How can I speed up the recovery of a bruised leg?

Question

There are those who say you have to cool and those who say you have to warm your leg, there are those who say you should rest and those who say you should keep using it as you would normally. It makes sense that the cooling stops the internal bleeding and/or reduces inflammation (so I do this right after training) and it makes sense that warming your muscle helps the recovery (so I do this the day after).

Do you guys have any tips of how to speed up the recovery even more? And is the method how I do it wrong?

Answer 1

Icing reduces swelling. That is the only reason to ice as far as I know. Swelling can inhibit the motion of joints and make the injury more painful. It may also take a long time to reduce back to normal levels. Icing is effective up to about 48 hours after the injury occurred. Basically, if it keeps swelling, then icing it will continue to help stop that swelling.

Warmth increases blood flow, which is involved with healing. So after the swelling stops being an issue, increasing blood flow will help healing. Exercise also increases blood flow, so that could also be beneficial, so long as you don't worsen the injury in doing so.

EDIT: Another way to reduce swelling is to strap the area using sports tape. This literally compresses area so that it cannot swell as much. The strapping can also help in stabilising joints, and I have used this technique with a rolled ankle which swelled a lot. Not too tight though!

Answer 2

Despite ice's enduring popularity and former recommendations for its use in RICE (rest, ice, compression, elevation) treatment, ice is no longer recommended for reducing inflammation or bruising. Gabe Mirkin, MD, who first coined the RICE mnemonic, explains on his blog dated Sept 2015 that ice delays recovery from injury. PhysicalTherapyWeb tells a similar story, with full article titles if you want to track references.

The summary is ice reduces inflammation in the short term, but impairs the healing process.

Answer 3

The things that help for me, or maybe I only thought they did, were:

• stretching and warming up thoroughly in the morning
• going for walks
• drinking plenty of water
• eating lots of quality food

In other words, the things we should be doing normally.

Answer 4

For me icing is the most effective. On the first two days, I iced bruised area for ten minutes. It keeps my bruised area from going black.

And I go jogging once a week. I feel that lots of minor injuries go away after running, since it helps blood flows.

Answer 5

I do gymnastics and I'm the worst on beam. What I do is I ice my bruises overnight, then let them rest and get warm until about 12 then ice it again.

Answer 6

All of these sound like "dirty hippy" solutions, but they work well for me!

• Epsom Salts - Take a warm bath with 0.5 - 1 cup of Epsom Salts added, soak injured section for as long as possible (may work in a cold bath, just never tried it).
• Arnica Cream - Use like "deep heat", rubbing the cream into the effected area.
• Cold showers/baths after training/injury. A lot of the pros are doing ice baths now, as it slows damage and aids in recovery (I've personally not been brave enough to try this).

I've got an injury to my hand now (low block to a shin) and the Arnica takes the sting from the bruise for half the day per application. Great stuff!

Answer 7

I haven't tried this myself, but a few of my friends who compete in Iron Man and the likes are big fans of compression clothing for use after training and competition. Supposedly it prevents the muscles from swelling up with blood, and reduces recovery time.

Might be worth a shot - http://www.2xu.com/product/239/Compression-Tight/12/296?set=us

Answer 8

What Is A Bruise

A bruise is a rupturing of the capillaries under the skin which causes blood to pool in the adjacent tissues. Swelling and increased pressure from the bleeding causes the firing of nerve endings in the area, which the brain translates as pain.

Treating a Bruise

Bruising heals in accordance with the severity of the damage to the tissues, and the aptitude of the human being in question to heal damage. For instance, consider two people receiving the same blunt force trauma to the same area; one may have a smaller bruise than the other due to increased genetic capacity to produce coagulating factors – this person will heal more quickly.

Standard treatment is RICE: Rest, Ice, Compress, Elevate.

• Rest - Decrease strain to the area. Continued pressure to the area will increase inflammation, which will prolong healing.

• Ice - Inflammation reducer; Recommended at 20 minutes per hour, with ice wrapped within a towel to prevent ischemia or frostbite.

