Thigh Hematomas and How to Heal
Joey Savatgy had a classic thigh hematoma this weekend at the Las Vegas that kept him from racing. Basically it became too painful to continue. The pain is usually from compression and irritation of the nerves where the hematoma occurred.
Motocross athletes are no stranger to bumps and lumps. Sometimes those bumps can turn into something more, called a hematoma. A hematoma (aka – hema-tomatoe) is a collection of blood that causes the leg to swell and even deform the thigh or leg. Not all hematomas are the same. Most bleed very slow, less often they bleed very fast and this is a medical emergency. Hematomas often arise after a pretty big fall, or they can even appear some days after the fall. Sometimes a hematoma keeps oozing (bleeding) uncontrollably and turns into compartment syndrome. Basically, this is a continuation of the hematoma that increases in size, causing actual compression of nerves, blood vessels, and other structures.
Thigh compartment syndrome is uncommon and often goes unrecognized. Most people don’t think about a little temporary numbness or pain in the lower extremities. The signs and symptoms of a thigh hematoma include a history of thigh swelling and/or hematoma and pain after minor injury. They often happen in a patient who is anticoagulated or has been taking a lot of ibuprofen. Rarely, surgery is required to relieve the compartment syndrome.
Compartment syndromes occur when the tissue pressure within an enclosed space exceeds the capillary perfusion pressure, leading to vascular compromise and ischemia. Orthopedic and Vascular surgeons are most familiar with compartment syndromes, but they can occur in any bone or fascia-encased compartment, including the head, abdomen, mediastinum, eyes, and extremities. Compartment syndromes of the extremities must be treated as soon as they are suspected to avoid permanent damage and tissue loss.
Symptoms of compartment syndromes are variable in their presentation, so one must maintain a high index of suspicion. Direct leg injury is the most common cause of thigh compartment syndrome. A history of anticoagulant use is also frequent in patients with thigh compartment syndromes such as use of ibuprofen or aspirin. The combination of minor trauma and anticoagulation produces bleeding into muscle and tissue spaces, leading to increased compartment pressure. Pain ranges from mild to severe and may be elicited only when the limb is moved through a range of motion or exercise. Other findings of vascular occlusion—pulse-less-ness, pale color, numbness and paralysis are possible, but rare.
Treatment of any injury starts the second after it happened. Proper care and treatment goes a long way towards a full recovery. Most thigh hematomas will go away on their own. However, it is prudent to treat a hematoma right away.
I often like to advise people to use R.I.C.E WITH NO ICE. I don’t believe in using ice to heal injuries and the science is very much against ice having anything to do with healing. Now if you are using it for pain control for brief periods, this is another thing. But do not think that you are healing the injury with ice.
Typical treatment would be:
Resting the thigh if possible. Continued use may make it worse.
No ICE. Just skip this part.
Compression. Use an ACE bandage and remember to not wrap it too tight, it is just a light compression.
Elevate the thigh above the heart if possible. This helps the blood and fluids be reabsorbed by the body.
If your leg is very painful or numb, GOTO the doctor right away! This is nothing to fool around with and you risk long-term nerve and muscle damage. If you think that you need to treat the pain, start with Tylenol if you ok to take this medication. If you think that you need something stronger, you should seek medical advice.
And just rest the thigh until the hematoma and the pain stops. Avoid getting a massage, hot tub, or anything else. Just get the pain under control and keep it elevated. And many people have asked me if the hematoma needs to be drained. This is almost never the case. The compartment may need to be released, but there is rarely a collection of fluid that can be easily drained.
Treatment After the first 48 to 72 hours
Stay active! Too much rest is not a good thing in this stage. As long as most of the swelling has subsided after the first 48 to 72 hours, you are now ready to start treatment with using several modalities (of course, check with your doctor first!). Light activity promotes blood circulation, but it will also activate the lymphatic system. The lymphatic system is vital in clearing the body of toxins and waste products, which can accumulate in the body following a sports injury. Activity is the only way to activate the lymphatic system.
Next, start these treatments:
LIGHT ACTIVITY: Start moving the injured thigh through its range of motion. This should not be too painful, if it is you may need to wait a little more. It is often better to let someone like a trainer or massage therapist range the thigh. A light spin bike may be a good thing to do as well. Walking is also good, and remember to not push it.
TENS: Transcutaneous Electrical Nerve Stimulation. The aim is to increase the amount of oxygen and nutrients to the damaged tissues. Physical Therapists accomplish this aim by using a number of treatments to stimulate the injured area.
The Marc Pro uses a technology that is different from other TENS devices. Marc Pro utilizes a decaying waveform, which grabs the muscle and gently releases as opposed to the square waveform used by traditional TENS devices. Marc Pro’s waveform used in combination with a long pulse duration, allow for a less fatiguing muscle contraction, which is critical for recovery. This allows for a comfortable experience that feels pleasant during use. Remember to place the pads on each side of the hematoma. The goal is to use the brain and cause no pain!
HEAT: Use a sauna for this. Any type of sauna will do as you are trying to deliver heat to the body to increase blood flow, sweating, and movement of body water.
ULTRASOUND: Ultrasound uses high frequency sound waves to stimulate the affected area, while TENS (or Transcutaneous Electrical Nerve Stimulation) uses a light electrical pulse to stimulate the injured area. And heat, in the form of a ray lamp or hot water bottle, is also very effective in stimulating blood flow to the damaged tissues.
MASSAGE: To speed up recovery and repair the damage tissue it is vital that you start light massage the injured area and connecting muscles. More is not better!
Remember the phrase: Use Your Brain, Cause No Pain! Listen to your body and everything will be all right.