Back Pain Doctor
Muscle Contusion (Bruise)
Written by Dr Joshua Hatch, Musculoskeletal GP, RACGP Fellow, Diploma in Musculoskeletal Medicine (FSEM UK).
A muscle contusion happens when a direct blow, or repeated blows, from a blunt object crushes muscle fibres and connective tissue without breaking the skin. Small blood vessels tear and bleed into the muscle, producing swelling, pain, stiffness and the familiar discolouration at the surface. Sometimes the blood pools into a discrete haematoma, felt as a lump. Contusions are among the most common injuries in contact sport, and also occur from falls or jamming a limb against a hard surface.
Assessment focuses on the location and depth of the injury and on what else may have been damaged. A fracture, dislocation, sprain or muscle tear can accompany a significant blow. Most limb contusions are diagnosed clinically without imaging. A blow to the chest or abdomen is a different matter and needs prompt assessment for internal organ injury. A lower threshold for review applies to people taking anticoagulants, to older people after a fall, and to anyone bruising unusually easily.
First-line care is relative rest, ice, light compression and elevation for the first day or two, with the muscle held in gentle stretch, plus simple analgesia. Massage is avoided. Gentle stretching begins early to preserve flexibility, followed by graded weight-bearing and strengthening as pain settles. Most people recover well; a large haematoma that has not resolved after several days may need draining. Persistent pain, a firm enlarging lump, or severe pain with numbness or circulatory changes should be reviewed promptly.
Common symptoms
- Pain and swelling after a direct blow or fall
- Bluish discolouration of the overlying skin
- Stiffness and weakness in the injured muscle
- A firm lump where blood has collected (haematoma)
Commonly seen in
Evidence for twelve treatment options in muscle contusion (bruise)
This is not a fixed ladder or a package of treatments. Every option is assessed independently against this diagnosis, including treatments with limited direct research that may still be reasonable for a clearly defined tissue target. The evidence level, likely benefit, risks, cost and alternatives are weighed at consultation.
Foundation: diagnosis, education and rehabilitation
The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.
Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care
What it involves
Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan, with weight management where that is clinically relevant.
What the evidence shows
Move it, within reason, rather than rest it. Pooling 22 studies, functional treatment beat immobilisation on return to sport, return to work, swelling, range of motion and patient satisfaction (Kerkhoffs, Arch Orthop Trauma Surg 2001). An overview of 46 systematic reviews found strong evidence for early mobilisation and moderate evidence for exercise (Doherty, Br J Sports Med 2016), and the international guideline prefers supervised exercise over passive modalities, reserving surgery for those who do not respond (Vuurberg, Br J Sports Med 2018). Exercise-based rehabilitation roughly halves the odds of doing it again within twelve months (Wagemans, PLoS One 2022). One caveat: in 503 patients with simple grade 1 to 2 ankle sprains, adding supervised physiotherapy to good advice produced no clinically important benefit (Brison, BMJ 2016).
Pairing reviewed 2026-09-02.
Where it fits
For a straightforward sprain or strain, clear advice and a graded return are usually enough, and you do not need to buy a course of anything. Supervised rehabilitation earns its place where the injury is more severe, where it keeps recurring, or where the demands you are returning to are high.
Muscle and symptom-modifying options
Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.
Wet needling and trigger point injection (trigger point injection) A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. No study in this condition
What it involves
The needle is placed into the tender muscle band and a small volume of 5% glucose with a very dilute local anaesthetic (0.02-0.08%) is injected. Often done in the same visit as your assessment, and usable where the tender area sits deeper. Dry needling (the same technique with nothing injected) is not offered here.
What the evidence shows
Searched 3 November 2026 (PubMed: trigger point injection, wet needling, trigger point, lignocaine or local anaesthetic injection with muscle contusion, muscle strain or muscle injury, 18 records; and a randomised-trial and systematic-review pass, 12 records). No human study of trigger point injection, wet needling or any injection into muscle after a muscle bruise was found; the contusion and muscle-injury records returned were laboratory animal studies.
