Iliotibial Band Syndrome
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The Oxford dictionary defines a dead leg as “an injury that occurs when somebody’s upper leg is hit by somebody else’s knee”. This is a relatively common injury in contact sports where two people might collide and the impact is taken to the quadriceps muscle. It can also occur as a result of a direct blow from a hard object, such as being hit or running into something solid. A dead leg is a contusion to the quadriceps muscle. The quadriceps muscle is impacted and compressed suddenly against the femur bone causing damage to the muscle itself, as well as the nerves and blood vessels.
A dead leg will have a sudden onset as it is caused by trauma. The muscle will have a sudden pain after the impact with a loss of power and strength in the leg, this can make it feel like it might or actually does give way. Therefore weight bearing can be difficult and feel unstable. The muscle might feel like it is painfully cramping or in spasm.
In the short term, there might be a loss or change in the sensation down the leg as the nerves have been damaged. The extent of damage will affect the severity and duration of this altered sensation. Swelling can appear quite quickly and may either be a focal lump where the impact hit or a diffuse swelling in the muscle. A symptom to develop later after the injury will be bruising, the extent of which will also depend on the severity of the injury, as well as the health of the individual and or whether they are taking blood thinning medication.
In the moments after injury, it may be possible to improve the symptoms or alleviate them completely if the injury is very minor. “Shaking it off” or “running it off” will only work in very minor injuries. For these cases, some movement of the leg, working the quadriceps muscle through its full range, by bending and straightening the leg may help. If this does not help or is painful then you should stop, rest and seek professional advice.
When seeking a diagnosis, you should go to a professional, either an experienced physical therapist or a sports doctor. A medical professional will perform a physical examination after taking your medical history and the injury details. The sensitivity over the injured area will be assessed with palpation, also looking if there is a palpable gap in the muscle suggestive of a tear. The strength and mobility of the muscle will also be assessed to see what the deficit is compared to the other leg. This can be a helpful baseline from which to track the progress through recovery. Finally, for confirmation or clarification of the injury, an ultrasound scan can be done. Ultrasound can show the extent of damage and the exact location, in which muscles.
It is important to diagnosis correctly, a differential diagnosis is a tear in the quadriceps muscle. You can read about this injury in our related article: Quadriceps Tear.
Treatment should be received quickly in the form of rest, ice, compression, and elevation to manage the extent of inflammation. Once the initial acute pain has settled gentle rehabilitation can be started in the form of mobility and strengthening exercises. You should follow the advice and guidance of a professional to optimise your recovery and reduce the risk of complications such as myositis ossificans. Additionally massage treatments can be helpful after the acute phase.
If not correctly managed and treated a severe dead leg, or contusion to the quadriceps can lead to myositis ossificans. This is the development of bone within the muscle. Calcification can occur in the injured muscle tissue, causing similar symptoms to a severe contusion injury. That is severe pain to contract the muscle, swelling and bruising, loss of range of movement, and loss of power in the muscle. The difference will be that on palpation a hardened lump may be felt and on ultrasound, the calcification can be clearly seen. In the worst cases, calcification can restrict blood and nerve supply and may need to be treated surgically.