Last Updated on Thursday, 31 January 2013 10:20
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: Last week while going down to stop a puck at the point, I got hit in my thigh. I am having trouble bending my knee and my thigh is swollen. What can I do to speed my return to playing hockey?
Answer: It sounds like you have experienced a severe bruising on the front of your thigh, an injury called “quads contusion.” These injuries are very common in ice hockey, especially in defensemen. They are most often due to a puck hitting the thigh, which causes bleeding into the quadriceps muscles.
The quadriceps muscles are the main muscles on the front of your thigh. They attach to the kneecap and when they contract they straighten out your knee and lower leg. They are among the strongest muscles in the body and are relied upon heavily in playing ice hockey. When they are hit by a fast moving puck, a portion of the muscle belly can be crushed and lead to significant amount of bleeding into the muscle.
To decrease the bleeding and speed recovery, you must apply ice and compression immediately. When ice is applied to a quads contusion, it should be applied directly over the area of the injury for approximately 20 minutes out of each hour. This helps to decrease the amount of bleeding by constricting the blood vessels. Compression should be applied continuously with an elastic wrap, which reduces the space available for blood and fluid to accumulate in. If one can limit the amount of bleeding and swelling, it will allow for a quicker return to hockey.
One other important aspect in treating quads contusions is to keep the knee in a bent position immediately after the injury to prevent stiffness. You should bend the knee back to at least 120 degrees of knee flexion and wrap it in this bent position with a compression wrap as much as you can tolerate for the first 12-24 hours. Although this can be uncomfortable, we believe it is essential to do this in order help maintain the knee’s normal range of motion. If one ices and wraps their knee when the knee is out straight, the knee will become stiff and it will be hard to get back to skating activities until the stiffness is worked out.
Once you get your full quadriceps strength and knee motion back, you can return to playing hockey. In minor cases, this may be in a day or two. In more severe cases, a skater may need to be on crutches for a few days until he can walk without a limp. For those athletes who need to cross train before they get back to on-ice activities, they should work on activities which maintain their aerobic and anaerobic endurance. We do this by having our athletes jog in a pool or work on an exercise bike as tolerated.
In the vast majority of cases, quads contusions respond very well to a program of icing, wrapping, and bending the knee as much as possible starting immediately after the injury. In those cases in which the athlete may not get full motion and strength back within the first few days, an evaluation by your team physician may be indicated.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it toeditor@letsplayhockey.com.