Pairing reviewed 2026-11-03.
Where it fits
Not part of early care for a fresh muscle bruise, which is protected movement and graded loading. Considered later only where a tender band persists and is limiting rehabilitation.
Ultrasound-guided injections Guidance means the needle can be seen reaching the target. What goes into the needle depends on the diagnosis. Series without outcome figures
What it involves
The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis, and corticosteroid is used sparingly, for the reasons set out below.
What the evidence shows
Searched 8 November 2026 (PubMed: muscle, thigh or quadriceps contusion and muscle haematoma with corticosteroid or anaesthetic injection, or with ultrasound-guided injection, aspiration or drainage, 39 records across two searches; and a randomised-trial and systematic-review pass, which found no trial). No controlled study exists. A radiology department's 18-year experience of 128 ultrasound-guided drainages and injections in 69 American footballers, including contusions and haematomas, describes the procedures as safe but reports no outcome figures (Dave, AJR Am J Roentgenol 2014). In Australian professional rugby league, local anaesthetic injected so that players could keep playing with iliac crest bruises was among the injections players rated most highly and appeared safe at an average of five years, in a retrospective survey that did not measure recovery (Orchard, Am J Sports Med 2010); that is pain relief to play, not treatment of the bruise. Local anaesthetic injected into muscle damages muscle fibres (Reurink, Sports Med 2014).
Pairing reviewed 2026-11-08.
Where it fits
Not a treatment for a fresh bruise, which settles with protected movement and progressive loading. A guided procedure, such as draining a collection, is considered only where ultrasound shows a large haematoma that is holding back the rehabilitation program.
V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Plausible: no studies
What it involves
A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.
What the evidence shows
No published clinical trial of this device in this condition. It is a vibration handpiece delivered from the same console as radial shockwave, and the rationale is myofascial rather than tendon- or bone-directed.
Pairing reviewed 2026-08-30.
Where it fits
A comfort measure used within a session where muscular tightness is limiting movement. Never the reason for the appointment, and not a substitute for the treatments that do have evidence.
Energy-based treatment options
Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.
Radial or focused shockwave? Read the overviewRadial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Not for a fresh bruise
What it involves
A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue, including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.
What the evidence shows
No trial has tested shockwave of either device for a fresh muscle contusion. Where shockwave has been used after a muscle bruise is in its calcified complication, myositis ossificans, and with the other device: 24 sportsmen given three sessions of electrohydraulic (that is, focused) shockwave with a rehabilitation programme showed only partial shrinkage of the bone formation on X-ray, but normal range of movement and no weakness by two months, and 87.5% were back to regular sport at three months (Buselli, Ultrasound Med Biol 2010). Uncontrolled, and a different device from the one this row describes.
Pairing reviewed 2026-09-25.
Where it fits
Not part of managing a fresh bruise, where the priorities are excluding compartment syndrome, restoring movement and graded loading. Relevant only if the bruise calcifies and stays painful, and that is a question about the focused form rather than this one.
Focused shockwave (ESWT) A true shock wave converging at depth: for tendon, joint, ligament and bone. Calcified bruise only: one series
What it involves
A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form used for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.
What the evidence shows
Searched 21 October 2026: shockwave terms with muscle injury, strain, tear, lesion, contusion or myositis ossificans in humans (25 records) and a trial and review pass (18). No trial has tested focused shockwave for a fresh muscle bruise. In a series of 20 muscle injuries in professional footballers treated from the day of injury, one buttock bruise was treated with a focused device and the rest with radial, with no comparison group (Morgan, J Orthop Surg Res 2021). The use with some evidence is the calcified complication, myositis ossificans: 24 sportsmen given three sessions of electrohydraulic shockwave, a generator type that focuses its energy, with rehabilitation had normal movement and no weakness by two months and 87.5% were back at sport by three, though the bone formation only partly shrank on X-ray (Buselli, Ultrasound Med Biol 2010; uncontrolled). Shockwave has also been reported as the cause of myositis ossificans in the back muscles, in one case report (Han, Medicina 2022).
