Bone Bruises: More Then Meet the Eye

The word bone bruise probably conjures images of some purpling discolouration of the skin. But the word "bone bruise" is a misnomer, making the injury seem less traumatic than it actually is. While we often think of a "bruise" as being a minor injury of the skin, a bone bruise is a more serious and painful injury, involving the bone and muscle, that can take a long time to heal and could even lead to the death of the bone.

What is a "bone bruise"?

A bone bruise is actually a small fracture of an inner-layer of bone.

Broadly speaking, you have two layers of bone:

• The outer-layer is called the "compact" bone. It is extremely strong.
• The innermost layer of bone is called the cancellous bone. It is spongy and, unlike the outer-layer (which is arranged in concentric layers), is arranged in plates. These plates form an irregular mesh, which isn't as strong as the "compact" outer-layer and chips easily.

In a bone bruise, tiny fractures (like cracks or chips) form in the cancellous bone as a response to stress or injury. If enough of the small small fibres that comprise a bone break apart, there will be a bone bruise.

Three possible types of bone bruise

There are three possible types of bone bruise:

• Subperiosteal Hematoma: where blood builds up in the area beneath your periosteum (a thin layer that covers most bones, except the long bones).
• Subchondral bone bruise: where there is bleeding and swelling in the area between your cartilage and the bone beneath.
• Interosseous bone bruise: where bleeding and swelling occurs in the marrow of your bone.

Causes of a bone bruise?

A bone bruise can result from any injury where there is direct force, but not force enough to break the outer-bone. The following kinds of injuries may cause a bone bruise:

• Sports injuries: especially when players collide at high velocity. Football and rugby players are especially prone to bone bruises.
• Twisting injuries: When you sprain an ankle or knee, bones collide forcefully causing a bone bruise.
• High velocity trauma: any blunt force injury may cause a bone bruise (a car accident, a fall, or something falling onto you from a height).

Arthritis patients are also prone to bone bruises. This is because bone surfaces are unprotected in arthritis, leading bones to grind against each other.

Where do bone bruises occur?

Bone bruises most commonly occur in the knee or femur (thighbone). They are also very common in the ankle. However, they can also occur in the: hipbone, wrist, heel, foot, and shoulder.

READ How To Warm Up Before Exercise And Avoid Injury: Do's And Don'ts

Symptoms of Bone Bruise

• Pain: As with all trauma, bone bruises hurt. They hurt far more than just regular bruising on the skin and muscle, and pain may be the first sign that your injury is more than a minor sprain. With bone bruises, the pain can last for weeks, or even months.
• Soft tissue swelling
• Discolouration: At first your skin may look blue or purple, due to the blood pooling beneath the skin (but may not if the injury is especially deep); as the injury is healing, the discolouration will be yellow or green in hue.
• Swelling or stiffness of the injured joint

Risks of Bone Bruises

With correct treatment, most bone bruises heal very well. However, a very large untreated  bone bruise may cause problems in getting blood flow to the area. This could lead to "avascular necrosis" and the eventual death of the bone. If you don't rest and take the appropriate steps, there's also the risk that your bone bruise may lead to a full fracture.

More About Bone Bruises

Diagnosing a bone bruise

A bone bruise will not show-up on an X-Ray or CT scan. Only an MRI is capable of diagnosing a bone bruise.

MRIs are expensive, and most doctors will only send you for one if your symptoms don't improve. A bone bruise can usually be diagnosed based on medical history, your symptoms, and how the injury occurred. Your doctor can also give you an exam that checks pain, bruising and swelling.

