Fitness and Performance
What causes you to get a dead leg?
You know that feeling when you get out of bed and you just can’t feel your leg? Or if you bang the side of your leg against a table and find yourself collapsing on to the floor? That’s dead leg in its mildest form. ‘Dead Leg’ is a phrase we use so often but have you ever stopped to think about what it actually means?
‘Dead Leg’ can be a very painful and chronic condition, in this blog we explain the anatomy and science behind ‘Dead Leg’ and how it can be remedied.
Quadriceps contusion/dead deg/corked thigh
Dead Leg, also known as a quadriceps contusion or a corked thigh, occurs when the thigh muscles receive a direct impact. A very common sporting injury, the impact causes the thigh muscles (quadriceps) to be crushed against the underlying thigh bone (femur). As a result, bleeding can occur both within and around the muscle and thigh. This can lead to wide-spread bruising, pain and restricted movement.
Very often, these injuries can be treated conservatively with minimal complications. However in severe cases and when treated inappropriately, myositis ossificans may result. This term refers to the formation of bone tissue within the muscle.
Signs and symptoms of dead leg
- Pain after direct impact to the thigh
- Acute loss of or altered sensation down the leg (short-term)
- Difficulty weight bearing through the injured leg
- Bruising and swelling at the site of injury (can be delayed)
- Reduced strength and movement in the leg
It can be difficult to protect yourself from direct impacts, particularly when you’re taking part in sports such as hockey, football and rugby. There are some steps you can take, however, to reduce your chance of injury.
- Wear appropriate supportive and protective equipment or padding over the thigh
- Make sure you’re taking in enough water to ensure your muscles are hydrated and remain supple
- Follow a well-balanced strength and conditioning program to increase your muscles’ resilience
- Perform sport-specific training to increase your readiness to participate in sport and avoid unnecessary contact
A clinical examination by your physiotherapist will determine the severity of your injury. This is key in informing your rehabilitation and treatment programme. Your examination will involve:
- Palpation to locate the precise area of injury
- Range of movement (ROM) and strength testing to establish a baseline and the degree of functional loss
- Ultrasound scans and imagery can be useful, but not necessary, to determine the size and location of the injury
Severity of dead leg and rehab times
Grade 1 (mild)
- Difficulty walking with a normal pattern
- Tension in the thigh
- Minimal or no swelling
- Mild or little pain with quadriceps contraction
- Minimal/no loss of the knee’s range of motion
Return to play: A player should expect to return to play within two to three weeks
Grade 2 (moderate)
- Unable to walk without a limp
- Tension and sharp pain with general mobility/activity
- Minimal to moderate swelling
- Possible bruising
- Pain with quadriceps muscle contraction
- Unable to bend knee fully
Return to play: As there is increased damage to the tissue, an expected return to play is between four and six weeks.
Grade 3 (severe)
- Unable to walk properly without the use of crutches or other walking aid
- Debilitating, severe pain throughout the thigh
- Wide-spread swelling and bruising
- Severe pain with muscle contraction
- Significant loss of the knee’s range of motion
- May have observable deformity in the muscle
Return to play: In severe cases the area of injury can be very tender for an extended period of time. As more tissue healing is necessary, you can expect to return to play after a minimum of eight weeks.
In more severe long-term cases, a condition known as myositis ossificans can develop. This involves the body laying down bone tissue into the muscle. This can become extremely debilitating and appropriate management early is important to avoid this.
- Severe pain, swelling and bruising
- A lump or bump at the site of injury (this can be very painful to touch initially)
- Significant loss of the knee’s range of motion
- Significant loss of power within the thigh muscle
- Muscle activation causes severe pain
Return to play: Myositis ossificans is a long-term complication. In certain cases, where functional return is extended and the ‘lump’ is compromising blood circulation or nerve conduction, surgery may be needed. A return to competition can take upwards of twelve months.
As soon as the injury occurs, apply the principle of PRICE – Protect, Relative rest, Ice, Compression, Elevation. This will reduce inflammation to the area. The next step is to seek professional help from your physiotherapist for an assessment and treatment program.
Your physiotherapist will be able to use various treatment methods to reduce pain, promote healing and get you back to normal life and sport. These treatments may include:
- Soft tissue massage
- Acupuncture/Dry needling
- Supportive strapping and taping
- A progressive exercise therapy regime
- Strengthening exercises
- Stretching exercises
- Proprioception/balance exercises
- Agility exercises
For a full and quick recovery, it is very important to have a correct diagnosis and appropriate rehabilitation programme. Inappropriate management may lead to delayed healing and development of a myositis ossificans.