Dead Legs: The Basketballers Guide
Dead Legs are the second most common basketball injuries according to research.
I received a dead leg at the end of last year and it is not one of the most fun when it comes to pain. Another name for this is a contusion (some may know them as a ‘Charlie Horse’ or a ‘cork thigh’) and in addition to pain…bruising, reduced movement and spasms can be symptoms. The most common cause will be another player’s knee striking the thigh and this often causes injury to the quadriceps. The quadriceps are squashed between the thighbone and the opposing player’s knee. This then can cause secondary bleeding within the quadriceps muscles.
In addition to a dead leg, the hips and thighs can also be prone to strains and sprains due to the fact basketball involves pivoting, running, jumping, skipping and rebounding.
2 types of dead legs
There are two types of dead legs: intramuscular (bleeding happens within the muscle) and intermuscular (bleeding spreads outside the muscle).
The intermuscular hematoma will look the worst! It is the one where the whole thigh goes to multiple colours of black, blue and purple. However, these are often the ones that heal quicker; they look a lot worse than they feel.
Intramuscular haematomas are less likely to give you the visual clue and you may only have a slight bruise. This is usually at the site of the impact on the thigh. Sometimes, it is worth monitoring for a few days as the discolouration comes later. When it comes to the intramuscular haematomas, the bleeding is contained; therefore, the pressure can build up and become more painful. You will often have a greater reduction in movement with this type.
Range of movement within the first few days is typically a good indicator for the extent of the injury. As a rule of thumb, if you are unable to achieve more than a 90-degree bend of the knee the day after the injury, recovery may take slightly longer. Although recovery depends on multiple factors. For a bad intramuscular contusion, you could be looking around 6-8 weeks. Very few ballers will develop any long-lasting problems and most recover in days to a few weeks.
Symptoms
Pain is likely to be felt at the point of impact. With minor dead legs, you may be able to continue participating in training or the game. However, once the muscle(s) start to cool down afterwards, you may find the pain gradually increases. This is because the bleeding and swelling continue after the activity. You may also experience a gradual tightening and stiffening of the quadriceps. Often worse, the following morning
Other symptoms may include:
- Limp/ mobility issues/ difficulty weight-bearing
- Reduced strength
- Reduced range of movement (usually bending and straightening the knee)
- Spasm/cramps
- Altered sensation down the leg (this is rare and usually a short-term symptom)
Minimising risk of dead legs
Now, the only way to minimise the risk of a dead leg is to wear padded undershorts. It is difficult to protect yourself from direct impacts when it comes to basketball. However, there some step that could help reduce your chance of injury or help recovery:
Conditioning, nutrition, sleep and minimising stress will help you recover from a dead leg quicker but they won’t reduce risk.
- Make sure you are hydrated enough and eat well to ensure your muscles are hydrated and remain supple.
- Have a well-balanced strength and conditioning programme to increase your muscles’ resilience and ability to cope with demand.
- Perform basketball-specific situational training to increase readiness to participate and avoid unnecessary contact.
Treatment
Treatment for a dead leg can vary dependent on the severity of your injury. The first focus is to promote healing of muscles Then the focus is to restore the function of the thigh before sports specific rehab. Final steps are a graded return to play programme.
Initial management
In the first 48 hours after a dead leg, you should minimise activities that can increase blood flow to the quadriceps. A condition called myositis ossificans can be caused if a dead leg is caused to re-bleed during recovery. An increase in blood flow can increase the amount of bleeding and swelling. This, in turn, can cause increased pain and prolong recovery. However, this does not mean to avoid all movement. Gentle movement and mobility for the first few days can help with reducing stiffness and swelling.
It is best to avoid or minimise the following in the first 48-72hrs: hot showers, quadriceps stretching, heat rubs, rubbing/ massage, consumption of alcohol and excessive activity.
- Optimise load: For a short period of time, reduce or modify activity to allow pain to settle. Complete rest should be minimised and find the balance between rest and movement.
- If needed, take pain relief medication. Over the counter medication is usually sufficient. Speak to pharmacist or GP about medication if you are uncertain of what you can take. Just remember that the body needs inflammation to help your tissues heal, taking anti-inflammatories such as ibuprofen in the first 48-72hrs may slow down recovery times.
- Consider a support or taping in the early days to allow mobilisation. Generally, these are not required.
- Use an ice pack or ice slush bath for 15 to 20 minutes and repeat every two to three hours while you’re awake. Remember to check the skin regularly to make sure you don’t give yourself freezer burn. If you have vascular disease, diabetes or decreased sensation, talk with your doctor before applying ice.
- Consider your nutrition for recovery
- Make sure you get a good night’s sleep
Rehab
Once the swelling and pain have lessened enough to resume movement, rehab consists of a series of exercises to restore your thigh’s range of motion, strength, flexibility and stability. Exercises will need to be progressed to ensure you continue to improve. The level of exercises is usually based on pain tolerance levels; this can vary from person to person.
Thinking about what might cause you to do too much or too little is a useful exercise. Think about what might be barriers to your recovery. Our guide to activity cycles is worth reading on this.
Proprioception, balance and agility training are important and often missed steps in rehab. This allows the thigh muscle to get used to the demands of basketball again. Grading this up is again essential to prevent you going backwards in rehab. These exercises may involve various degrees of balance challenges, such as standing on one leg and dribbling a basketball or change of direction drills.
Return to Sport
Once the thigh is able to tolerate normal movements and loads. It is important to do basketball-specific drills as part of rehab. By this I mean, layups, jump stops, pivoting, rebounding and cutting. You can turn these activities into sport-specific rehab drills. Building this up gradually is crucial, those that return too soon or try rushing rehab often go backwards and recovery takes longer.
If you are struggling to get the right balance of activity, seeing a performance coach or therapist may be required. They can help with training loads and put a suitable plan together to reduce the risk of reoccurrence.
A gradual return to training and games is also recommended.
That’s the basketballers guide for a dead leg. Stay tuned for further info and resources on specific stages of rehab for thigh injuries.
Remember, these resources should not replace diagnosis and management from a medical professional. Always check before you follow the guidance.