What Is Dead Leg?
A dead leg, also known as charley horse or quadriceps contusion, is a condition where a forceful impact causes the thigh muscle to be crushed against the thigh bone (femur) resulting in a contusion or a bruise on the thigh bone. Thigh or quadriceps contusions vary in severity and are graded 1, 2 or 3 depending on the severity.
A dead leg can often be ignored as a minor injury; however, it is important that a correct diagnosis is arrived at with correct treatment initiated immediately. If an athlete tries to play sports or perform exercises too soon after sustaining dead leg or a mild injury to the thigh, without receiving any medical attention, then it may cause delayed healing or even permanent damage.
Contusions can be intermuscular or intramuscular. Treatment for Dead Leg depends on the type of contusion and grade of the injury and generally consists of R.I.C.E technique, pain medications, crutches, stretching and strengthening exercises and surgery in severe cases.
Causes Of Dead Leg
Dead leg or quadriceps contusion is caused by direct trauma or impact to the anterior region of the thigh. This results in compression/crushing of the muscle against the thigh bone (femur) leading to bleeding and tissue damage which is known as Quadriceps Contusion. Athletes who play contact sports, such as foot ball, rugby, basket ball, are more prone to having dead leg or quadriceps contusion. Other sports, such as lacrosse, softball, baseball, where the sports device can come in contact with the thigh also results in dead leg or quadriceps contusion
Signs & Symptoms Of Dead Leg
- Pain is felt immediately after the injury or trauma resulting in dead leg.
- Patient will have restricted movement of the leg.
- Patient has swelling and later on bruising.
- In dead leg or grade 3 quadriceps contusion, patient is not able to move his leg through its entire range of motion.
- Patient may walk with a limp and may need crutches for support after sustaining dead leg injury.
Types Of Dead Leg (Quadriceps Contusion)
Intramuscular Contusion: Dead leg from intramuscular contusion occurs when the muscle gets torn within the sheath surrounding it. This causes the initial bleeding to cease within hours due to increased pressure inside the muscle, but the fluid and blood is not able to escape from the muscle sheath, as the sheath prevents it from doing so. This causes significant pain and loss of function for the patient and can take anywhere from days to weeks to recover from this type of dead leg injury. Bruising is often present in intramuscular contusion.
Intermuscular Contusion: In dead leg from intermuscular contusion, the muscle as well as part of the sheath surrounding it gets torn. This results in delayed stopping of the initial bleeding, especially if the patient does not use ice therapy. However, patient often recovers faster in this type of dead leg injury when compared to intramuscular contusion as the blood and the fluids can easily flow away from the injury site. Bruising is often present in this type of contusion.
Classification Of Dead Leg (Quadriceps Contusion)
- Grade 1: In dead leg of grade 1 contusion of quadriceps, patient has tightness in his/her thigh and will limp while walking. The swelling is very mild and so is the pain. Patient has almost complete range of motion upon stretching.
- Grade 2: In dead leg of grade 2 contusion of quadriceps, the patient is not able to walk properly and limps when walking. Patient will experience bouts of pain upon activity and also has some swelling. Patient also has pain upon extending the leg against resistance. Pressure on the site also produces pain and the patient is not able to completely flex the knee.
- Grade 3: In dead leg of grade 3 contusion of quadriceps, patient has severe pain with obvious swelling and is not able to walk without the help of crutches or other kind of support. Muscle contraction can produce an obvious gap or bulge in it. This type of dead leg or contusions needs at least a month or two to completely heal.
Investigations For Dead Leg
- Physical exam and medical history.
- Magnetic resonance imaging (MRI).
Treatment For Dead Leg
Treatment for Dead Leg of Grade 1 Contusion of Quadriceps:
Immediately after the injury, it is important to apply ice or cold therapy and a compression bandage. Patient will benefit from using a heat retainer or compression bandage and should continue using it till the pain subsides. A physician or a sports injury professional should be contacted immediately. Gentle stretching exercises of the quadriceps should be started as soon as the pain recedes. Sports massage also helps in boosting the recovery process of dead leg, but it should be started after the pain has subsided and the patient has passed the acute phase of the injury; as massaging the injured muscle early on can result in severe damage and could also cause myositis ossificans. Patient can also benefit from ultrasound and electrical stimulation. Patient should also perform stretching and strengthening exercises of the quadriceps to strengthen the muscles and increase flexibility. In dead leg of grade 1 contusion of quadriceps, with treatment, patient can get back to his/her normal activities within a week or so.