Treating a bone bruise

If you have a bone bruise, I'm afraid there's no magic bullet to make you better. There are, however, several proven therapies which can provide relief:

• Ice: Immediate application of an ice-pack to minimise swelling and bruising. Apply for 10 minutes a time, 3-4 times a day, until swelling subsides.
• Immobilisation: Immobilise the joint with bracing, to protect it from the risks of weight-bearing, which might cause further damage, and allow to healing. Immobilise the area with a brace, support, or sling (and consider using crutches for a lower-limb injury).
• Take rest: It's important to rest the joint when possible. Re-injury is a real risk for people who use their joint too soon. You should take several days off work, immediately after the injury, to kick-start to recovery process, and negotiate altered duties for your return, so you won't have to use the injured area. If basketball star Marvin Williams can sit it out with a bone bruise, so can you.
• Raise the area above your heart when resting: This will reduce swelling
• Medication: Try taking an non-steroidal anti-inflammatory (NSAIDs) such as Ibuprofen or Diclofenac to reduce pain and swelling. Be sure to take them with food to avoid potential side-effects.

Self-help for bone bruises

Although there's no magic medicine, there are some simple steps that you can take to speed your recovery, while following your doctors' treatment plan.

Avoid:

• Alcohol: Alcohol thins the blood and leaches calcium from the bones. If you have a bone bruise, it prevents healing and may actually cause degeneration.
• Nicotine: Smoking constricts the blood vessels and increases the risk of deadly blood clots. It also slows the healing of bones.
• Sugar: Processed sugar increases inflammation, which is the last thing you want with a bone bruise. Like alcohol, it also sucks the calcium from your bones.

Eat:

• Green leafy veggies: Rich in Vitamin K, green leafy veggies are essential to help blood clot and prevent excessive bleeding. They also strengthen bones, and reduce infection.
• Citrus fruit: Full of healthy Vitamin C, citrus fruits are great for bone bruises. Vitamin C (also found in strawberries and kiwi) heals bruises, helps form collagen and heals bone.
• Salmon: Salmon has 800-1000 units of the necessary bone-strengthening Vitamin D your body needs to absorb the Calcium.
• Dairy: If you want to build strong bones, you're going to need calcium. Dairy is one of the best natural sources of calcium (non-dairy sources include baked beans, sardines, and spinach). Aim for at least 1000mg of Calcium a day (1200mg, if you're a post-menopausal woman, or Celiac). Particularly good options include:
  • Buttermilk: 370mg of Calcium per 250ml serving
  • Cheese (low-fat cheddar; mozzarella; Swiss; goat; Gruyere): 396-506mg of Calcium pet 50g serving
  • Cheese (cheddar; Colby; edam; gouda; blue): 252-366mg of Calcium per 50g serving
  • Fruit yoghurt: 189-285mg of Calcium per 175g serving
  • Milk (2%, 1%, chocolate): 291-322 mg of Calcium per 250ml serving.

Take

• Bromelain: This enzyme, found in pineapple, helps the body heal. Try taking a supplement of 500 - 2000mg of Bromelain, twice a day, to get the bone-healing effects.
• Calcium and Vitamin D: Calcium is essential for bone health, while vitamin D is essential to absorb Calcium. Working together, they lower bone loss and reduce the risk of a fracture.

Use

• Arnica Oil: Arnica oil is an excellent topical product for bone (and other) bruises. Rub it in at the location of the injury, and it may help to reduce pain and inflammation.

How long does recovery take?

Every bone bruise is different.

However, contrary to what you might expect, it will take longer to heal from a bone bruise than it might a full-fracture, as those delicate inner-layers of bone are more fragile and take longer to heal.

You may resume your activities slowly over a period of weeks to months. Ask your doctor for advice.

READ Rehabilitating An Injury: The Rules

When should I see my doctor?

Always see a doctor when you have severe pain following an accident or injury. You'll need an X-Ray to confirm that the injury isn't a full fracture. You should also see a doctor if your pain is moderate, but you have the following symptoms:

• Your skin is cold and pale below the injury
• It's painful to bear weight on the limb
• The pain isn't improving after 3-4 days of rest, ice and pain medication, or the swelling suddenly increases.

Last words

Bone bruises are painful, and they can take a long time to heal. Just one step below a full break, if improperly managed, they can cause long-term pain, and serious complications. But problems like that are rare.

Most people will be back to their old selves in two to four months. And the good news is that there are plenty of sensible self-help steps that you can take to get you there.

It just takes time.