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Haematoma formation in hamstring muscle strains

PROMPT diagnosis and early treatment of thigh muscle injuries are a pre-requisite for early return to normal football activities after injury.
A football player who has not fully recovered from thigh muscle injuries will spend most of the time in the doctor’s room than on the pitch.
Thigh muscle injuries, which are typically categorised as hamstring strains and quadriceps contusions are always associated with footballers.
It is for this reason they deserve mention.
In the last three weeks I have seen three to four hamstring muscle strains whose history is almost similar.
My main worry has been the recurrence rate of these injuries when the thigh muscle injury, especially hamstring strain is not given time to heal.
Though we can have a lot of other injuries affecting the knee, ankle and the hip among many others, I really want to discuss haematoma formation in muscle injuries.
In the past, when I discussed the thigh muscle injuries, it was mentioned why early treatment of such type of injuries is important.
The first reason why such injuries have to be treated early is to reduce the pain, limit the inflammatory process, limit the bleeding that occurs when the muscle is injured.
A haematoma can be defined as a collection of blood outside the blood vessel.
The term haematoma is derived from two words: Haema, which means blood and -oma, which is derived from the Soma (Greek word for body).
A haematoma can also be seen as a body of blood.
Haematoma formation can occur or happen in a muscle after a muscle strain or indeed after muscle contusion.
There are many instances when haematoma formation occurs but for this discussion, I want to highlight haematoma formation during participation in sport.
In the case of thigh muscle injuries, we mainly refer to the hamstring injuries as hamstring strains and the quadriceps muscles as the quadriceps contusions.
It is important to give a player good explanation on the type of injury they have and how best to treat it.
It is only when there is good understanding that players will heed to medical advice and improve the outcome of an injury.
Limiting the size of the haematoma is vital in sport because it enhances the recovery and prevents other complications associated with haematomas.
A haematoma always implies that there is some bleeding, which is happening or has already happened and limiting the size of the haematoma is crucial.
Recently, one of the national team players reported to the team’s training camp, with a thigh muscle contusion.
The good part is that early treatment with ice was initiated and the time he reported for camp he only had residual pain.
The history with this player was that of suffering a direct blow to his thigh after a collision and this resulted in sudden pain and difficulties in running. The outcome of this type of injury is better when treatment is started early followed by a good rehabilitation.
In both the quadriceps muscle (muscles of the front part of thigh) contusions and hamstring (Muscles of the back of thigh) strains bleeding occur which can be minor or major.
Sometime back, I discussed the issues relating to compartment syndrome, which can occur as a result of bleeding within a confined space surrounding the muscle.
However, today my main interest is to emphasise the importance of early treatment of thigh muscle injuries, which result in bleeding.
It is not the cooling effect of the spray, which the team physiotherapists use in injuries that limit the bleeding, but it is the immediate application of ice to the affected part, compressing the injured part and followed by elevation, which is important.
This is what is referred to as the RICE Principle and this stands for, Rest, Ice, Compression and Elevation.
In practice it is of great importance to assess the severity of the injury on the sideline and treatment must be started within the shortest possible time. Treatment must not be delayed and players must not wait for many hours before getting the RICE therapy.
It is such a simple and yet important principle to apply so that haematoma formation is limited.
It is important to have ice available all the time on the sidelines during training and also during competition.
Improvement of injury outcomes has a lot to do with how injuries are treated in the first 48 hours.
Ice as it is well known by many people helps to reduce the blood flow to the affected area and help in reducing the bleeding in that particular area.
It also acts as a pain-relieving agent, which is the preferred mode of treating pain in the early stages.
The use of the common drugs for pain relief in the initial stages is not encouraged because of the potential they have in further worsening or promoting bleeding.
The other important thing to remember is not to ever massage an acutely injured muscle, as massaging will further increase the blood flow to the affected part, cause pain and worsen bleeding.
Massage has also been shown to further cause more damage to the affected muscle with the unwanted effects of bleeding and haematoma formation coming into play.
Massage should mainly be considered later when the chances of further bleeding are minimised and also during the rehabilitation phase.
Many surgeons will go and removal the haematoma through surgery in the early stages, if there is potential of severe accumulation of blood leading to compartment syndrome.
There is also the issue of another complication that might arise later because of the haematoma in the muscle.
This is known as Myositis Ossificans because it results in formation of bony like structure within the muscle.
This will limit muscle contraction and if it affects the thigh muscle it will limit bending of the knee.
A haematoma is a very common phenomenon encountered in everyday sports activity, but the important thing is how swift the medical team moves in, in order to limit the size of this.
Haematomas related to sport must be fully treated on the field of play and other investigations like the magnetic resonance imaging (MRI) becomes handy in looking at the size of the haematoma.
In most cases the haematoma resolves spontaneously and return to football activities is guaranteed within a few weeks especially if well handled in the initial stage.
All team physicians must be concerned about the use of the non-steroidal anti-inflammatory drugs in the immediate or acute phase of muscle injuries because of the danger in worsening the bleeding and haematoma formation.
For questions and comments write to Dr Kabungo Joseph
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