Treatment for Dead Leg of Grade 2 Contusion of Quadriceps:
R.I.C.E technique is employed for this type of injury, i.e. Rest, Ice, Compress and Elevate. Patient needs to use crutches for support for around 4 to 6 days. A professional sports massage helps in speeding up the recovery of dead leg of grade 2 contusion of quadriceps, but the massage should only be started after the patient is past the acute phase (24 to 48 hours). Patient can also benefit a lot from electrical stimulation and should enroll into a rehab program for dead leg of this grade of thigh contusion.
Treatment for Dead Leg of Grade 3 Contusion of Quadriceps:
Again, R.I.C.E. (Rest, Ice, Compress, Elevate) technique should be employed here and medical attention should be sought immediately. Patient should rest and use crutches when walking. Resting and ice therapy is the main line of treatment initially and recovery of dead leg of grade 3 contusion of quadriceps will take longer than other grade contusions. Ice therapy should be done for 15 minutes every hour for a day or two till the symptoms of dead leg subside. Sports massage should be started after the patient is past the acute phase (24 to 48 hours) of the injury. This helps with the recovery process of dead leg. Massaging in the acute phase of dead leg injury can result in severe damage, such as myositis ossificans. Patient should also enroll in a complete rehabilitation program for dead leg in order to get back to his/her old fitness level and regain former strength and flexibility.
In severe cases, surgery may be required.
Rehabilitation For Dead Leg
It is recommended that the patient seek professional advice before beginning on any rehabilitation program for Dead Leg injury. The aim of rehab program for dead leg or thigh contusion is to minimize the initial pain and swelling, maintaining and improving flexibility, re-gaining muscle strength so that the patient can gradually return to his/her former fitness level.
The following are the aims of rehabilitation for dead leg injury:
Reducing Pain & Swelling
- R.I.C.E technique is applied.
- Rest is very important.
- The limb should be kept elevated as much as possible.
- Compression and ice therapy should be applied for 15 to 20 minutes each hour for initial 24 to 48 hours. Ice should never be applied directly to the skin, but should be wrapped in a towel or a cold wrap in order to avoid ice burns.
- Patient should wear a compression bandage 24/7 to reduce swelling and to give support till the pain has subsided.
- Crutches should be used if required. Dead leg of Grade 3 Contusions may require using crutches for a week or so.
- Never, ever apply heat therapy or perform deep massage in the initial acute stage (24 to 48 hours) of dead leg injury, as this can aggravate the injury or lead to myositis ossificans.
Improving Mobility & Flexibility
- Gentle stretching should be done if it is not causing any pain. The stretch should be held for 30 seconds and should be repeated 4 to 5 times in a day.
- Stretching can be started after the acute stage (24 to 48 hours) has passed.
- Heat therapy, using hot water bottle and hot baths, can be started after the acute stage of dead leg injury has passed. This can be done after four days, and not earlier, from the day the dead leg injury was sustained.
- Gentle sports massage can be done after the initial acute stage of dead leg injury has passed.
Rehabilitation Program for Dead Leg of Different Grades of Contusions
Rehab For Dead Leg of Grade 1 Contusion:
- R.I.C.E (Rest, Ice, Compress and Elevate) technique.
- Gentle stretching exercises for quadriceps should be done.
- Hold the stretch for 30 seconds and repeat this 5 times in a day.
- Do leg extension exercises about 4 sets consisting of 10 repetitions, each about thrice a week.
- Slowly move on to weights for strengthening of the quadriceps.
- If you are feeling pain, then ease down on the training process till the pain subsides.
Rehab For Dead Leg of Grade 2 Contusion:
- R.I.C.E (Rest, Ice, Compress and Elevate) technique.
- Patient should use crutches for 4 to 6 days.
- From day 4 onwards, patient can start pain free static exercises of quadriceps comprising of contracting the quads and holding it for 10 seconds in the sitting position.
- Patient should flex and extend the leg to enhance flexibility; however, should stop doing it if there is any pain.
- Heat therapy, by using hot water bottle or hot baths, can be done.
