Bruises are one of the most common minor injuries and can occur at any time, whether from bumping into furniture or sustaining a sports injury. Medically known as contusions, bruises develop when small blood vessels (capillaries) under the skin break due to trauma, leading to blood leakage into surrounding tissues [1]. This results in discolouration, swelling, tenderness, and pain.
Understanding how to properly manage a bruise can reduce discomfort, speed up the initial healing phase, and potentially prevent complications. In this article, we will discuss generally accepted first aid for bruise treatment and how you can swiftly minimise pain and swelling.
Understanding Bruises (Contusions)
A bruise, or contusion, forms when blunt trauma damages capillaries beneath the skin, allowing blood to pool in the soft tissue [1]. The resulting skin discolouration changes as the body naturally breaks down and reabsorbs the pooled blood (haemoglobin), progressing from red/purple/black in the first few days to shades of green and yellow before gradually fading away [2], [3]. Most typical bruises heal within approximately 2 to 4 weeks, though the exact time varies based on severity and individual factors [3], [4].
Individuals with certain health conditions, such as bleeding disorders, those taking blood-thinning medication (anticoagulants), or the elderly with naturally fragile skin, may experience easier or more severe bruising [1], [5]. The severity of a bruise is also influenced by the force of the impact and the area of the body affected.
Types of Bruises
Bruises can occur at different tissue depths. Understanding the location can help determine the severity and expected pain level. The three main types are:
- Subcutaneous Bruises: These are the most common and occur just beneath the skin. Minor trauma typically causes them, appearing as flat, discoloured patches that change colour as they heal.
- Intramuscular Bruises: These occur within your muscle tissue, often due to a hard hit during an activity. They are typically more painful than subcutaneous bruises and may involve greater swelling or limited movement due to blood pooling within the muscle fibres [6].
- Periosteal Bruises: These occur on the periosteum, the dense connective tissue surrounding bones. A hard fall or collision can cause these, and they can be very painful, sometimes mimicking the pain of a fracture [6].
Immediate First Aid for Bruises (R.I.C.E. Protocol)
The R.I.C.E. (Rest, Ice, Compression, Elevation) protocol is a widely accepted traditional first-aid approach for acute soft tissue injuries, including bruises, aimed at managing immediate pain and swelling [7]. Here’s a step-by-step guide for initial treatment:
1. Rest:
- Avoid activities that stress or may worsen the injury. Giving the bruised area time to heal is essential, especially if it involves joints or muscles. This prevents further damage to the capillaries and soft tissue.
2. Ice (Cryotherapy):
- Apply ice or a cold compress immediately (within the first 24 to 48 hours) after the injury [7]. The cold temperature helps to constrict blood vessels (vasoconstriction), slowing blood flow to the area, which minimises the size of the bruise and helps reduce swelling and pain [7].
- Crucially, always wrap the ice in a cloth or use a cold pack to avoid direct contact with your skin and prevent ice burn.
- Apply it on your bruise for 10-15 minutes at a time, taking breaks of at least 20 minutes to allow the skin temperature to return to normal [7].
3. Compression:
- If swelling is significant, gently wrap the bruised area with an elastic bandage (like a crepe bandage) for compression [7].
- Compression helps to limit the amount of swelling (oedema) that can form. Ensure the bandage is snug but not too tight to avoid restricting circulation. If you feel numbness, tingling, or increased pain, loosen the bandage immediately.
4. Elevation:
Elevate the bruised area above your heart level whenever possible, especially during rest, by propping it up with pillows or cushions. This uses gravity to help reduce blood flow to the area, thereby minimising swelling and throbbing [7].
When to Consult a Healthcare Professional
While most bruises are minor and heal on their own, some situations warrant consultation with a physician to rule out a more severe injury or an underlying health issue:
- Severe or Persistent Pain: If the pain is severe and does not significantly improve with over-the-counter pain relief and R.I.C.E., it may indicate a more serious injury, such as a fracture or a deep haematoma [1].
- Bruises Not Improving: If your bruise shows no signs of improvement after two weeks, or if it worsens over time, consult your doctor promptly [3].
- Large, Growing, or Unexplained Bruises: If a bruise is unusually large, appears without a known apparent reason, or continues to grow in size, it could signal an underlying issue, such as a bleeding disorder or medication side effect [1], [5].
- Frequent or Easy Bruising: Frequent, recurring bruises without significant trauma should be medically evaluated to screen for potential clotting issues or other underlying conditions [1], [5].
- Signs of Infection: If the bruised area becomes increasingly red, warm, swollen, or develops pus, these are classic signs of a potential infection that requires urgent medical help [1].
- Joint/Movement Difficulty: If the bruise is near a joint and you experience difficulty or inability to move the limb or joint, it’s essential to consult a doctor immediately, as this may indicate additional damage to muscles, ligaments, or bone [1].
Frequently Asked Questions (FAQs)
What should I avoid when treating a bruise?
Avoid applying direct heat (like a hot water bottle) for the first 48 hours, as this can increase blood flow and potentially worsen swelling and the size of the bruise. Also, avoid vigorously massaging the bruised area.
How long does it take for a bruise to heal?
A typical, mild bruise usually takes about two weeks to fully fade [3], [4]. However, larger or deeper bruises (haematomas or intramuscular) can take several weeks or even a few months to resolve completely [3].
Can bruises be a sign of a more serious condition?
Yes. Persistent, recurring, or unusually large bruises, especially those appearing without clear impact or physical trauma, can be a symptom of a blood-clotting disorder, certain nutrient deficiencies, or other underlying medical conditions [5]. Seek medical attention if you are concerned.
What should I do if a bruise doesn’t improve?
If your bruise doesn’t show signs of fading after two weeks, or if it is accompanied by severe pain, increasing swelling, or numbness, consult your family doctor promptly.
References
[1] Mount Sinai Health System. (2024). Bruise Information. https://www.mountsinai.org/health-library/injury/bruise
[2] Medical News Today. (2023). Bruise colors: Stages, causes, and when to contact a doctor. https://www.medicalnewstoday.com/articles/322742
[3] Verywell Health. (2025). How Long Does It Take for a Bruise to Heal?. https://www.verywellhealth.com/how-long-does-it-take-for-a-bruise-to-heal-11788265
[4] MedlinePlus. (2024). Bruise healing – series—Healing, part 2. U.S. National Library of Medicine. https://medlineplus.gov/ency/presentations/100207_3.htm
[5] Cleveland Clinic. (2025). Bruises (Ecchymosis): Symptoms, Causes, Treatment & Prevention. https://my.clevelandclinic.org/health/diseases/15235-bruises
[6] Mount Sinai Health System. (2024). Bruise Information (Specifically for types of bruises). https://www.mountsinai.org/health-library/injury/bruise
[7] Cleveland Clinic. (2025). RICE Method: Rest, Ice, Compression, & Elevation. https://my.clevelandclinic.org/health/treatments/rice-method