Pairing reviewed 2026-10-21.
Where it fits
Not part of managing a fresh bruise, where the priorities are excluding compartment syndrome, restoring movement and graded loading. Relevant only if the bruise calcifies and stays painful, alongside rehabilitation.
EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Usually painless, no contact. Plausible: no studies
What it involves
You sit with the applicator positioned over the area for a short session. It is usually painless and needs no gel or skin contact. It is usually given as a course, commonly alongside shockwave.
What the evidence shows
There are no published randomised trials of EMTT in this condition, or in any musculoskeletal condition, that could be identified. The supporting work is laboratory work: EMTT increased tenocyte proliferation, migration and collagen expression in cultured human tendon cells (Mancini, Int J Mol Sci 2025). The nearest human evidence for a related electromagnetic therapy is negative. A randomised trial of pulsed electromagnetic field therapy added to eccentric exercise for Achilles tendinopathy found no improvement in outcome scores or tendon neovascularity over eccentric exercise alone (Ko, Orthop J Sports Med 2024).
Pairing reviewed 2026-08-30.
Where it fits
Offered only as an adjunct alongside treatment that does have evidence, never as the plan itself, and only after that gap is explained. Much of the EMTT literature is manufacturer-affiliated, which is part of why it is described this way.
Biologic and joint injection options
Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.
Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Not offered for this
What it involves
Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.
What the evidence shows
Not tested in a muscle bruise in people. A search for PRP in muscle contusion, muscle haematoma and myositis ossificans returned eight records: six animal experiments, which disagree with one another, and two reviews, with no clinical study. In the animal study built around muscle function, PRP injected into a bruised rat calf made no difference to strength or healing, and its authors advised against recommending it until clinical studies exist (Delos, Am J Sports Med 2014). The nearest human trial is of a different injury: 71 people with a leg muscle tear and a collection of blood that was drained, in whom recovery took 32 days with PRP and 38 with a dummy procedure, a difference that could have been chance (Martinez-Zapata, Blood Transfus 2016). There is also a reason for caution. The complication to avoid after a deep muscle bruise is bone forming inside the muscle, and at one surgical centre that complication was seen far more often in athletes with groin muscle injuries who had been given PRP, including 22 of 28 professional American footballers against none of 28 matched players. That is an observation from one centre, not proof that PRP caused it (Poor, Am J Sports Med 2024).
Pairing reviewed 2026-10-10.
Where it fits
Not offered for a muscle bruise. These injuries are monitored and rehabilitated. A bruised muscle has already bled into itself, so an injection of concentrated platelets is unlikely to add to what is there. Early protection, then restoring movement and strength, is what changes the outcome, and extra bone forming in the muscle is the complication to avoid.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. Only if relevant
What it involves
Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.
What the evidence shows
No human trial has tested prolotherapy in muscle contusion, and the animal work points both ways. Dextrose reduced muscle damage markers and promoted satellite-cell regeneration in a mouse contusion model (Tsai, Int J Med Sci 2018), while a rat muscle-injury model reported a prominent inflammatory reaction with necrosis and excess connective tissue, and the authors advised against using it for muscle injuries (Kunduracioglu, Neurosciences 2006). Reviews of orthobiologics for muscle injury report no high-level clinical evidence (Droz, Clin Sports Med 2024).
Pairing reviewed 2026-09-05.
Where it fits
Not offered for a bruised muscle. The concern with injecting an injured muscle is added scar, not just absent benefit. Management is protection early, then graded loading.
Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. Not used here
What it involves
One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.