- Patient should consult a specialist for ultrasound.
- If there is no pain, then patient should start doing straight leg raises thrice a week of 4 sets consisting of 10 repetitions each.
- Leg extensions can be started after a week comprising of 4 sets of 10 repetitions, thrice a week.
- Patient can do swimming or cycling 2 to 3 times a week.
- Stretching exercises can be done on a daily basis where the stretch should be held for around 30 seconds.
- Slow jogging can be started after 2 weeks have passed and if the patient is not feeling any pain.
Rehab For Dead Leg of Grade 3 Contusion:
- Week 1: Medical attention should be sought immediately and R.I.C.E. (Rest, Ice, Compress, Elevate) technique should be employed. Patient should also use crutches.
- Week 2: Pain free static contractions should be done. Stop immediately if it hurts. Heat therapy can also be started. Patient should also do straight leg raises barring there is no pain.
- Week 3: Patient should do all of the above along with straight leg raises using weights comprising of 4 sets of 10 repetitions about thrice a week.
- Week 4: Leg extension exercises should be started, as long as they are pain free, comprising of 4 sets of 10 repetitions thrice a week. Swimming and cycling can be done 2 to 3 times a week. Stretching exercises should be started about 5 times a day, where the stretch should be held for 30 seconds.
- Week 5: Start slow jogging, squats of 4 sets with 6 to 8 repetitions twice a week. Patient/athlete can slowly move onto sports specific exercises.
When Can Exercises Be Started For Dead Leg?
- For dead leg of grade 1 contusion of quadriceps, strengthening exercises can be started as soon as the pain has subsided. Patient should start with mild exercises and should move on to difficult ones as the dead leg pain subsides and patient’s comfort level increases. Increased intensity exercises should be done thrice a week and mild exercises should be done on a daily basis.
- For dead leg of grade 2 contusions of quadriceps, strengthening exercises should be started after a week or so; and in grade 3 contusions of quadriceps, strengthening exercises should be started more than a week later. Patient should start with gentle warm up exercises and finish with good stretching exercises. Strengthening exercises should be continued for many weeks after complete healing of the injury has occurred.
- If for any reason, patient/athlete is not able to do or continue exercises, then another option is to go for cycling or swimming for strength training.
Stretching Exercises For Dead Leg
Given below are two simple stretching exercises, which are an important part of rehabilitation program for dead leg or quadriceps contusion.
Note: The following exercises are for information purpose only and patient should always seek doctor’s permission before starting any exercise and do them under a physician’s guidance.
Thigh Contusion Stretching Exercise
- Stand on one leg and hold the leg which is to be stretched behind you.
- Slowly pull the heel towards the buttocks.
- Keep both the knees together in order to avoid twisting them.
- You can hold onto something for balance/support.
- In case you do not feel the stretch, then slowly tilt your pelvis backwards to lengthen/stretch the quads.
- Hold the stretch for about 30 seconds.
- Repeat 4-5 times thrice a day on a daily basis.
Hip Flexor Stretch
- Place one knee on the floor and place the other foot flat on the floor in front of you.
- Slowly push your hips forwards while keeping your back/spine straight.
- You can feel the stretch in the anterior side of the hip. Hold this stretch for 30 seconds.
- Repeat this stretching exercise 4-5 times a day.
Recovery or Return To Full Fitness After Sustaining Dead Leg Injury
Recovery time for dead leg or returning to former level of fitness after sustaining dead leg injury is a slow process and requires a lot of patience and determination. For dead leg of grade 1 quadriceps contusions, patient/athlete can start normal training after a week. It is important to do stretching and strengthening exercises for regaining complete strength and flexibility of the muscle. Patient can also start slow jogging and gradually build it up to running for about 45 minutes.
Prevention Of Dead Leg (Quadriceps Contusion)
- Athletes should always wear protective gear, especially in the leg/thigh region.
- Athletes should make sure that the protective pads are worn in the right manner and are correctly positioned in the anterior part of the thigh.
- It is not always possible to prevent a quadriceps contusion; however, it is possible to prevent quadriceps contusion from developing into myositis ossificans. In order to prevent this, the patient should ensure that proper healing has occurred before returning to sports and other activities. Massage and heat therapy should not be applied before complete healing has occurred.