Muscle Injuries in Youth Soccer: The "Dead-Leg"
How many times have we heard the expression “It’s only a dead-leg, just run it off”? The answer is far too often in my opinion.
The statement that you can just run off a ‘dead leg’ is one of the most inaccurate phrases used in football and is also one of the most common myths in soccer. It’s an out of date saying that has been used for years and has no place in the sport today.
A proper ‘dead-leg’ can be a serious injury and players often end up in hospital as a result so it’s not an injury to be taken lightly.
What Exactly is a Dead-Leg?
A dead-leg is another name for a bruised muscle, or contusion in medical terms. The expression ‘dead-leg’ comes from the accompanying numbness which often results from muscle contusions, leading to altered skin sensation.
In most contact sports, particularly in soccer, the front of the thigh is the most common area to sustain a contusion as a result of a direct blow.
The injury commonly referred to in touch-line language as a dead-leg is simply a contused thigh muscle, which can lead to the formation of a haematoma – or pooling of blood - in and around the affected tissues.
This can be an incredibly painful injury. A thigh contusion normally occurs as a result of direct contact injury sustained to the muscles of the front of the thigh. These muscles are known collectively as the quadriceps, or ‘quads’ for short, because as a group there are four muscles that act as a unit to actively straighten the knee.
In fact, one of the four quads, the muscle known as the rectus femoris, is generally referred to as ‘the kicking muscle’ since that is what it effectively does. The rectus femoris muscle (named because of it’s action in ‘raising the femur’ or thigh bone) is a long powerful muscle that flexes the hip and straightens the knee. This is exactly what happens with the kicking action.
Because most tackles in football will come from the front, the thigh is a sitting duck for contact injuries. Often, a simple bruising will be nothing serious, but occasionally thigh contusions – aka dead legs – can result in serious complications.
When a muscle sustains an impact strong enough to result in a contusion some bleeding will occur. This bleeding leads to a collection of blood at the injury site, known as a haematoma, and most muscle contusions normally result in haematomas because the force of the direct impact leads to bruising in the affected area. The damage caused to the small capillaries leads to the blood tracking around and into the muscle tissues themselves.
Thus, when a direct blow is sustained to a muscle the injured muscle will bleed. The problem with thigh contusions lies in differentiating whether the actual injury site is on the peripheral surface of the muscle or if the bruising is contained deep within the muscle itself.
What Type of Muscle Injury Do I Have?
If the bruising and subsequent haematoma is contained within the muscle tissue itself, then this can be a serious injury and may lead to surgery or require surgical aspiration of the fluid. With the common type of thigh contusion injury, the bruising / contusion is situated on the outside of the muscle, and gravity will allow the haematoma to drain away naturally over the next few days.
This bruising will be evident within a few hours of the injury being sustained and generally looks a worse than it usually is; often tracking further down the leg in a nice black, yellow or dark blue colour, and will be accompanied by pain and limitations of movement.
Attempting to bend the knee will be sore, and walking might be difficult.
This is the usual scenario with thigh contusions and the injury is known as an ‘intermuscular haematoma’. The intermuscular bit comes from the bruising being on the surface of the tissues in between adjacent muscles; this allows for the haematoma to drain away naturally.
As stated earlier, though, the danger lies if the injury results in the bleeding taking place within the tissues of the injured muscle itself. This is known as an ‘intramuscular haematoma’ and results in the blood pooling being trapped within the actual muscle.
In this case, there is nowhere for the blood / bruising to drain away to since the injury lies within a confined space. This is a potentially serious injury and if the bleeding results in an increase in swelling leading to pressure on the actual muscle tissues, then as we said, surgery can be required to release that pressure.
Since an intramuscular haematoma arising as a result of bruised and damaged tissue is confined within the muscle itself as opposed to being superficial between adjacent muscles, this means that any increase in swelling will simply lead to increased internal pressure.
The standard presentation of an intramuscular haematoma is one of a warm, swollen thigh muscle with minimal surface bruising evident. It may be possible to feel the fluid with your hand as the injured area will look and feel different to the unaffected leg, and the whole area will be painful.
Movements will hurt and the player isn’t going to want to let anyone touch it; even the pressure of applying an ice-pack can lead to more pain. The swelling arises from the amount of blood collected in the injured area, and this can be quite considerable.
It’s when that swelling continues to increase in the few hours immediately after the injury has been sustained that it can become obvious that we are not dealing with a straight-forward thigh bruising.
How Should I Treat These Types of Injuries?
Massage and heat treatments are strongly contradicted in the case of an intramuscular haematoma. Any attempt to massage the affected area or apply heat to the injured tissues will simply result in an increase in symptoms and may lead to potential surgery.
This follows the principles of immediate management advising that ice should be used to relieve pain and limit swelling as opposed to applying heat, since heat will lead to an increase in swelling. With this kind of muscle injury any attempt to “run it off” or exercise will only lead to further bleeding since any increase in body temperature will lead to even more heat and increased blood flow in and around the injured tissues.
Further complications can arise if you attempt to return to play or exercise too quickly after the injury has been sustained. In some cases, bony calcification of the injured tissue as a result of blood remaining pooled in the affected areas can occur and this is known as a ‘calcified haematoma’.
It’s one of the most common injuries sustained in adult football but can occur in youngsters as well. Lots of older, retired, professional players have had these over the years and the effects are there to see in terms of limitation of movement and distortion of the muscles, often as the result of trying to come back to play too soon before the original haematoma has had the time to become absorbed and dispersed naturally through the body's own healing process.
The conditions resulting from a calcified haematoma is known in medical terms as ‘Myositis Ossificans’; and shows on a plain x-ray of the thigh as an obvious mass in the muscle tissue.
So although a bruised or contused thigh is a relatively common injury in soccer, the problems lies with the actual location of the injury; and whether the resultant haematoma is deep or superficial to the muscle tissues.
Why You Can't Just Run It Off
The popular misconception remains that you can simply “run these off”; but as we’ve attempted to explain, this isn’t always the best idea.
If the bleeding is superficial and appears almost immediately after the blow, then in most cases the injury will be superficial and could technically be ‘run off’, although pain and limitation of movements accompany these injuries for a reason.
To clarify, therefore, severe bruising of the thigh muscles can result in two different presentations; the haematoma arising as a result of the injury will either be superficially to the surface area of the muscles; or deep in the muscle, which results in the bleeding remaining within the tissue and unable to clear naturally.
So if the injury has been sustained a few days ago and the thigh muscle still continues to swell, it becomes difficult to bend the knee, and / or the injury feels warm despite applying ice etc; then further medical opinion is needed.
Enforced rest is required plus examination by a physician if the symptoms of deep muscle bruising are not easing within 48 hours after injury.
This is the kind of ‘dead-leg’ that you simply can’t just “run off”.
Gerry Delahunt is a sports physiotherapist residing in England.