When presented with a haematoma, the most important assessment is to determine whether it is inter or intra-muscular, the latter having the greater potential for complications if not treated correctly. If the fascia surrounding the muscle is damaged (inter-muscular), this will allow the exudate to spread widely allowing the body to reabsorb and remove these fluids more easily. The superficial signs of discoloration are often more evident although the discomfort related to the swelling is usually less.
An intra-muscular haematoma may be harder to observe as the bleeding is limited to a confined area where the increased pressure on the sensory nerve nedings, often making this far more painful. In managing this type of injury it is vital that no further bleeding occurs into the affected muscle and that all efforts are directed towards removing the fluids before they become too viscous. It must therefore be emphasised that the person rests and does not undertake any activity that may open the recentlly sealed blood vessels. Treatment must include all manual therapy techniques aimed at dispersing the fluids from the damaged tissue and the practitioner will use verbal and tactile feedback, plus their expertise to determine the rate, intensity and duration of specific techniques towards this goal. No compression bandages are recommended at this stage although compression massage techniques may be the most effective in encouraging removal of fluids from the muscle.
IMPORTANT: If you have access to the person frequently during the first 3 weeks after injury and progress is clearly limited, it is advisable to refer to hospital where they may choose to aspirate. Here is a video link where a haematoma has not been successfully resolved and surgery was necessary to remove the congealed blood.