**6. Imaging**

The evaluation of the longitudinal size (measured in mm) is a more important severity predictor than the cross section of the lesion and the entity of the hematoma. Ultrasonography, with panoramic vision, performed after 24-48 hour is useful in localizing the hematoma and in characterizing its different types. Findings can include the following: circumscribed lesion, anechoic lesion compatible with a liquefied hematoma, circumscribed lesion of mixed echogenicity compatible with areas of liquefied hematoma, coagulated blood, and edema. Considerations could also be made on investigation methods: Ultrasound (Fig. 3 and Fig. 4) is considered an operator-dependent method while MRI (Fig. 5 and Fig. 6) appears to be more sensitive to follow the evolution and to well evaluate extensive lesions.

**Figure 3.** Transversal section: 4,6 x 2 cm lesion in Rectus femoris at day 6, before drainage

**Figure 5.** Axial and Coronal MR of hematoma in the hamstring muscle group at day 10.

The Treatment of Muscle Hematomas http://dx.doi.org/10.5772/56903 209

**Figure 6.** Axial and Coronal MR of hematoma in the hamstring muscle group at day 10.

**Figure 4.** After drainage at day 6

**Figure 5.** Axial and Coronal MR of hematoma in the hamstring muscle group at day 10.

with panoramic vision, performed after 24-48 hour is useful in localizing the hematoma and in characterizing its different types. Findings can include the following: circumscribed lesion, anechoic lesion compatible with a liquefied hematoma, circumscribed lesion of mixed echogenicity compatible with areas of liquefied hematoma, coagulated blood, and edema. Considerations could also be made on investigation methods: Ultrasound (Fig. 3 and Fig. 4) is considered an operator-dependent method while MRI (Fig. 5 and Fig. 6) appears to be more

sensitive to follow the evolution and to well evaluate extensive lesions.

**Figure 3.** Transversal section: 4,6 x 2 cm lesion in Rectus femoris at day 6, before drainage

**Figure 4.** After drainage at day 6

208 Muscle Injuries in Sport Medicine

**Figure 6.** Axial and Coronal MR of hematoma in the hamstring muscle group at day 10.

Aside from the different degrees of seriousness in muscle damages, it is necessary to consider the anatomical location where the damage occurred in order to plan the most proper rehabil‐ itation treatment.





Renström and Peterson, 2001; Prentice, 2004).

in muscle injury (Costantino et al., 2005).

injured skeletal muscle to pre-injury levels.

**7.5. Mobilisation**


The lowering of the temperature causes an increase in blood viscosity with a reduction of blood flow and a reduction of vascular permeability in the cooling area. This physiological effect induced by cold is the key mechanisms in the reduction of edema due to the increasing of venous diameter and of the inflammatory reaction (Smith et al., 1993; Low and Reed, 2000). A crucial point in cryotherapy application is the duration of cooling. The cooling of a healthy body area initially causes a reflex vasoconstriction, for a period between 9 to16 minutes, followed by a vasodilatation phase between 4 and 6 minutes, after which vasoconstriction reappears. For this reason the application of cold pack on a hematoma should have a duration between 12 and 15 minutes, with interruption of about 10 minutes. The total duration of treatment cryotherapy, however, must be appropriate to the level of the lesion (Lindsey, 1990), because unfortunately is based on empiricism (Bleakeley et al., 2004). We recommend ice bag for 20 minutes (Meaney et al., 1979) or airjet cryotherapy at -3°C for 5 minutes applied several times in a day. The muscle becomes tenser, stiffer, and less elastic as a result of cooling, and the mechanical properties are not fully recovered even after 15 min. So, in results of muscle injuries, warming-up is suggested after cooling to enable normalization of mechanical properties of the muscle.In any case cryotherapy appears particularly indicated in the first 24 hours post-trauma (Gray, 1977; Williams, 1980; Klein, 1990; Lachmann and Jenner, 1994;

The Treatment of Muscle Hematomas http://dx.doi.org/10.5772/56903 211

Cryotherapy is used to prevent muscle damage, ( Bailey et al 2007) either separate or associated to stretching in the stretching -spray technique (Taylor et al., 1995). Cryoultrasound (cryo‐ therapy with ultrasound) therapy has more scientific evidence in treatment of tendonitis thank

In the treatment of injured skeletal muscle, an immobilization should immediately be carried out or, at least, an avoidance of muscle contractions should be encouraged. The key to a right therapy consists in the appropriate timing between immobilization and mobilization. How‐ ever, the duration of immobilization should be limited to a short period, sufficient to produce a scar able to bear the forces induced by re-mobilization, thus avoiding to mobilize a lesion healed with type I collagen fibers that would facilitate re-injury. The muscle activity (mobili‐ zation) should be started gradually respecting the physiological phases of wound healing and with the limits of not pain. On the other hand, early return to activity is desirable to optimize the regeneration of healing muscle and recovery of the flexibility, elasticity and strength of the