What the evidence shows
Untested in people. A search pairing hyaluronic acid with muscle injury, muscle strain, muscle tear, calf strain, hamstring injury, tennis leg and contusion terms returned 39 records. Twenty-five were animal, hydrogel, scaffold or spinal cord studies, and none of the other 14 was a trial of hyaluronic acid for a muscle injury. The nearest were a single case of a torn adductor muscle given hyaluronic acid together with platelet-rich plasma (Giannini, J Sports Med Phys Fitness 2023) and a review of injections in professional footballers, which gives hyaluronic acid a role only for cartilage injury (Jader, Int Orthop 2024). The only record about treating a bruise used the opposite agent: hyaluronidase, an enzyme that breaks hyaluronic acid down, injected into facial bruising after injury in an uncontrolled report (Han, Arch Craniofac Surg 2018). No study has injected hyaluronic acid for a muscle contusion.
Pairing reviewed 2026-10-05.
Where it fits
Not offered for an acute muscle injury. A contusion settles with early protection, then graded movement and loading.
Nerve-targeted options
Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve, not simply because pain is present.
Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. Only if relevant
What it involves
Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.
What the evidence shows
No study has tested small dextrose injections under the skin for a bruised muscle. Searching the perineural injection, neural prolotherapy, subcutaneous dextrose, glucopuncture and neurofascial terms against contusion, muscle injury and muscle tear returns no treatment study of any design, and widening to any dextrose or prolotherapy injection finds no human study of a muscle contusion. Reviews of injection treatments for muscle injury report that high-level clinical evidence is lacking (Droz, Clin Sports Med 2024) and that the few clinical studies are inconclusive (Stephens, Phys Med Rehabil Clin N Am 2023). The one report of a skin nerve trapped after a direct blow is a 31-year-old with nerve pain down the inner shin fifteen years after being struck on the leg. An ultrasound-guided fluid injection around the saphenous nerve gave complete but temporary relief, and surgery was needed to free it (Henderson, J Orthop Case Rep 2025). That is hydrodissection rather than this treatment, and it is one case.
Pairing reviewed 2026-10-06.
Where it fits
Not offered for a bruised muscle. Management is protection early, then graded loading. Considered only if a patch of tender, hypersensitive skin or nerve-type pain remains long after the bruise itself has gone.
Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Only if relevant
What it involves
Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.
What the evidence shows
Searched 10 November 2026 (PubMed: hydrodissection, hydrorelease or perineural injection with contusion (5 records, none a bruise) and with Morel-Lavallée lesion, thigh contusion or myositis ossificans (12 records, none a bruise); the same terms with quadriceps, thigh, rectus femoris or vastus, 24 records; a randomised-trial and systematic-review pass returned none). No study has tested hydrodissection for a muscle bruise or corked thigh. The nearest is a series of seven people with pain persisting at least eight weeks after a hamstring injury (a strain, not a bruise), in whom an ultrasound-guided injection of dilute lignocaine into thickened tissue around a skin nerve was followed by pain falling from 10 to under 1 out of 10, with no comparison group (Shiwaku, J Funct Morphol Kinesiol 2025).
Pairing reviewed 2026-11-10.
Where it fits
Not a treatment for a muscle bruise, which settles with early pain-free movement and graded loading. Considered only if nerve-type pain persists in the area long after the bruise has healed.
This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Every treatment above is described in full on the non-surgical treatments page, including what each one is used for and what the evidence supports. Ratings apply to the named diagnosis; an adjacent muscle, tendon, joint or nerve problem is assessed as a separate target. The method behind the ratings, and the treatments not offered, are set out on the evidence page.
Corticosteroid injection is reviewed separately for each diagnosis.
Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.
So treatment plans are not built around it. Where an injection is the right call, the specific diagnosis and target are reviewed, what is being injected and why is discussed, the number is kept low, and it is paired with the loading work that changes the longer-term course.
When it might still be considered
- Pain severe enough to block rehabilitation
- A clear inflammatory or bursal target on imaging
- A specific short-term goal: a trip, a procedure, a return to work
- Diagnostic use, where the response shows where the pain is coming from
When a cortisone injection is worth doing, and when it is not
Other general conditions
Pain in the same area can come from more than one source, and the label matters less than what the examination and history point to. These are the other guides for this region.
Frequently asked questions
Should I massage a bruised muscle?
What are the warning signs of something more serious?
When can I get back to sport?
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