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Muscle strains (tears) and contusions (deep bruises) are among the most common sports injuries. In professional football, muscle injuries made up 31% of all injuries, and 92% involved the hamstrings, adductors, quadriceps or calves.1 Most heal well with the right early care and a structured rehab program, but a severe tear, a tendon avulsion or a large contusion needs careful management to avoid prolonged time out and complications.2,3

At a glance

  • Strain: a pulled or torn muscle, usually while sprinting, kicking or stretching
  • Contusion: a deep bruise from a direct blow, often a ‘charley horse’ to the front of the thigh
  • For a thigh contusion, holding the knee bent to 120 degrees early speeds recovery24,25
  • Early, progressive loading heals muscle better than prolonged rest9,10
  • Tendon avulsions in athletes may need surgical repair4,31

Muscle strains (tears)

A strain happens when a muscle is stretched while contracting, often at the muscle-tendon junction. In the thigh and groin, the common ones are:

  • Quadriceps (rectus femoris): common in sports with repetitive kicking and sprinting.5
  • Adductors (groin): athletes with partial tears returned to play in 1 to 7 weeks with physical therapy.22 Pubic-related groin pain is covered on the osteitis pubis page.
  • Hamstrings: the most common muscle injury in sprinting sports. Complete tears at the pelvis are covered on the proximal hamstring tears page.

Injuries are graded on MRI from 0 to 4, and whether the tear extends into the tendon matters: rectus femoris injuries involving the tendon took longer to return, and grade 3 injuries recurred more often.6,7

Muscle contusions (thigh bruises)

A contusion is a crush injury from a direct blow, such as a knee or helmet to the front of the thigh. Bleeding inside the muscle causes pain, swelling and loss of knee bending. Severity is graded by how far the knee bends 12 to 24 hours later; in West Point cadets, mild, moderate and severe contusions kept them out an average of 13, 19 and 21 days.23

Early treatment matters: holding the knee bent to about 120 degrees (with a wrap or brace) for the first 24 hours limits bleeding and preserves motion. In one study, athletes returned to full activity in an average of 3.5 days.25,26 Regaining 120 degrees or more of knee bending is the key criterion for returning to play.24

Symptoms

  • Sudden pain or a pulling or popping sensation in the thigh or groin
  • Swelling and bruising, which may track down the leg over days
  • Pain with stretching or contracting the muscle
  • With contusions: a firm, tender lump and difficulty bending the knee
  • With a complete tear: a gap or bunched-up muscle and marked weakness

Diagnosis

Dr. Dold examines the muscle for tenderness, strength, flexibility and any defect. Ultrasound or MRI is used for more significant injuries, to grade the tear and check for tendon involvement or retraction that may need surgery.3,6 Larger injuries on imaging and lasting strength deficits raise the risk of re-injury.8

Treatment of strains

  • Early phase: a short period of relative rest, compression and ice for comfort,3 though evidence for ice itself is limited.12
  • Early mobilization: after a short rest, gradual loading within pain limits produces better muscle healing than prolonged immobilization.9,10,11
  • Progressive rehab: agility and trunk stabilization exercises help recovery.9 For hamstrings, a lengthening-exercise program shortened return to play from 51 to 28 days in footballers15 and from 86 to 49 days in sprinters;16 starting it early or a little later gave similar results.17
  • Pain medicine: NSAIDs and acetaminophen relieve pain similarly,13 and NSAIDs may slow tissue healing,14 so a short course is preferred.26

PRP injections: what the evidence shows

PRP for acute muscle injuries has been studied mostly in hamstring strains, with mixed results:

  • In two well-designed randomized trials, a PRP injection did not speed return to play or reduce re-injury compared with intensive rehab or placebo.18,19
  • Pooled analyses suggest PRP may shorten return to play by about 1 week, without changing re-injury rates, with low to moderate certainty.20,21

Rehabilitation remains the foundation, and PRP may help selected patients, for example an athlete with a tight timeline. Dr. Dold reviews whether PRP is reasonable in your situation.

