How and why we bruise easily (and sometimes it’s our own fault)

EVERY four years we have the pleasure of watching some of the world’s finest athletes perform.

This year in Paris the image of the Olympic rings is seemingly everywhere, whether that be on banners, TV screens or tattooed on the arms of athletes.

But it is the rings on the backs of many of the athletes, most noticeably the swimmers, that I want to talk about.

These rings are the hallmarks of the therapeutic technique known as “cupping”.

Cupping is almost unique in the medical world in that, where many other ancient medical treatments and therapies such as bloodletting have fallen by the wayside, the process of cupping has endured.

Indeed, there are records of this technique being used by the ancient Egyptians and Macedonians.

The process involves placing a cup over an area of skin and then withdrawing air from the cup, either mechanically or by heating and subsequent cooling, to produce a vacuum effect on the underlying tissue that is supposed to help relieve pain, improve immune function and promote healing.

In truth the science behind it is sketchy to put it mildly but clearly some Olympians believe in it.

I write this not because I wish to delve into the contentious world of pseudo therapies but because the rings the process of cupping leaves behind on people’s backs provide a segue into the topic of bruising.

The world of bruises is not quite as straightforward as you might expect.

For a start, a bruise can go by other names, such as “haematoma” or “ecchymosis”. You may also hear reference to petechiae (tiny pin prick dots on the skin often associated with pressure build up or inflammation of blood vessels) and purpura (purplish non-blanching spots).

Put simply, a bruise is an area of bleeding caused by leakage of blood from blood vessels.

This can happen in the skin, where we see the most visible forms, but also in muscle and even in bone. Basically, anywhere there is a blood supply.

Most commonly, a bruise occurs due to blunt force to the skin. In fact, the word bruise itself comes from the old French and English words for “break” and thus is interestingly named after the cause of the injury rather than the injury itself.

Purpura and petechiae are mostly caused by other processes such as infections, including meningitis.

GPs are quite frequently contacted by people a bit concerned by the amount of bruising they get.

Naturally, people are inclined to think of sinister causes such as leukaemia.

Leukaemia does present excessive bruising in 24 per cent of cases. But while these bruises are similar in appearance to a normal bruise (a black, blue or purple mark on the skin), they tend to appear in unusual places, for example, the back, the legs or the hands.

If this is coupled with evidence of unusual bleeding elsewhere, for example heavy periods, frequent nose bleeds or bleeding gums, this raises the suspicion that something is not quite right with the normal blood clotting process and you should see your GP for further investigation and a blood test.

One of the most important things to check here is a platelet count.

Platelets are integral to normal clotting but in leukaemia their production is interrupted so bleeding continues unabated when it would normally stop before it became apparent.

Bruises tend to take about four weeks to disappear, over which time they will most likely turn various different colours, often more yellowy, as the pigments from the breakdown of the blood within begin to release themselves.

Fortunately, for the vast majority of the time, bruising is completely normal.

Often people are concerned about bruises because they can’t remember how they got them.

In some cases this might be put down to an UDI (unidentified drunken injury) but in truth some people are simply more susceptible to bruising so seemingly innocuous contacts can bring one out.

It is thought there may be a genetic element to this but also those with fairer skin might show bruises more obviously.

Those who are overweight are more prone due to extra pressure on the blood vessels at the peripheral areas of the skin.

As we grow older, our risk of bruising increases due to thinning skin coupled with a breakdown of collagen which normally holds things together, giving less protection for the vessels within.

This is another reason why older people feel the cold more. Don’t forget there are man-made causes too and I don’t just mean cupping.

Some of the medication we give ourselves ups the risk of bruising. Blood thinning medication such as warfarin and the newer classes of drugs such as apixaban and rivaroxaban are there to thin the blood.

Although these medications are prescribed for good reason, it does mean that any damage to blood vessels takes longer to clot.

Likewise antiplatelet medications such as aspirin and clopidogrel might cause more bruising, as can even common medications such as ibuprofen.

Of course, some people are simply more clumsy than others, or perhaps more adventurous and less worried about knocks and bumps.

Invariably, it tends to be these individuals that pose a higher risk for more traumatic injury.

Bones are very vascular (in other words they have an ample blood supply) and so if they break, bruising occurs, just deeper down.

Thus swelling around an injury as well as bruising is a good indicator that there’s something not quite right deeper down. Likewise, a torn muscle causes bleeding from the injury site and so has the same effect.

In very traumatic cases, bruising can help physicians pinpoint the site of possible injury.

If one presents with bruising around both eyes — a sign known in the profession as “panda eyes” — it can be a sign of a fracture at the base of the skull. (Fittingly, pandas do seem to be one of the clumsier animals).

Bleeds big enough to cause swelling, more often referred to as haematomas, can take much longer to heal and are correspondingly more painful. They also pose a risk of infection, albeit this is rare.

Short of draining these surgically, which is done in only the most severe cases. there is not much more one can do to “treat” a bruise.

Big or small, the best way to limit bruises is by applying ice as quickly as possible to the area after injury. This slows blood flow and therefore reduces the volume of blood escaping.

While there are various laser treatments to treat run-of-the-mill bruising, this is a bit like getting a rocket scientist to change a light bulb.

A bruise is a bit like toothpaste — once it is out of the tube, you can’t put it back in.