A bruise and a strain are two different medical diagnoses that can be related to the same injury if presented together. A strain is an injury, most likely a tear to the muscle, while a bruise, also called a contusion, is usually the result of blunt force to the muscle, causing bleeding. If a strain is serious enough, a contusion may present itself as one of the symptoms.
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There are three degrees of muscle strains. A back muscle strain that has a bruise suggests significant tearing, leading to the pooling of blood in the region, meaning at least a grade two or three strain. Your doctor will properly assess the injury, making sure there is nothing more significant to be concerned over, such as a spinal injury or a broken bone. An MRI will show the extent of muscle tearing and determine whether surgical repair is necessary. Dealing with both nonsurgical injuries, the strain and the contusion, follows the same protocol, whether it is on the back or anywhere else in the body.
The first few days after the injury are used to reduce inflammation and swelling. The acronym R.I.C.E. is well known in the medical and physical therapy communities. It means, "rest," "ice," "compression" and "elevation." This applies to the first 24 to 48 hours, when you should refrain from any sports, strenuous activities and try to stay off your feet as much as possible. Ice the injury for 20 minutes at a time three times daily. If you can, wrap the injured area to create compression. This might not be practical with a back injury, but it can be achieved with elastic wraps. Elevating your back may be problematic as well since you can't bring your back up higher than heart level in some cases without inverting yourself, which isn't recommended. If you are unable to compress or elevate the area, use over-the-counter anti-inflammatory medications to help with swelling and pain.
Seeking Further Treatment
It may take several weeks for a contusion to completely clear up, varying from person to person. However, there should be signs that the contusion is healing within days of the injury. If the contusion doesn't reduce in color at all, go back to the doctor, who may need to surgically drain the contusion to reduce clotting and restore circulation to the area. Nonsurgical options include using electrotherpay or ultrasound therapy to break up the contusion and increase circulation. Surgery for the strain itself should only be for significant and complete grade three tears. If you didn't go to the doctor immediately after the injury occurred and there is no improvement to the injury over several days, you may have a level three tear. A grade two injury doesn't need surgery but will present considerable pain in the area.
Return to Activity
Return to activity as pain reduces. Try to refrain from contact sports or any sport that could lead to a significant strain on your back to prevent reinjuring the area equally or worse. An injury in the middle of the back can make breathing difficult if mobility in the thoracic region is hindered. Ease back into sports slowly to minimize pain and rebuild your stamina. It can take up to three months for a grade two stain to completely heal. You can still play sports, but be sure to warm up and cool down properly, including icing the strain for 20 minutes after playing.