Complications to watch for

  • Myositis ossificans: bone forming within a bruised muscle. It developed in 9% of cadets with quadriceps contusions and was linked to knee bending under 120 degrees, football injuries, prior quadriceps injury, treatment delayed more than 3 days and knee swelling.23,27 Most athletes resumed light activity by 3 months and their earlier level by 6 months.28
  • Compartment syndrome: rarely, bleeding after a thigh contusion raises pressure in the thigh, causing severe, increasing pain and tightness. It is an emergency that needs surgical decompression,29 and it can develop hours later.30
  • Re-injury: returning before strength and flexibility recover raises the risk; re-injuries cause longer absences.2,8

When surgery is needed

Most muscle strains heal without surgery.33 Surgery is considered for tendon avulsions and complete tears with retraction, particularly in athletes.4,31 After repair of proximal rectus femoris tears, 93.3% of competitive athletes returned at about 10.5 months.32

Recovery

  • Mild strains and contusions: often days to 2 or 3 weeks.23
  • Moderate strains: several weeks of progressive rehab.15,22
  • Tendon repairs: many months.32

Return to sport is based on pain-free movement, strength and sport-specific testing rather than time alone.8 Dr. Dold reviews your timeline based on your injury.

Frequently asked questions

What’s the difference between a strain and a contusion?

A strain is a pulled or torn muscle from stretching while contracting. A contusion is a deep bruise from a direct blow. Both cause pain and swelling, but early treatment differs.

Should I stretch a thigh bruise?

Early on, gently holding the knee bent toward 120 degrees helps limit bleeding and preserve motion. Avoid aggressive massage or heat in the first days, which may increase bleeding.

Should I take ibuprofen?

A short course can help pain, but NSAIDs may slow tissue healing, so a short course is preferred. Acetaminophen relieves pain similarly.

Does PRP help a muscle tear heal faster?

Studies are mixed. High-quality trials in hamstring strains didn’t show faster return, while pooled analyses suggest about a week faster. Rehab is the foundation.

When should I worry about a thigh bruise?

Increasing, severe pain, a very tight swollen thigh, or numbness needs urgent evaluation for compartment syndrome. A hard lump weeks later may be myositis ossificans.

Pulled muscle or deep thigh bruise? Request an appointment online or call 469-850-0680. Our staff will contact you by phone and text within an hour of your request (during business hours, Monday–Friday, 8 am–5 pm). Walk-in visits are welcome Monday, Wednesday and Friday, 8:30–10:30 am at 6700 Dallas Parkway, Suite 100, Frisco, TX 75034. Same-day appointments available. Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.

