WHAT IS A BONE BRUISE?

The hitter slides into home plate for another run and then the crowd goes wild. He bruises his knee and has trouble walking but hopes to shake it off in a few days. The pain doesn’t go away. His joint is stiff and swelling. It is possible he has a bone bruise. A blunt trauma caused in a sporting event, a fall, or even an accident can result in a bone bruise that is often more painful and lasts longer than a soft tissue injury. A Physical Therapist can help reduce symptoms and restore the body, but it can take months to heal.

Bones are extremely hard and resilient to stresses and strains of human life.  The human bone is made up of two types of bone tissue, compact and cancellous.  The compact bone is the outer portion of the bone.  It is dense, well-organized, and extremely hard.  If an injury occurs to this compact bone, it is diagnosed as a stress fracture or stress reaction.  Cancellous tissue, is the inner most part of the bone and is a mesh work of bone tissue known as the trabeculae.  The trabeculae are not well organized and not nearly as strong as the compact bone. Injuries to this area of the bone are small areas of damage to the trabeculae and can be classified as a “bone bruise.”

There are three types of bone bruises, subperiosteal hematoma, interosseous bruising and subchondral lesion.  The subperiosteal bruise occurs when blood accumulates under the outer covering of the compact bone (periosteum) due to a direct blow to the bone.  The interosseous bruising happens in the trabeculae due to repetitive stress and the subchondral bruise is between the articular cartilage on the end of the bones and the compact bone underneath it usually following a ligamentous injury.

Bone bruises occur due to impact forces or repetitive stress/force on the bone.  The type of bone bruise is usually directly correlated with the area of the bone that is involved with the impact force.  The injury can be associated with a direct blow to the bone, ligament injuries that enable the two bones to make contact with each other or damage to neighboring body structures that allow the bone to be “hit” and bruised.

Symptoms of a bone bruise are pain, swelling, immobility, and loss of strength due to pain.   Many times the pain persists after the bruising on the skin has resolved and the doctor will order an MRI or CT scan to confirm the diagnosis of a bone bruise because they cannot be diagnosed on a regular x-ray.

Treatment of a bruise has to deal with the acute symptoms of pain, swelling and decreased motion.  As the acute symptoms are brought under control, it is reasonable to have the patient begin a slowly progressing strengthening program.  The motion should be nearly normal with minimal pain prior to introducing a strengthening program.  Any exercise that is performed prior to the relatively pain-free status should be used to enhance the healing process, increased range of motion and establish normal neuromuscular activity at the injury site.

Physical Therapists are some of the best healthcare professionals to treat a bone bruise.  The modalities, hands on techniques and exercise prescription that can be utilized by the Physical Therapist can help speed up the healing process. Unfortunately, it is not uncommon for the healing time of a bone bruise to be measured in months instead of days or weeks.

A bone bruise can be extremely painful and limit the functional capabilities of the individual that suffers the injury.  Most of these injuries occur due to a direct blow to the bone or when two bones “smash” together.  The treatment for these injuries is addressed best in Physical Therapy and initially, the goal is to reduce the acute symptoms with the final goal of returning to pre-injury status.