What is the therapy for bruises?

Therapy for Bruises

Localized cold therapy with or without pressure is the recommended first-line treatment for bruises to reduce hematoma size and promote faster healing. 1

First Aid Management of Bruises

Immediate Treatment

• Apply cold therapy (ice pack) to the bruised area as soon as possible after injury
• Use compression along with cold therapy when possible
• Elevate the affected area if it's on an extremity
• Continue cold application for 15-20 minutes at a time, with breaks in between

Cold therapy works by causing vasoconstriction, which helps limit bleeding into tissues and reduces the size of the hematoma. The 2015 International Consensus on First Aid Science recommends localized cold therapy with or without pressure as beneficial for hemostasis in closed bleeding in extremities 1.

Secondary Measures

• Rest the affected area to prevent further injury
• Restrict activity of the injured area
• Protect from further injury during healing

Special Considerations

Deep Muscle Bruises

For deep muscle bruises, a more structured approach is needed 2:

• Rest and restrict activity immediately
• Reduce swelling with cold therapy
• Protect from further injury
• Complete rehabilitation before returning to normal activities

Inadequate treatment of deep muscle bruises may lead to complications such as muscle shortening 3.

Topical Treatments

While some topical agents have been studied:

• 20% arnica ointment has shown some effectiveness in reducing bruising compared to placebo in controlled studies 4
• Evidence for vitamin K creams is less conclusive 4
• Homeopathic arnica (oral) has not shown benefit over placebo in controlled trials 5

When to Seek Medical Attention

Warning Signs

• Bruising in infants who are not yet mobile (may indicate abuse) 6
• Bruising in unusual locations (ears, neck, buttocks, genitals)
• Patterned bruises that resemble objects
• Extensive or disproportionate bruising relative to reported trauma
• Bruising accompanied by other symptoms like severe pain or swelling

Medical Evaluation

Medical evaluation should be considered when:

• Bruising is severe or extensive
• Bruising occurs without adequate explanation
• There is concern for underlying bleeding disorder
• Bruising fails to improve with first aid measures

Common Pitfalls to Avoid

1. Applying heat too early: Heat therapy should be avoided in the first 48-72 hours as it can increase bleeding and swelling
2. Massaging the bruise: This can cause further damage to injured tissues
3. Ignoring bruising in non-mobile infants: Bruising in infants who cannot yet cruise or walk is rare and warrants medical evaluation 6
4. Overlooking the need for screening for bleeding disorders: In cases of unusual or excessive bruising, especially with family history of bleeding problems 1

The evidence supports that simple measures like cold application, compression, and elevation remain the cornerstone of bruise management, with the strongest evidence supporting localized cold therapy as recommended by international first aid guidelines 1.