Corkies – what is it and how are they managed?
What is a corky?
A corky, also known as a muscle contusion, is a bruise in your muscle caused by a direct hit from a blunt object. Corkies are second only to strains as the leading cause of sports injuries and commonly occur in contact sports. Strong forces such as falling on the ground or being tackled can lead to corkies.
Most muscle contusions are minor and heal quickly with at-home treatment. However, severe bruises can cause deep tissue damage which can take several months of rest to recover.
Signs and Symptoms
Common characteristics of a muscle contusion include:
● Pain and swelling
● Skin bruising
● Weakness or stiffness in the injured muscle
● Difficulty moving your joints near the site of injury
Additional injuries may occur from a high intensity trauma, such as:
● Muscle haematoma (buildup of blood in your muscle tissue)
● Sprain
● Dislocated joint
● Muscle strain
● Broken bone
● Damage to internal organs if hit in the abdomen
Figure 1. Quadriceps muscle contusion
Figure 2. Muscle haematoma
Pathophysiology (the disease process)
The injury follows a sequence of events:
1. A blunt object strikes a part of the body, crushing the underlying muscle fibres and connective tissue without breaking the skin.
2. Small muscle fibres tear at the site of injury, leading to bleeding and swelling in the muscle.
3. Scar tissue will slowly replace the damaged muscle fibres, followed by muscle regeneration.
Complications
Other complications may arise if the muscle contusion is severe or improperly treated:
● Myositis ossificans: This is when bone forms inside your muscle or other soft tissue, leading to the development of a painful, tender lump. It sometimes occurs when athletes try to rehabilitate a contusion too quickly, resulting in the body producing bone cells instead of muscle cells in an attempt to heal itself.
● Compartment syndrome: This is when dangerously high pressure builds up inside the muscles from internal bleeding or swelling. The high pressures decrease blood flow which prevents oxygen from reaching the nerves and muscle cells. Symptoms include severe pain, sensation of pins and needles, and weakness in the affected area.
How are corkies diagnosed?
A corky is usually caused by being kicked, kneed, tackled or falling onto the ground. A sharp pain is usually felt immediately after and may be associated with swelling, loss of motion and reduced function.
Our physiotherapists will take a comprehensive history and physical exam to diagnose the muscle contusion. The physical exam will include:
● Feeling the length of the injured muscle for any defects and locating the area of maximal tenderness
● Assessing muscle strength, range of motion and flexibility
Our physiotherapists may also order imaging such as an ultrasound or MRI if more detail is required to determine the location of the muscle contusion. X-rays can also be used to differentiate a contusion from bone-related issues such as stress fractures, tumours or myositis ossificans.
Physiotherapy Interventions
Acute Stage:
Right after the injury, inflammation and bleeding in the muscle should be controlled by following the RICE protocol for the first 48 hours:
● Rest: Stop or reduce your activities to prevent further injury. You may use assistive devices for extra support e.g. sling, crutch.
● Ice: Use a cold pack for 20 minutes at least 4 times a day. Do not apply ice directly onto the skin.
● Compression: Lightly compress the injured area with a bandage or wrap to reduce swelling.
● Elevation: Raise the injured area at or above the level of the heart to reduce swelling.
Your doctor may give you nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for short term pain relief. Do not massage the injured area within the first 72 hours.
Mild contusions tend to heal quickly on their own, but more severe contusions may require a rehabilitation program with a physiotherapist.
Rehabilitation Stage:
Rehabilitation begins approximately 3 to 5 days after the initial injury once the pain, inflammation and swelling has started to decrease.
● Gentle stretching
○ Should be done to the point of discomfort but not pain
○ Aim: To alleviate stiffness and improve range of motion
● Resistance exercises
○ Can begin gradually with isometric exercises and progress to isotonic exercises.
○ Aim: To strengthen the muscles and tendons
● Functional and sport-specific activities
○ Can begin when pain-free active range of motion is attained
○ Aim: To improve the performance of everyday movements and facilitate a return to sport.
Return to Sports
References
Alessandrino, F., & Balconi, G. (2013). Complications of muscle injuries. Journal of ultrasound, 16(4), 215–222. https://doi.org/10.1007/s40477-013-0010-4
Ishøi, L., Krommes, K., Husted, R. S., Juhl, C. B., & Thorborg, K. (2020). Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport – grading the evidence: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). British journal of sports medicine, 54(9), 528–537. https://doi.org/10.1136/bjsports-2019-101228
Kary J. M. (2010). Diagnosis and management of quadriceps strains and contusions. Current reviews in musculoskeletal medicine, 3(1-4), 26–31. https://doi.org/10.1007/s12178-010-9064-5
Mulcahey M. K. (2019). Muscle Contusion (Bruise). OrthoInfo. https://orthoinfo.aaos.org/en/diseases–conditions/muscle-contusion-bruise/#:~:text=Contusions%20occur%20when%20a%20direct,body%20against%20a%20hard%20surface.
Rhodes J.T., & Tagawa A, & Coomer W, & Skinner A, & Miller S, & De S (2022). Orthopedics. Bunik M, & Hay W.W., & Levin M.J., & Abzug M.J.(Eds.), Current Diagnosis & Treatment: Pediatrics, 26e. McGraw Hill. https://accesspediatrics.mhmedical.com/content.aspx?bookid=3163§ionid=266222940
