Have a Knee Contusion? Take It Seriously, Even If There Is No Swelling or Bruising at First
Knee injuries resulting from blunt trauma, such as a fall or car accident, can be severe. Several of the symptoms, including the following, sometime only emerge hours or even days after the injury:
- Soft tissue damage
- Torn tendons and knee ligaments
- Knee cartilage damage
- Damage to blood vessels in the knee area
Symptoms of Knee Injuries
Acute knee injuries often display signs of swelling, either immediately after the contusion or a few hours afterwards. Swelling can be severe, and the injured area its surroundings can continue to swell a day or two after the impact.
Acute swelling, which occurs after an injury, is due to fluid accumulation in and around the knee. There are two different types of fluid within the knee: blood and non-bloody fluids.
- Blood: Blood in the knee is usually associated with a fracture of the bone or cartilage. When bleeding is the cause of knee swelling, the onset is rapid and the swelling intense. Fluid usually accumulates within minutes of the injury.
- Non-bloody fluids: Non-bloody fluids accumulating in the knee are usually a result of meniscus tears and ligament sprains. The swelling is acute in onset, but less rapid than with blood accumulation. Typically, this type of swelling is seen hours to days after the injury. The amount of swelling can still be severe.
Bruising, like swelling, can be severe with knee injuries. During the impact, the tiny blood vessels in the knee break, resulting in subcutaneous bleeding. If a bone is fractured or ligaments torn, bleeding will be more intense, resulting in severe swelling and bruising. The blood filters through the soft tissues around the knee and spreads down the calf and up the thigh. With more severe bleeding, it's not uncommon for bruising to extend right up to the inner thigh and groin area or down to the ankles.
Bruising will eventually clear itself, but it can take days, even weeks, to do so. A reassuring fact to remember is that this type of bruising has nothing to do with deep vein thrombosis (DVT) or blood clots. See the examples of severe bruising ranging from immediately after the injury to a few days post-injury.
With all knee injuries, the standard treatment applies: RICE.
- R = Rest
- I = Ice
- C = Compression
- E = Elevation
Rest the injured knee immediately. Get your weight off it until you have determined how serious it is. If it is a non-serious injury, rest it for a while before you put your weight back on it. With more serious injuries, don't bear any weight on it until you've had an X-ray or scan. Putting weight on a fractured bone or broken ligament will make the injury and recovery time worse.
Ice the injury as soon as possible to limit swelling and bruising. The cold temperature contracts the blood vessels and slows the bleeding. It also slows the cell metabolism to curtail the spread of the bruising. Don't apply ice directly onto your skin, rather use a tea towel to cover your skin first. Leave ice on for 15 minutes every hour for the first day to minimise swelling.
Compress the wounded area by wrapping it in a bandage or a brace. This not only supports the knee but also helps control the swelling. The bandage should not be too tight, but it should be firm enough to offer support.
Elevate the knee by propping the ankle up on a couple of pillows. Your knee should be in line with your heart level. This ensures the swelling will be absorbed by the rest of the body rather than accumulating in the calf and foot, causing complications such as restricted blood flow to those areas.
NSAID–Take anti-inflammatory drugs to help with the swelling and inflammation. An ibuprofen product like neurofen or voltarol are over-the-counter options. Don't take these if you have previously suffered from a gastric ulcer or stomach disorders, as they can worsen the condition. Over-the-counter painkillers like paracetamol will also help manage the pain.
When to Seek Emergency Treatment
Seek emergency treatment if:
- Your knee swells immediately after the injury or you can't bear weight on it. Go to your doctor or hospital for an X-ray to make sure no bones are fractured. If they are, you will be given a splint or a cast to protect your knee from movement and advised to keep your weight off it at all times.
- Swelling hours after the injury is severe and painful—and your knee swells to three or four times its normal size. This could mean more serious tissue damage, traumatised ligaments or tendons, or torn cartilages. You'll need a scan to determine the extent of the damage (usually a CT scan or an MRI scan), although your doctor will probably recommend waiting until the swelling has decreased before a scan is performed. Follow the RICE method of treatment to decrease swelling.
- You experience any tingling or numbness in your lower limbs, such as your toes or feet. This could mean the swelling is causing nerve damage and you'll need to be assessed in order to receive appropriate treatment. Draining the knee of excess fluid is one option, although this is rarely done anymore as the risk of infection is so high. Generally, the doctor will recommend anti-inflammatory drugs such as Neurofen or Voltarin to decrease the inflammation.
- Arnica ointment and tablets help reduce swelling and bruising and increase healing time. Arnica homeopathic tablets can be taken every two hours for the first six doses after injury. Thereafter, take it four times a day until the swelling has stopped. The ointment can be applied to the affected area three times a day. Arnica also helps with shock.
- Witch Hazel helps reduce bruising and lessen the associated tenderness. It is available at your local pharmacy.
- Yunnan Baiyao, "the Chinese Spray," is a natural Chinese herbal medicine that helps bruising and internal bleeding. Revered in China, this medicine (powder, ointment, or spray) is applied directly to the bruised area as per the package instructions.
- Aromatherapy oils like camomile and lavender have anti-inflammatory properties and can be applied to non-broken skin when diluted with a carrier oil such as almond oil. Alternatively, put a few drops in the bath. They stimulate healing and reduce inflammation, as well as helping with shock.
- Rescue Remedy will help with the shock immediately after the injury and in the hours that follow. Administer it every half hour in acute cases or three times a day otherwise.
Please note that this advice is meant in good faith and is based on personal experience and my sessions with doctors, physiotherapists, and other emergency personnel. If you have a knee injury, I recommend you get it checked out by a health practitioner in addition to the treatment methods recommended in this article.