treatments for them.

Hamstring strain

Muscle injuries are the most common sporting injuries of the thigh. A hamstring strain (or pulled hamstring) happens when you tear one of the three hamstring muscles that run down the back of the leg. It's a common injury in sports where sprinting and kicking are involved such as football. Hamstring injuries are likely to re-occur, particularly if you start playing sport again too soon. A hamstring injury can range from a mild pull that you might not notice, to a complete rupture of the hamstring muscle.

What are the symptoms of a hamstring injury?

How severe your symptoms are depends on how bad the injury is. In general, the symptoms include:

sudden pain
difficulty or inability to run
bruising - this will be extensive if the hamstring muscle is torn right through
extreme tenderness in the back of your thigh
pain when you try to bend your leg against resistance and also on straightening it

If there is a partial tear in the muscle, you might hear a pop, and there may be a painful lump on the back of your thigh as well.

How can I reduce the risk of hamstring strains?

There are various things you can do that may help to reduce the risk of a hamstring strain. These include:

warming up before you start - five to 10 minutes of low intensity exercise to warm up your muscles
stretching after your warm-up, and also during cool-down
pre-season strength and endurance training - some professional football clubs now have specific pre-season programmes to strengthen players' hamstring muscles, which have helped to reduce the risk of players injuring these muscles

Thigh (quadriceps) contusion

Thigh contusions, or bruises, are the most common acute injury in sport. They happen when you receive a direct blow, often from a blunt object such as another player's knee, to the front of your thigh. This type of injury is sometimes called a "charley horse". There are two types of contusion injury:

Intramuscular contusion

This is when the muscle is torn within its protective sheath. Bleeding is limited to within the muscle, but pressure builds up because the fluid can't escape.

Intermuscular contusion

This is when both the muscle and the sheath that surrounds it are torn. Blood can escape from the sheath so it's easier for the bruising to come out and the injury to heal.

What are the symptoms of quadriceps contusion?

Symptoms of thigh contusion include:

immediate pain and tenderness after a knock to your leg
muscle spasm
swelling
difficulty bending and straightening your leg against resistance - this will also be painful

If bruising has appeared after a couple of days, you probably have an intermuscular injury. If the swelling has not gone down after two or three days and you can't bend your knee more than 90 degrees, you probably have an intramuscular injury.

How should hamstring strains and quadriceps contusions be treated?

You should visit your GP for diagnosis and advice about treatment. However, if you have a severe quadriceps contusion, it's important that you see a sports injury specialist who can offer advice and treatment to prevent serious complications from developing.

Immediate treatment

The usual treatment for all muscle injuries is RICE - Rest, Ice, Compression and Elevation, which aims to reduce pain and swelling. It's essential to start this as soon as possible because the most important period in the treatment of a quadriceps contusion is the first 24 hours after injury so that any bleeding can be quickly controlled.

Rest your leg for up to 48 hours to avoid causing pain. If you need to move around, crutches may help.
Apply a cold compress, such as ice or a bag of frozen peas wrapped in a towel, to reduce swelling and bruising. You should not apply ice directly to your skin as it can damage your skin. Repeat every couple of hours as needed, allowing your leg to warm up between ice sessions. Hold the ice pack against your thigh with your leg bent as much as possible without it being painful.
Compression will make your leg more comfortable because it restricts movement, and may also reduce swelling. Use an elasticated bandage. The bandage should be firm but not so tight that you cut off circulation.
Elevate your leg by resting your foot up above the level of your heart, including overnight. This reduces swelling. It may be most comfortable to lie down with your foot on pillows.

For severe thigh contusions it's very important to rest your leg and elevate it. It's also recommended that you don't use massage, ultrasound or passive stretching. Don't drink alcohol or use heat treatment as these may lead to further bleeding.

Over-the-counter painkillers such as paracetamol should reduce pain and some may help reduce swelling. Always follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. However, you should not take aspirin as this may cause more bleeding.

You should only need to have surgery if an essential muscle is torn through completely.

Getting back to your sport

Your GP may refer you to a sports injury specialist or a physiotherapist. He or she will give you advice on rehabilitation. The first goal is to relieve symptoms. In very serious injuries there is a risk that a haematoma (an area of clotted blood) may form within the muscle and become calcified. This condition is called myositis ossificans and means new bone grows within the muscle. This can be very painful and disabling and may take several weeks to settle down.

Once your symptoms have improved, you need to restore a full, pain-free range of movement, as well as power and strength. A physiotherapist can help advise you on a range of exercises, as well as appropriate aerobic training to keep up your fitness. The last stage of rehabilitation involves doing exercises based on the movements you normally do in your sport.

Following a hamstring injury, it's very important that you work on strengthening not only your hamstring muscles but also those that assist them, such as the gluteal (buttock) muscles. You may also have problems with your lower back or pelvis that mean you are more likely to injure your hamstring so it's important that these are treated.

When you can return to sport depends on how severe your injury was and how your recovery progresses.

Key points

Pulled hamstrings and thigh contusions are common sports injuries.
You should treat them with RICE: rest, ice, compression and elevation to reduce pain and swelling.
You may need to see a sports injury expert for advice on rehabilitation.