David Blow
NeuroMuscular Taping Institute, Rome, Italy

Causes of hematoma

  • In most cases, trauma that ruptures capillary vessels with hematoma as a consequence.
  • A consequence of surgery
  • Hemorrhagic diseases, especially those involving alteration of coagulation factors, can typically cause hematoma among clinical symptoms.
  • When the hematoma cannot be traced back to trauma, other possible causes are: capillary fragility, blood coagulation disorders, leukemia and ongoing therapy using anticoagulant drugs.

The location and the volume of hematoma depend on the kind and magnitude of the trauma, on the size of the injured vessel and on the characteristics of the tissue in which the hematoma has formed. Symptoms can range from a feeling of tautness and pain in the affected area to acute pain, which is exacerbated by movement of the affected part. Hematomas may be more or less noticeable, subcutaneous or intramuscular and large or small in volume. The blood congestion forming the hematoma is absorbed slowly. The hemoglobin from the red corpuscles partially transforms into pigments that give a yellowish-greenish color to the hematoma being absorbed. Hematomas are rich in iron ions and devoid of oxygen, therefore ideal sites for infection and the spread of bacteria. The same hematoma obstructs inflammatory cells, reducing the ability of phagocytes and other antibacterial processes to access the trauma site. When a hematoma is extensive, surgical emptying may be required to avoid infection.

Traumatic Causes – Contusions

Contusions or bruises are the result of traumatic lesions accompanied by the seepage of blood of varying magnitude. Bruising may develop complications through the formation of hematoma, or rather, localized gathering of blood seeping from broken vessels into adjoining tissues. There are various types of bruising that are differentiated by the area affected: cutaneous, muscular, tendinous, articular and osseous.

Cutaneous bruising is often associated with wounds or skin lesions, which may be more or less deep. The trauma is accompanied by the formation of hematoma, which may take on major significance when larger venous or arterial vessels have been injured. Treatment in the acute phase is through application of ice and rest in order to contain hematoma formation.

Muscular contusions are lesions of varying magnitude of the subcutaneous and muscular fascia. The severity of a contusion is greater if it occurs with the muscle in contraction. Muscular lesions usually occur when the muscle structure has limited elasticity and/or with a sudden or rapid movement. There is always development of hematoma, which tends to spread. Acute-phase first-aid treatment comprises: absolute rest, ice and containing bandaging.

Tendinous contusions usually cause distress to tendon sheaths. Less likely than bruising is lesion of the tendon. Tendons are the fibrous or connective ends of muscles, where they are inserted onto a skeletal segment, another muscle or the derma. Tendinous bruises lead to tenosynovitis. Acute-phase first-aid treatment consists in: absolute rest, ice and containing bandages.

Articular contusions affect the joints and may cause an immediate hemarthrosis – the seeping of blood into a joint cavity. Or it may also cause a synovial reaction with hydrarthrosis – the effusion of synovial fluid into a joint cavity, which may not always be immediate but can occur within 12 to 24 hours of the injury. Therapies to be applied are ice and rest, even without absolute immobilization.

Osseous contusions are accompanied by sharp pain located in the periosteum – the fibrous membrane enveloping the external surface of the bone. The most suitable first-aid intervention here is the use of ice.

Decompressive Technique:

  • Decompression of skin, vascular, neurological, lymphatic, muscular, tendinous and articular tissue
  • Improve vascular circulation and lymphatic drainage nurture and drain tissues

Compressive Technique:

  • Compression of muscular, tendinous and lymphatic tissue
  • Improve muscular and tendinous performance as well as articular stability


  • If bruising is moderate it is enough just to apply ice. The cold causes vasoconstriction, limits the discharge of blood and leads to healing in a few days.
  • When the trauma has affected a risk zone: head, chest or abdomen, medical consultation is essential. In such cases, even though the hematoma may be invisible it might have affected an internal organ.
  • In general, where the hematoma is limited in size, it will be reabsorbed spontaneously within a few days, leaving no trace within a week or two following the trauma. A large-sized hematoma, however, will tend to transform into a concentration of liquid enclosed within a fibrous shell.

RICE(rest, ice, compression, elevation)

is a first-aid approach to treating soft tissue lesions and managing accidents involving trauma.Damage to soft tissue invariably leads to swelling and edema. Swelling is caused by the release of intercellular fluid at the point of injury, as well as by an increase in blood flow to the site. The build up of fluids in edema slows down the healing process being the body’s mechanism for hindering articular movement and serving as a signal to the body not to use the injured joint by reducing blood flow as well as any drainage in the area. The application of ice to the area has the effect of restricting the flow of blood to the affected area. This is useful of trauma treatment during the acute stage as it reduces the amount of swelling. Ice also has a secondary effect on pain receptors in the affected structures. In general, the application of cold is most effective within the first 72 hours following a soft-tissue lesion. Compression is a useful first-aid treatment as the application of pressure reduces the effects of any internal hemorrhaging. Compression has two distinct roles:

  • Limits damage to the soft tissue at the trauma
  • Reduces blood flow towards the injury

The duration of the acute stage of a lesion and its treatment using RICE depends directly on the magnitude of the lesion. As the acute phase of the trauma is overcome, the application of cold and compression lose their usefulness and may indeed reduce the body’s ability to heal itself. Cutaneous and muscular tissue depends on continuous vascularization and lymphatic drainage for reconstruction of damaged cells at the trauma site. Application of NeuroMuscular Taping in decompression, with the purpose of promoting vascularization and drainage has become a fundamental rehabilitative method for the post-acute stage therapy. Applied using the fan-shape-cut technique and in decompression, the tape increases the interstitial spaces that have become congested by the edema and hematoma.Application of NeuroMuscular Taping specifically to hematic congestion has become today’s most innovative and widely used technique for the initial post-traumatic and post-surgical rehabilitative window, as it guarantees rapid, visible outcomes and offers a highly reliable solution

Case Study 1: Contusion Trauma
Before application of the fan-cut
Case Study 1: Contusion Trauma
Application of the decompressive fan
Case Study 1: Contusion Trauma
Three days later
Case Study 2: Post-surgical hematoma following fracture of the femur
7th day after surgery
Case Study 2: Post-surgical hematoma following fracture of the femur
1st Application
Case Study 2: Post-surgical hematoma following fracture of the femur
After 2 days
Case Study 2: Post-surgical hematoma following fracture of the femur
3rd application after 5 days
Case Study 2: Post-surgical hematoma following fracture of the femur
Final result after a total of 7 days


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