• Compression - Prevents edematous swelling. Under normal circumstances, lymph fluid flows to the site to protect the injury. However, this can cause increased pressure, which increases pain and inhibits healing.

• Elevation - Elevating early will prevent additional blood from pooling at the site, minimizing pressure and appearance.

In addition, it is recommended that anti-inflammatories (preferably NSAIDs, never Aspirin) are used to reduce pain and swelling. Some topical creams, such as those containing mucopolysaccharide polysulfuric acid, retinol, or alpha hydroxy acids can help increase healing or reduce appearance of bruises.

Risks of Bruises

Bruising is often not a problem. However, part of being responsible in your practice and care is about knowing the risks.

Bruises are pools of blood, and therefore susceptible to clotting. Clotting can increase pressure in an area, causing nearby major blood vessels to receive additional pressure, effectively closing them off and preventing blood flow to other tissues; this is known as Compartment Syndrome.

Additionally, small blood clots can break away and be swept back into the blood vessels as an embolus, causing an obstruction to the blood vessel. Obstructions can lead to infarcts, in which the surrounding tissue is deprived of oxygen, resulting in necrosis.

Much as how any strike can be deadly, so too can any bruise. Caring for your body means prevention as much as treatment.

Answer 9

You should try keep your muscles in shape by doing light exercise without harming any damaged part (if it is the joint, then avoid exercise with impact. Walk and make rotations in water, or do exercise in the air with some weight attached to the leg). After some light training, take a rest until your tone gets normal. This is to check if all goes well. Depending on the results you may repeat this the next day, perhaps a bit harder.

Answer 10

I would like to throw in another view I found effective and, considering the explanation behind that, coherent:

A physiotherapist once told me that while cooling directly after the blunt trauma is of course important against the swelling, a different treatment should be considered afterwards.

As bruises include ruptures of capillaries, therefore an accumulation of clotted blood and potential local inflammations as pointed out by e.g. @stslavik, the treatment should be twofold.

First cooling down for a good minute at least, causing a contraction of the capillaries and tissue surrounding the injury. Directly afterwards, warming without compressing for about double the time. This - so I have been told - causes a comparatively explosive opening of the capillaries and tissue (more than mere warming), easing the flow of blood. The effect is therefore both that the clotted blood is washed away and blood flow in general is restored locally and that the white blood cells coming in with fresh blood can deal with potential inflammation better, allowing the body to remove the remnants of the trauma.

This should help better than warming from normal body temperature, which seems to be the standard treatment. Seems logical to me as the maximum temperature difference would be around 4-5 degrees Celsius before denaturation sets in, whereas with cooling beforehand it can be double the span.

This procedure should be repeated for about half an hour of change between cold and hot (not the other way round).

I know that I should support my writing with some science, but surprisingly, I couldn't find any regarding this exact procedure. She had learned it at a workshop for physiotherapists, so I guess there should be some, though. But I can only report very positive outcomes I experienced myself compared to treatments I used before.

Answer 11

Ice and heat are both about blood circulation.

When the injury first occurs, there is damage and there is bleeding at the site of the wound - either externally visible or internally. Ice, while the injury is still bleeding, reduces the blood flow, and reduces the amount of blood lost to the injury, which reduces initial swelling/inflamation/bruising.

Once that initial trauma starts to heal and stops bleeding, then increased blood flow helps the body to speed the healing process and to gradually cycle out dead blood and tissues from the injured site, so heat is then recommended.

When I've had muscle pulls/tears, very aggressive icing for the first 24 hours to a day and a half made a huge difference in the amount of swelling and inflammation, and, consequently, the speed of recovery.

Once your body is in recovery mode, that bruise or dead blood doesn't really offer anything useful to the body. You body gradually cycles it out, but I notice, personally, a lot of overall aches and discomfort in my whole body, which I anecdotally attribute to the fact that all that "trash" the body is trying to clean from the injury site basically travels throughout by body as it is carried in the bloodstream.

Methods of extracting the bruise/pooled blood, artificially, can be helpful, but these methods are not considered to be scientifically proven, as far as I know. "Cupping" and, even, leeches, would be methods to facilitate this.

