By Dr. Rob LaPrade
http://drrobertlaprademd.com

Question: Last week while going down to stop a puck at the point, I got hit in my thigh. I am having trouble bending my knee and my thigh is swollen. What can I do to return to skating?

Answer: Thigh bruises are very common, especially in defensemen. Almost always, they are due to the puck hitting the thigh which causes bleeding into the quadriceps muscles. These injuries are called “quads contusions.”

The quadriceps muscles are the main muscles on the top of your thigh. They attach to the kneecap and help to straighten out your lower leg. They are among the strongest muscles in the body and are essential for playing ice hockey. When they are hit by a puck, there can be significant bleeding into the muscle because the impact bursts a portion of the muscle belly as it is compressed against the underlying bone.

To decrease the bleeding and speed recovery, apply ice and compression immediately. When ice is applied to a quads contusion, it should be applied directly over the area of the injury for approximately 20 minutes out of each hour. The icing helps to decrease the amount of bleeding by decreasing the size of the blood vessels.

Compression should be applied continuously with an elastic wrap. Compression helps to make sure that there is less space for the swelling and bleeding to occur. If one can control the amount of bleeding, it will allow for a quicker return to hockey.

The other important way to treat quads contusions is to keep the knee in a bent position immediately after the injury to prevent stiffness. You should bend the knee back to at least 120 degrees of knee flexion and wrap it in this bent position with a compression wrap as much as you can tolerate for the first 12-24 hours.

Although this can be uncomfortable, we believe it is essential to do this to restore one’s knee motion back to normal as soon as possible. If one ices and wraps their knee when the knee is out straight, the knee will become stiff and it will be hard to get back to skating activities until the stiffness is worked out.

Once you get your full quadriceps strength and knee motion back, you can return to playing hockey. In minor cases, this may be in a day or two. In more severe cases, a skater may need to be on crutches for a few days until he can walk without a limp.

For those athletes who need to cross train first before they get back to on-ice activities, they should work on cross training activities which maintain their aerobic and anaerobic endurance. We do this by having our athletes jog in a pool or work on an exercise bike as tolerated.

In the vast majority of cases, quads contusions respond very well to a program of icing, wrapping, and bending the knee as much as possible at the time of injury. In those cases in which the athlete may not get full motion and strength back within the first few days, an evaluation by your team physician may be indicated.

Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado.  He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. If you have a question for the Hockey Doc, e-mail it to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .