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Dead Leg (Charley Horse)

What is a dead leg?


A dead leg occurs when a hard impact causes the thigh muscle to be crushed against the femur (thigh bone). This results in a contusion or bruising on the thigh bone.

The injury sometimes goes by the name of ‘quadriceps contusion’ or is known colloquially as ‘a Charley horse’. Injuries are graded from one to three and can result in little more than numbness all the way to a debilitating injury. Ultimately, this leads the leg to be unable to support body weight.

A dead leg is often regarded as a minor injury. However, correct diagnosis is necessary, with appropriate treatment to be applied immediately. Commonly with an injury associated with sports, if an athlete attempts to play on, or undertakes exercise too soon without a correct diagnosis then delayed healing can be caused and, in the worst case scenario, permanent damage.

Contusions in a dead leg can be intermuscular or intramuscular, with treatment depending on the level of injury and the type of contusion.

Intramuscular contusions are the result of a tearing of the muscle within the sheath that surround it. While initial bleeding may stop early within the first few hours of injury, fluid is unable to escape as the muscle sheath prevents it. Intramuscular contusions result in a considerable loss of limb function and a level of pain that can take anywhere from days to weeks to recover. With intramuscular contusions, the risk of bruising is low.

Intermuscular contusions are the result of a tearing of the muscle and a portion of its surrounding sheath. While initial bleeding in this form of contusion will take longer to stop, especially when not iced, the recovery is often faster as the blood and fluids are able to flow away from the site of injury through the tear in the muscle sheath. With intermuscular contusions there is an increased likelihood that you will see bruising occur.

Symptoms


Symptoms of dead leg are often first recognised as pain felt at or near the area of impact. While often dead leg will stop you from playing sports immediately, for some you may be able to continue participating for a short while. However, as your muscles begin to cool down and your body temperature lowers, the pain felt from dead leg may begin to increase. This increase in pain is a result of the bleeding and swelling that continues after the event has occurred.

In addition to pain at the site of impact, those suffering from dead leg may also experience a sense of tightening and stiffening in the quadriceps.

Additional Symptoms of Dead Leg May Include:

• Mobility Issues
• Reduced Movement Range
• Muscle Spasms
• Muscle Cramps

Grades of Thigh Contusions


Grade 1 - thigh contusions usually feel a sense of tightness in the thigh that can often cause the patient to walk with a limp. With Grade 1 contusions the likelihood of swelling is low and straightening the knee is not likely to produce much pain. Patients with Grade 1 contusions usually maintain a full range of motion when stretching out their muscle.

Grade 2 - thigh contusions often affect the patient's ability to walk properly. Patients with Grade 2 contusions will often feel sudden sharp pains especially during activity, and it is possible that they will experience some swelling and straightening of the leg as it works to resist the pain from the contusion. Pressure on the injured area is likely to be painful and the knee will not be able to fully bend.

Grade 3 - contusions often mean the patient will be unable to walk without the assistance of crutches. Grade 3 contusions cause severe pain and significant swelling is likely to appear immediately after injury. Patients with Grade 3 contusions will likely notice a visible bulge or gap in the muscle when flexing. This level of contusion can take 3 to 12 weeks to heal fully.

Treatment


Whatever the level of injury, the PRICE principles of treatment are best applied. These are:

  • Protection
  • Rest
  • Ice
  • Compression
  • Elevation

Treatment should be applied as soon as possible after the injury is incurred.

Ice and compression can be applied immediately, with ice re-applied for ten minutes every two hours for up to three days. This will help to reduce internal bleeding, swelling, and pain. The leg should be elevated to allow tissue fluids to drain away from the area. A compression bandage will offer support to the injury and further reduce swelling.

Misdiagnosis can be dangerous, and so assessment should be carried out by a competent professional. A complete rupture of an intramuscular injury can occur if the leg is used for exercise or sport too quickly, and this can lead to a permanent disability.

Myositis Ossificans can result if heat is applied inappropriately. This is characterised by bone formations within the injured muscle and can be a very serious condition which requires expert medical examination and attention.

A dead leg can also be treated by a sports doctor or similar with the application of ultrasound which speeds up recovery. A rehabilitation plan for a more serious case is also a good idea, to ensure that pressure is not applied to the damage before it has had a chance to adequately heal. As little pressure should be put on the injury as possible prior to proper assessment. Furthermore, the use of crutches may be necessary.

How long does a dead leg take to heal?


charley horseThe speed of recovery depends on the extent of the injury. For a grade one injury, recovery will be quite rapid with stretching possible soon after diagnosis and recovery likely within one to two weeks.

A grade two injury can take two to four weeks to recover, sometimes longer. Pain lingers, and it will be difficult for the patient to walk properly. Twinges are likely, and straightening the leg will be hard.

When the injury is at the most serious, Grade 3 level, then the patient will suffer severe pain and have significant and immediate swelling. It is likely that a recovery of time between three and twelve weeks will be necessary.

Recovery


For Grade 1 contusions, strengthening exercises can be performed to help rebuild muscles as soon as the person no longer feels pain. It is recommended that you begin with easier exercises and progress at your own comfort level with more difficult exercises being introduced as the recovery process progresses.

For Grade 2 contusions, it may be over a week before strengthening exercises can be started. It's important to warm-up before beginning any strengthening exercises and finish with a long stretch to ensure you are keeping your muscles healthy. Strengthening exercises should likely be continued for weeks or until the injury has fully healed.

If you are unable to continue with your regular athletic training, cycling and swimming offer alternatives that still allow you to build and maintain leg muscle. If these exercises are too strenuous on your injury it is recommended to focus on upper body strength building while you heal instead.

 

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