Massage therapy · Kitchener–WaterlooKnee Bone Bruising

Bone bruising usually comes from an impact injury, such as a direct blow, a fall or a twisting injury to the knee, often alongside an injury to the ACL (Cleveland Clinic, 2024; Papalia et al., 2015). It can also come from repeated overload, for example in high-impact sports, or from extra pressure on the bone because of arthritis or a damaged meniscus (the cartilage cushion in the knee) (NHS Tayside, n.d.).

Sometimes there is no obvious injury. The person may have knee pain on weight bearing that won't settle, and bone bruising shows up when they have an MRI scan. Bone bruises cannot be seen on X-rays (Cleveland Clinic, 2024).

With an impact injury, the smooth cartilage covering the bruised bone is bruised too, and it can be permanently damaged, thinning over time (NHS Tayside, n.d.). Damage affecting both the cartilage and the bone underneath is called an "osteochondral lesion". The literal meaning is osteo (bone) and chondral (cartilage).

People often think bone bruising will heal quickly, but it can take a long time and be very painful. For painful bone bruises, most settle within 3 months, but some take over a year (NHS Tayside, n.d.).

Warning signs: if you have had a major injury, such as a bad fall or a car accident, especially with sharp, intense pain that seems to come from the bone, call 911 or go to the emergency room at your nearest hospital (Cleveland Clinic, 2024).

Where the tibia and femur meet, there are two parts of the bones called the condyles. The inside part is known as the medial condyle, and the outside part the lateral condyle. They occur on the tibia as well as the femur. This is where the knee joins together to form the knee joint.

Tendons keep the leg muscles and knee bones connected to enable the knee joint to move. Ligaments join all of the knee bones and deliver stability to the knee.

The anterior cruciate ligament is the one that prevents the femur from sliding backward along the tibia. The medial and lateral collateral ligaments make sure the femur doesn't slide from one side to the other. It is the posterior cruciate ligament that prevents the femur from sliding forward along the tibia.

No treatment has been proven to speed up the healing of a bone bruise (NHS Tayside, n.d.), but the following can help you manage the symptoms while it heals.

1. Rest

After the bruise has been diagnosed, you want to rest the knee. Avoid heavy weight bearing through the knee and any stress that might slow the healing process down. It is fine to walk gently, but running or jumping is not recommended. Don't go back to sport or intense activity until your healthcare provider says it is safe (Cleveland Clinic, 2024).

2. Ice

Apply a cold pack wrapped in a towel or thin cloth for 15 minutes at a time, a few times a day (Cleveland Clinic, 2024). Never put ice directly on the skin. Ice can help ease pain and swelling.

3. Pain Relief

Cleveland Clinic (2024) says over-the-counter anti-inflammatory painkillers (NSAIDs) and paracetamol (acetaminophen) can relieve pain, and advises not taking painkillers for more than 10 days in a row without talking to your healthcare provider. (This medicine information comes from Cleveland Clinic, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

Options outside my scope

• MRI scan: bone bruises show up on an MRI scan but not on an X-ray (Cleveland Clinic, 2024).
• Brace, splint or crutches: your consultant may suggest a brace or splint to reduce stress on the bone while it heals, or crutches to take weight off the joint (Cleveland Clinic, 2024).

How I can help (see the My Approach tab)

• Exercises to restore movement and strengthen the muscles around your knee
• Hands-on work for the thigh, hamstrings, calf and hip
• Help setting up crutches or a brace if you've been advised to use them
• A gradual return to sport and intense activity

If your knee aches more the next day, we ease off. Even once the pain has eased, the bone needs time to heal fully before intense activity.

If your knee gives way, locks or swells up quickly, or the pain isn't settling, see your family doctor or nurse practitioner.