Request an AppointmentCall 469-850-0680

Research cited on this page

  1. Ekstrand J, Hägglund M, Waldén M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med. 2011;39(6):1226-32. PubMed
    In professional football, muscle injuries were 31% of all injuries; 92% involved the hamstrings, adductors, quadriceps or calves.
  2. Ekstrand J, Krutsch W, Spreco A, et al. Time before return to play for the most common injuries in professional football: a 16-year follow-up of the UEFA Elite Club Injury Study. Br J Sports Med. 2020;54(7):421-426. PubMed
    Most time lost to injury in professional football came from injuries keeping players out up to 4 weeks; re-injuries of muscles caused longer absences.
  3. Lempainen L, Mechó S, Valle X, et al. Management of anterior thigh injuries in soccer players: practical guide. BMC Sports Sci Med Rehabil. 2022;14(1):41. PubMed
    Anterior thigh injuries are managed with initial rest, ice and compression and a structured return-to-play plan; MRI identifies tendon retraction needing surgery.
  4. Plastow R, Raj RD, Fontalis A, et al. Quadriceps injuries. Bone Joint J. 2023;105-B(12):1244-1251. PubMed
    Quadriceps injuries range from minor strains to tendon avulsions that may need surgical repair in elite athletes.
  5. Mendiguchia J, Alentorn-Geli E, Idoate F, et al. Rectus femoris muscle injuries in football: a clinically relevant review of mechanisms of injury, risk factors and preventive strategies. Br J Sports Med. 2013;47(6):359-66. PubMed
    Rectus femoris strains are common in sports with repetitive kicking and sprinting.
  6. Pollock N, James SL, Lee JC, et al. British athletics muscle injury classification: a new grading system. Br J Sports Med. 2014;48(18):1347-51. PubMed
    The British Athletics Muscle Injury Classification grades injuries 0 to 4 on MRI, adding whether the tendon is involved.
  7. McAleer S, Macdonald B, Lee J, et al. Time to return to full training and recurrence of rectus femoris injuries in elite track and field athletes 2010-2019; a 9-year study using the British Athletics Muscle Injury Classification. Scand J Med Sci Sports. 2022;32(7):1109-1118. PubMed
    Rectus femoris injuries extending into the tendon took longer to return, and grade 3 injuries recurred more often.
  8. Orchard J, Best TM, Verrall GM. Return to play following muscle strains. Clin J Sport Med. 2005;15(6):436-41. PubMed
    No return-to-play criteria eliminate re-injury; strength deficits and larger injuries on imaging increase recurrence risk.
  9. Järvinen TA, Järvinen TL, Kääriäinen M, et al. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol. 2007;21(2):317-31. PubMed
    After a short rest, gradual mobilization within pain limits optimizes muscle healing; agility and trunk stabilization help recovery.
  10. Järvinen TA, Kääriäinen M, Järvinen M, et al. Muscle strain injuries. Curr Opin Rheumatol. 2000;12(2):155-61. PubMed
    Immobilization should be no longer than needed; early mobilization improves healing of strained muscle.
  11. Järvinen MJ, Lehto MU. The effects of early mobilisation and immobilisation on the healing process following muscle injuries. Sports Med. 1993;15(2):78-89. PubMed
    Early mobilization after a short immobilization produced better-aligned muscle regeneration than prolonged immobilization.
  12. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med. 2004;32(1):251-61. PubMed
    Evidence for ice after soft-tissue injury is limited; ice plus exercise appeared most effective.
  13. Jones P, Dalziel SR, Lamdin R, et al. Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury. Cochrane Database Syst Rev. 2015(7):CD007789. PubMed
    NSAIDs and paracetamol give similar pain relief for acute soft-tissue injuries; NSAIDs have more gastrointestinal side effects.
  14. Dideriksen K. Muscle and tendon connective tissue adaptation to unloading, exercise and NSAID. Connect Tissue Res. 2014;55(2):61-70. PubMed
    NSAIDs may inhibit connective tissue healing and the benefit of exercise on tissue repair.
  15. Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2013;47(15):953-9. PubMed
    In elite footballers, a lengthening-exercise program returned hamstring-injured players in 28 vs 51 days.
  16. Askling CM, Tengvar M, Tarassova O, et al. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2014;48(7):532-9. PubMed
    In elite sprinters and jumpers, a lengthening program shortened return after hamstring injury (49 vs 86 days).
  17. Vermeulen R, Whiteley R, van der Made AD, et al. Early versus delayed lengthening exercises for acute hamstring injury in male athletes: a randomised controlled clinical trial. Br J Sports Med. 2022;56(14):792-800. PubMed
    Starting lengthening exercises early or later gave similar return-to-sport times after hamstring injury.
