What is the recommended management for a soft tissue injury, such as a bruise?

Management of Soft Tissue Injury (Bruise)

Apply cold therapy (ice and water mixture in a damp cloth) for 20-30 minutes, 3-4 times daily for the first 2-3 days, combined with rest and activity limitation to reduce pain and swelling. 1

Immediate First Aid Management

Cold Application (Primary Intervention)

• Use a plastic bag filled with ice and water surrounded by a damp cloth - this achieves the greatest tissue cooling compared to gel packs or ice alone 1
• Apply for 20-30 minutes per session, 3-4 times daily during the first 2-3 days after injury 1
• Never place ice directly on skin to prevent cold injury 1
• If 20 minutes is uncomfortable, limit application to 10 minutes 1, 2
• Cold therapy reduces pain and swelling acutely but has not been shown to improve long-term function or recovery time 1

Rest and Activity Modification

• Avoid activities that cause pain and limit use of the injured area 1
• This prevents worsening of the injury, particularly important since bruises may mask more serious injuries like fractures 1
• Early mobilization guided by pain response should begin after the acute phase (48-72 hours) to promote functional recovery 3

Compression (Optional)

• Compression wraps may provide comfort in the acute setting but do not reduce swelling or improve recovery time 1
• If used, apply without compromising circulation - avoid overtightening 1
• Evidence is strongest for ankle injuries; limited data exists for other locations 1

Elevation

• Elevate the injured extremity when possible, though evidence for this specific intervention is limited 1, 4

When to Seek Medical Attention

Activate emergency services or seek immediate medical evaluation if: 1

• The injury limits use of the extremity significantly
• There is obvious deformity, severe swelling, or inability to move the limb
• Visible bone protrusion or open wounds are present
• The extremity appears blue or extremely pale (vascular compromise)

Common Pitfalls to Avoid

• Do not apply heat in the acute phase - cold therapy is superior to heat for acute soft tissue injuries 1
• Do not use continuous ice application - repeated 10-20 minute sessions are more effective than prolonged continuous application 2
• Avoid bearing weight or returning to activity prematurely - reflex activity and motor function may be impaired for up to 30 minutes after ice treatment, increasing reinjury risk 2
• Do not ignore injuries that fail to improve - persistent pain or swelling beyond 48-72 hours warrants medical evaluation to rule out fracture or more serious injury 1

Rehabilitation Phase (After 48-72 Hours)

• Begin progressive resistance exercises (isotonic, isokinetic, isometric) once acute inflammation subsides to restore full muscle and joint function 3
• Rehabilitation is complete when the injured tissue is restored to full pain-free functional capacity 3
• Continue monitoring for complications such as muscle shortening if inadequately treated 4

Evidence Quality Note

The 2024 American Heart Association and American Red Cross First Aid Guidelines provide the most current and authoritative recommendations for bruise management, emphasizing that while cold therapy effectively reduces acute pain and swelling, it does not accelerate overall healing or functional recovery 1. The evidence base is limited by small studies and lack of long-term outcome data, but the safety profile and modest symptomatic benefit support its use as standard first aid 1.