If I say ‘Cork’ and you think ‘Wine!’, this article probably isn’t for you. For those that have sustained a ‘muscle cork’, you may well recall how painful and debilitating they can be.
A ‘cork’ is simply a contusion (or bruise) sustained by a direct blunt trauma, often an opponents knee, shoulder or a hockey ball in the case of our client (pictured right). The extent of the bruise really is multifactorial; how hard you are hit, what has bled as well as age and physiological issues. Most of us have bumped our leg on the furniture and noticed a bruise come out the next day. These bruises generally come from ruptured small vessels of the skin and don’t necessarily result in damage to the muscle below. If, however, the bump is forceful enough, disruption to the muscle fibres and its vessels will result. For this reason, severe corks should be considered as muscle strains and treated accordingly, ie. with respect.
Like a well executed ‘Dim Mak’, forces can be transmitted to the deep structures underlying the impact point. Corks are more severe in these instances and more still when the resulting haemorrhage is intramuscular. Intramuscular strains or contusions are constrained by the surrounding healthy tissue, almost forming a balloon. It is more difficult for the body to remove the rapid accumulation of blood in the muscle, which not only creates pressure within the muscle but also becomes a chemical irritant, making this type of injury very painful.
Extreme Corkage! (Acute Compartment Syndrome)
Groups of muscles run together in compartments or connective tissue sleeves called fascia. Fascia has little elasticity and extensibility and severe corks can result in severe bleeding. When the bleeding is unable to be controlled by the body fast enough, the area can balloon and create significant compartment pressures, placing the muscle, vessels and nerves within the fascia at great risk of strangling itself of oxygen. This is an emergency situation that is characterized by severe pain and dysfunction (e.g inablility to move the limb or weight bear), paraesthesia (pins and needles) and even anaesthesia (numbness) as a late sign – Get to the hospital ASAP.
Here is one of our clients who developed an acute compartment syndrome in his lateral thigh after being tackled in rugby league. Pressures were more than 5x higher than normal requiring an emergency fasciotomy (surgical release) to ease the pressure. The amount of blood drained required a transfusion. Early recognition, hospitalisation and surgical intervention prevented more devastating consequences in this instance and he is making an excellent recovery if not for the hectic incision scar (below).
Chris Dillon, Sports Physiotherapist