  18. Hamilton B, Tol JL, Almusa E, et al. Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial. Br J Sports Med. 2015;49(14):943-50. PubMed
    In a randomized trial, a single PRP injection did not speed return to play after hamstring injury compared with intensive rehab.
  19. Reurink G, Goudswaard GJ, Moen MH, et al. Rationale, secondary outcome scores and 1-year follow-up of a randomised trial of platelet-rich plasma injections in acute hamstring muscle injury: the Dutch Hamstring Injection Therapy study. Br J Sports Med. 2015;49(18):1206-12. PubMed
    In a placebo-controlled trial, PRP did not shorten return to play or reduce re-injury at 1 year after hamstring injury.
  20. Nakagawa H, Krochmal P, Thomas I, et al. Effects of percutaneous platelet-rich plasma injection on return-to-play after acute hamstring muscle injury: a systematic review and meta-analysis. Br J Sports Med. 2026;60(5):370-378. PubMed
    A pooled analysis of 6 trials found PRP shortened return to play by about 8.6 days, with low to moderate certainty and no change in re-injury.
  21. Bensa A, Fattini Fellini G, Boffa A, et al. Platelet-Rich Plasma Accelerates the Return to Sport in Athletes with Acute Muscle Injuries: A Systematic Review and Statistical Fragility Index-Based Meta-Analysis of Randomized Controlled Trials. Sports Med Open. 2026;12(1). PubMed
    A pooled analysis of 9 trials found faster return to sport with PRP, without a difference in re-injury.
  22. Farrell SG, Hatem M, Bharam S. Acute Adductor Muscle Injury: A Systematic Review on Diagnostic Imaging, Treatment, and Prevention. Am J Sports Med. 2023;51(13):3591-3603. PubMed
    Athletes with partial adductor tears returned to play 1 to 7 weeks after physical therapy.
  23. Ryan JB, Wheeler JH, Hopkinson WJ, et al. Quadriceps contusions. West Point update. Am J Sports Med. 1991;19(3):299-304. PubMed
    In West Point cadets, quadriceps contusions kept them out an average of 13 to 21 days by severity; myositis ossificans developed in 9%.
  24. Aronen JG, Chronister RD. Quadriceps Contusions. Phys Sportsmed. 1992;20(7):130-136. PubMed
    Regaining 120 degrees or more of knee bending is the key criterion for returning after a quadriceps contusion.
  25. Aronen JG, Garrick JG, Chronister RD, et al. Quadriceps contusions: clinical results of immediate immobilization in 120 degrees of knee flexion. Clin J Sport Med. 2006;16(5):383-7. PubMed
    Holding the knee bent to 120 degrees right after a quadriceps contusion led to return to full activity in an average of 3.5 days.
  26. Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013;32(2):317-24. PubMed
    Thigh contusions are treated with the knee bent to 120 degrees for 24 hours; NSAIDs beyond 48 to 72 hours may impair healing.
  27. Beiner JM, Jokl P. Muscle contusion injury and myositis ossificans traumatica. Clin Orthop Relat Res. 2002(403 Suppl):S110-9. PubMed
    Myositis ossificans is one of the most debilitating consequences of muscle contusion.
  28. Simon T, Guillodo Y, Madouas G, et al. Myositis ossificans traumatica (circumscripta) and return to sport: A retrospective series of 19 cases. Joint Bone Spine. 2016;83(4):416-20. PubMed
    Athletes with traumatic myositis ossificans mostly resumed light activity by 3 months and their earlier level by 6 months.
  29. Martinez SF, Steingard MA, Steingard PM. Thigh Compartment Syndrome. Phys Sportsmed. 1993;21(3):94-104. PubMed
    Thigh compartment syndrome after a contusion is rare but limb-threatening and requires urgent surgical decompression.
  30. Joglekar SB, Rehman S. Delayed onset thigh compartment syndrome secondary to contusion. Orthopedics. 2009;32(8). PubMed
    Compartment syndrome after a thigh contusion can develop later as bleeding accumulates.
  31. Knapik DM, Trasolini NA, Diaz CC, et al. Avulsion Injuries and Ruptures of the Proximal Rectus Femoris in Skeletally Mature, High-Level Athletes: A Critical Analysis Review. JBJS Rev. 2021;9(7). PubMed
    Proximal rectus femoris avulsions may need surgery; chronic injuries that fail non-surgical care can leave pain and weakness.
  32. Hinz M, Geyer S, Winden F, et al. Midterm outcome and strength assessment after proximal rectus femoris refixation in athletes. Arch Orthop Trauma Surg. 2022;142(9):2263-2270. PubMed
    After repair of proximal rectus femoris tears, 93.3% of competitive athletes returned at about 10.5 months.
  33. Mullen S, Vopat BG, McEntee R, et al. Injuries to the Rectus Femoris: A Review of Evaluation, Management, and Return to Sport. J Am Acad Orthop Surg. 2026;34(11):e1489-e1494. PubMed
    Most rectus femoris injuries are treated without surgery; surgery is reserved for full-thickness tears and avulsions in high-level athletes.

Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Your own diagnosis and treatment plan depend on your exam and imaging.