Answer 12

FAIL! After writing all this, and cycling too hard, it seems to me that I have been failing really badly in treating my haematoma and by exercising so much have caused ongoing bleeding. I am now not using my leg at all.

Addendum: my thigh is heeling really slowly so all the below should be treated with caution.

I have 'karate thigh' right now. I should have blocked or used neko-ashi stance or something, but now I am faced with treatments which are as the OP says vague but I agree with what the OP says: cooling straight afterwards to reduce initial haemorrhaging, warming after once haemorrhaging has stopped.

I am not a doctor and the following items are not medical advice. Hematoma's can lead to calcification, and deep vein thrombosis resulting in disability and death respectively. Several of the items below may increase the chance of these dire outcomes.

Also 1) A full on Japanese karateka recommends strapping lower leg to thigh that night. If you can do this then you will likely be able to extend your leg the next morning but if you sleep with straight leg, and in general, the problem is the inability to bend at the knee. However, strapping the lower leg to the thigh while there is still damage to the veins sounds like it could be dangerous, leading to DVT and death.

2) There are Chinese herbal potions such as Zheng Gu Shui　which I have not tried but are available cheaply though the internet. I don't know what they do but I have ordered some. It arrived. It smells a bit like Vicks Vaporub (eucalyptus) and has a similar anaesthetic efficacy to Japanese poultices. It works better on the superficial bruises to my ribs.

3) Stretching and or exercise such as swimming, jogging and cycling are generally recommended so long as you are not going to increase /re-start haemorrhaging. That said, at least one poster has suggested that exercise can increase one of the worse outcomes - the blood turning to bone. Still, I am cycling.

4) Blood letting while still liquid, or injecting blood thinners (e.g. heparin) and then blood letting, or surgery is used. The haematoma YouTube videos are gross! I am going to try natural for a while longer but there are people saying that getting the blood drained before it clots works for a lot quicker recovery. I may go to a hospital to discuss this if my leg does not get better in a week or two and immediately post trauma should it happen again. I did go to a hospital but was told that no local hospital would perform this operation unless the hematoma had solidified and required surgery.

5) I have found that using my heated shiatsu massager (like a spring tipped soldering iron with the diameter of a banana) can work the gunky blood around in my leg to get it fluid enough to allow (3). These are cheap on auction in Japan https://goo.gl/td34HL This continues to work well. Massage at room temperature takes longer. When I am not near my heated massager I put hot water in a PET bottle and massage myself with that.

6) Pain killing poultices such as generally sold for muscle pain in Japan (Banterin etc) are minimally effective in what they say they do but may help (3).

7) When I was dehydrated with a hangover my leg froze solid, so not boozing and fluids are a (no brain?) good idea.

8) For bruises some are recommending natural blood thinners, such as onion and garlic. I like onions so I am doing that. Aspirin might also be an idea as it thins blood as it reduces pain.

9) There are haematoma taping videos on YouTube. I have not tried (other than the compression with icing immediately after the strike). I have now tried taping, immitating the kinesio taping videos on youtube, using a tape in a hand with long fingers shape. This may help to reduce the effect of gravity (see 11 below) as does a simple bandage compression.

10) Bromelain as found in pineapple and some meat tenderisers can be applied topically. I have not tried this either.

11) Elevation seems to help since otherwise gravity puts the jello blood sludge in one place where it fills the gap between the muscles and thus restricts movement. This may natures way of getting the injured to lie down. I find that lying with my thigh vertical helps improve mobility. I could ride my bike againt after 15 minutes of digital cold vertical thigh massage, as opposed to about half that with my hot massager seated. Conversely after a few minutes of standing, at a convenience store mid ride for instance, it becomes difficult to ride again.

I repeat, I am not a doctor, the above is not medical advice and may kill you.

Here below is the video version of the above, which it may not be appropriate to post (if so please remove, or tell me and I will) https://www.youtube.com/watch?v=lyioOwbXEGI

Answer 13

Arnica cream works well; it brings out the swelling faster and hence makes the bruise go away quicker.