Context: It is common practice to treat musculoskeletal injury acutely with cryotherapy with compression. A tobacco poultice and the SportsWrap are touted as effective acute care treatments, yet are unproven. Objective: Compare four treatments (cryotherapy with compression, compression alone, a tobacco poultice, and the SportsWrap) of an experimentally induced bruise to determine their effectiveness at limiting bruise formation, thereby decreasing overall bruise duration. Design: Randomized, controlled, blinded trial. Setting: Research laboratory. Participants: 64 male participants (height: 180.2±6.4cm, weight: 78.0±16.2kg, age: 22.1±2.8yrs) volunteered. Participants committed to not exercise during participation and were free of medication affecting coagulation or inflammation at least 3 days before and throughout the study. Interventions: Participants were shot in both quadriceps with a tennis ball fired from a tennis ball machine at ~31m/sec from 46cm. Digital pictures were taken of the trauma site immediately before and on days 2, 4, 6, 8, and 10 post-trauma. Within 5 minutes of being shot, participants were randomly assigned to receive 1 of 4 treatments to one of their legs: 1) cryotherapy with compression (applied 5 times separated by 2 hours, compression applied with and without the ice until return on Day 2); 2) compression alone (worn continuously until Day 2); 3) a tobacco poultice (worn for no less than 12 hours, then removed; compression reapplied until Day 2); and 4) the SportsWrap (worn continuously until Day 2). Treatment times reflected clinical practice. Untreated leg served as control. Two raters, blinded to treatment and treatment leg, analyzed each bruise, while a third analyzed an unbruised control area for normalization. Software calculated average pixel values of cyan, magenta, yellow, black, and luminosity for each picture. This analysis was shown to be reliable during pilot data collection (ICC = .77) and has been used previously. Main Outcome Measures: Color difference, a unitless value, was calculated as the difference between the treatment and control legs from the normalized average pixel values. A 2 x 4 x 6 mixed model ANOVA followed by Bonferroni post hoc analysis determined differences between limbs and treatments over time. Results: There was no treatment (F3,60 = .47, P = .70) or limb (F1,60 = .04, P = .84) effect, but there was a day effect (F3.9,234.5 = 6.82, P < .001). The mean color difference values were greater on Days 4 and 6 than Days 0 and 10, and Day 4 was greater than Day 2 (Bonferroni < .05). None of the interactions were significant. Conclusions: Treatment had no effect on the degree of bruising that we produced in this study. We are reluctant to generalize this data to musculoskeletal injury beyond what we caused because of insufficient bruising/too great of variance in bruising.



College and Department

Life Sciences; Exercise Sciences



Date Submitted


Document Type





color difference analysis, contused quadriceps, injury intervention