Recovering from the dreaded Corky

By Nicola Stevens

What is a muscle corky?

Many of us will have heard the word ‘corky’, but what actually is a corky? A corky is essentially a deep muscle bruise or ‘contusion’. This sort of injury often occurs due to a direct trauma or repeated blow to the muscle, damaging the underlying muscle fibres and bleeding internally to form a haematoma (blood mass).

A contusion can occur in any contact injury so they’re common in all contact sports, including Australian Football (AF).  They can occur with a strike from an opponent, or where a hard ball or object strikes the body of an athlete. The most common region to sustain a contusion is the thigh. This is particularly an area of concern for ‘ruckmen’ in Australian Football.

How can I protect myself from sustaining a contusion?

Most athletes will have sustained a contusion at some stage in their playing careers, so it is important to understand the nature of the condition and what you can do to help it, and reduce your risk of its occurrence.

There are certain factors that help to promote healthy muscle tissue, these include:

  • Completing a warm up and cool down
  • Adequate muscle conditioning
  • Adequate recovery time between sessions
  • A healthy and well balanced diet

It is also important to consider any medical condition or family history of a bleeding disorder, smoking habits, age and obesity as these factors can all effect bleeding tendencies and therefore, influence management and healing times.

It’s recommended that players wear protective equipment over the thigh while playing but it is equally important that we check the sporting environment for hazards so that we can limit the risk of injury occurring.

What do I do if I have a contusion?

If you have sustained a contusion, you may experience pain and reduced range of movement, the extent of this is dependent on the severity of impact and your tendency to bleed. Contusions are classified according to their severity, ranging from mild to severe.

  • A player may be able to continue playing with a mild contusion (Grade 1) and may experience some soreness particularly as the muscle cools down.
  • A moderate contusion (Grade 2) may limit a player’s ability to continue playing. Stiffening and swelling may occur at rest and the player may walk with a limp. Range of motion can be limited up to 50%.
  • Severe contusions (Grade 3) incur a rapid onset of swelling and obvious bleeding and aren’t likely to continue playing. There is usually greater than 50% movement loss and often associated difficulty with full weight bearing.

Heat, alcohol and vigorous massage increase the bleeding after a contusion and therefore should be avoided. The standard management of contusions are to follow the RICER protocol up to 48-72 hours post injury, to reduce bleeding and damage to the muscle- relative rest, gradual loading, ice and compression are the key principles of RICER. The main aim of management in this acute phase is to limit damage and to reach pain free range and strengthening of the affected muscle 2-7 days post injury.

Basic activation exercise to begin strengthening the affected area*;

  • Quad Sets: laying on your back with a towel rolled up behind the knee to add a slight bend. Contract quad and extend knee to lift the heel just a few centimeters off the surface. Hold for 10 seconds, repeat 10 times, 3 times a day.

*If the affected area was the quadriceps (thigh).

So when is a corky, no longer a corky?

Most contusions are minor and heal very quickly without limiting competition time. In some cases however, more severe contusions can lead to complications. A common complication of severe contusion is myositis ossificans – this occurs when a haematoma calcifies. Myositis ossificans should be expected in any contusion that fails to resolve within the normal time frame.

Some signs and symptoms that may indicate myositis ossificans are;

  • Morning pain
  • Persisting pain on muscle contraction
  • Hard lump in the muscle

The most appropriate management for myositis ossificans is conservative and expected recovery is usually slow. The bone formation in response to the bleed usually ceases after 6-7 weeks.

Although it is far less likely, it is important to be aware of another, more serious complication of contusion, known as Acute Compartment Syndrome. This occurs when pressure within the muscular compartment at the site of impact builds to dangerous levels. The increased pressure can disrupt blood flow to the muscles and nerves within the compartment. Acute Compartment Syndrome requires immediate surgical decompression so it pays to know the difference. When an acute compartment syndrome occurs, early diagnosis and intervention is necessary to prevent permanent damage.

Some features of this syndrome include:

  • Persistent pain (greater than one would expect given the nature of the injury)
  • Swelling, feeling of tightness or fullness within the muscle
  • Pain on passive muscle stretch of the involved compartment
  • Progressive loss of sensory and motor function

When can I return to full activity?

Providing there are no hiccups along the way and the contusion is gradually improving, within the first 2-7 days post injury, you should begin to see a significant reduction in pain and return of range of motion. This is the case for most mild to moderate contusions with full resolution of symptoms in 4-6 weeks.

In some cases, more severe contusions may take a little longer to fully recover. Returning to play will be dependent on the ability for you to achieve pain free range of motion and full strength under load of the affected area.

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References:

Compartment Syndrome – OrthoInfo – AAOS. (2019). Retrieved 15 August 2019, from https://orthoinfo.aaos.org/en/diseases–conditions/compartment-syndrome/

Quadriceps Contusion (Cork Thigh) | Sports Medicine Australia. (2019). Retrieved 15 August 2019, from https://sma.org.au/resources-advice/injury-fact-sheets/quadriceps-contusion-cork-thigh/

Muscle Contusion (Bruise) – OrthoInfo – AAOS. (2019). Retrieved 10 September 2019, from https://orthoinfo.aaos.org/en/diseases–conditions/muscle-contusion-bruise/

Walczak, B., Johnson, C., & Howe, B. (2015). Myositis Ossificans. Journal Of The American Academy Of Orthopaedic Surgeons23(10), 612-622. doi: 10.5435/jaaos-d-14-00269

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