Lower Leg Contusion: Symptoms, Treatment, Stretching, Strengthening Exercises, Sports Massage

A contusion is a condition in which the tissues are injured causing pain and purplish or bluish discoloration of the skin, which is known as a bruise. The cause of the contusion is a direct blow or trauma to the muscles in which the muscles may be crushed against the bone. Lower leg contusions are commonly seen in sports people such as soccer players. When the soccer player gets kicked in the lower leg, it causes internal bleeding in the muscles and the surrounding tissue resulting in a bruise. There may be spasm or cramp in the leg causing further pain. The internal bleeding causes the bluish-purplish discoloration known as the bruise.

Any type of direct, blunt trauma or force to the lower leg results in lower leg contusion.^[1]

• Pain upon sudden force or impact.
• Inability to use the lower limb.
• Pain upon stretching.
• Inability to walk properly.
• Bruising is present.
• Swelling is present.
• Tenderness to touch.
• Skin is warm and hard to touch.

• Rest is important for healing.
• Ice or cold therapy helps in reducing pain, bleeding and swelling.
• R.I.C.E. techniques should be applied.
• A compression bandage or support can be used to alleviate the bleeding and swelling.
• NSAID’s such as ibuprofen and naproxen can be given for reducing pain and swelling.
• When the pain subsides, gentle stretching of the calf muscles can be done.
• Sports massage can be done after the acute phase (2 to 3 days) has passed and the pain has subsided.

It is advised that the patient seek medical approval before starting any type of exercise.

Gastrocnemius Muscle Stretch for Lower Leg Contusion

• Stand with the legs shoulder width apart.
• The heel of the back leg should be positioned on the floor with the knee straight.
• The front knee should be bent forwards along with leaning forwards and pushing against a wall if necessary.
• This stretch should be held for 10 seconds.
• Repeat three to five times for three times a day.
• Increase the duration of the stretch gradually (up to 45 seconds).

Soleus Muscle Stretch for Lower Leg Contusion

The same method as above should be followed but the stretching leg should be flexed at the knee. This excludes Gastrocnemius muscle attaching above the knee from the stretch and will stretch the soleus muscle present down the leg. Hold for 20 to 30 seconds and repeat 5 times daily.

Stretching on a Step for Lower Leg Contusion

• Stand on the border of a step with the heel hanging and stretch.
• A gentle stretch can be felt. Hold this position for minimum 15 seconds.
• Do not over-do this stretch.

Exercise 1: Heel Drop – (Double Leg)

• Stand on the border of a step.
• Lower both the heels down at the same time.
• The pressure on the injured leg can be reduced by placing maximum of your weight on the good leg.
• This exercise should be repeated as much as is comfortable.
• Do not over-do this exercise, particularly in the initial stages.
• Repeat it two times daily.
• You can advance to doing it two and then three sets at a time.
• After the exercise is done, cold therapy should be applied to the tendon.

Exercise 2: Heel Drop – (Single Leg)

• The same procedure as above should be followed, but only one leg is used.
• This exercise should be repeated as much as is comfortable.
• Again, do not over-do this exercise.

Required Equipment

The first and foremost equipment which is required for a massage is a lubricant. This enables smooth gliding of hands during massage. For this purpose, the massage oils can be used or simple baby oil will also suffice. Care should be taken not to use too much oil, as it will cause lack of control during massage. Apart from a lubricant, the other equipment needed is a firm and flat surface to lie upon during the massage.

Technique 1: Effleurage

This technique is used to initiate massage and for even oil application. It also helps in warming up the tissues in order to prepare them for deep massages. Light strokes should be applied using the hand from above the heel to the knee. The direction should always be upwards towards the heart, because this is the direction of the blood flow. Doing it the opposite way causes vein damage. After these strokes are done, the hands should be brought down the outside of the leg while keeping them firmly on the skin without too much pressure. This whole movement should be repeated using gentle stroking techniques and covering as much area of the leg as possible. This technique should be repeated for 5 minutes while slowly increasing pressure on the up strokes.

Technique 2: Petrissage

This is a kneading type of massage technique, which helps in additional relaxing and warming up of the muscles. The palms or the knuckles are used in this massage technique. A firm, kneading pressure is applied using the hands. Half the muscle should be pulled towards you using the fingers of one hand and half the muscle should be pushed away using the thumb of the other hand. Then the direction of the massage should be changed to reverse. Try to cover as much area as possible by working the hands up and down the muscle. This technique should be continued for about 5 minutes and can be alternated with the effleurage technique.

Technique 3: Stripping the Muscle

This is a common massage technique done to smooth out any knots or scar tissue present. Deep pressure should be applied using both thumbs at the center of the calf muscle with the intention of separating the heads of the Gastrocnemius muscle. This massage technique should be done slowly and deliberately in order to ‘feel’ the muscle underneath. It should be repeated 3 to 5 times in a row, alternating with petrissage for 5 minutes. For deeper pressure, a single thumb can be used along with a couple of fingers from the other hand. This massage should be appropriately deep and should not cause any pain to the athlete.

Techniques 4 and 5: Circular frictions and Trigger points:

The thumb is used in a circular motion for massaging. This helps in breaking down the adhesions and scar tissue. Circular frictions and stripping techniques are used alternatively for deep massage of the muscle tissues. About 10 to 20 circular frictions should be applied at a time changing with stripping and petrissage techniques. If any lumps, knots or sensitive spots are felt, then constant and deep pressure should be applied to these points using the thumbs. A localized, sensitive point in the muscle is known as a trigger point. The pressure on the trigger point should be increased till it reaches a 7/10 on the pain scale (10 being painful). Pressure should be held until the pain decreases to 4/10 on the pain scale (about 5 seconds). Then the pressure should be increased again until it reaches 7/10 on the pain scale. Again continue holding the pressure till the pain decreases. Repeat this technique once more.

This technique is very grueling for the thumbs and it is vital that the thumbs are slightly flexed while applying pressure in order to prevent any damage to the joints.

Finishing Off

The massage therapist can finish off by more petrissage techniques and finally with the effleurage technique again. The entire process should not exceed 30 minutes.

If the massage is done lightly, then massage therapy can be applied every day, but the deeper massage techniques should be given a day’s time to allow the tissues to “recuperate.”

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