The bane of the bruiser! That lovely blemish on the skin that is often photographed and treasured as a hard-ass trophy or symbol of dedicated commitment to physical exertion or toil. The heraldry of physical pain endured usually in the pursuit of adrenalin infused extreme sports. The teller of tales, the indicator of nights of imbibed joy, the progenitor of greater adventures and even the confessional of the minor clumsy oaf that seems to always find the one corner in the room! Bruises are like scars, that we try to hide but surreptitiously parade to our chosen few, usually accompanied by great stories and conversation starters.
But why do we bruise? What is a bruise and why do some get them so easily?
Technically a bruise is damage to the tissues that lie underneath the skin. When trauma to the tissues in the body occur, blood vessels can become broken and blood escapes the cardiovascular system, weeping out into the interstitial space (space between cells). A bruise does not involve broken skin. That would be bleeding. But essentially damage to the underlying tissue creates internal bleeding and it is this function that creates the blemished colouring on the body.
Bruising can be an indicator of other trauma that is linked to other conditions such as hematoma, internal bleeding, fractures or even cancer. However, these conditions are not linked to the usual small bruises that we find when we have suffered a blunt trauma (such as hitting the coffee table with our leg). Bruises can be an indicator of coagulant issues with blood, platelet disorders (such as leukemia) or even meningococcal disease, however this type of bruising is usually more widespread in the body and have a mildly different colouration or pattern of discolouration than the normal average bruise. If you bruise easily and have long term bruising, this can be an indicator of more underlying issues with blood coagulation and platelet formation and should be investigated by a medical professional.
Sometimes bruising occurs in areas of the body where impact has occurred but wasn’t directly on the site of the bruise. This condition is called ecchymosis and is often brought about by loose tissues at the site of the injury. In this case, blood is allowed to travel through the tissues and ends up pooling in another location. The best example of this is a black eye after injury to the nose or facial region. The blood travels through the looser tissue areas or cavities and pools in the occular region.
So for the purposes of this article, why do some of us bruise more easily than others? Bruising has a lot to do with tissue strength. It also has a lot to do with Capillary wall strength and the quality/integrity of our blood vessel walls. If our vessel walls are strong and well maintained then obviously impact isn’t going to damage them as much. There are other factors that weigh in concerning soft tissue as firmer tissue has more integrity than does soft tissue. (muscles for example).
Thus the elderly are more prone to bruising owing to the thinner tissue (incl skin) and less elastic soft tissue that are the factors of ageing. Females tend to bruise more easily as well due to subcutaneous fat. That is not fat content but the thin layer of fat that lies under the skin which is larger in females than males. Likewise the more vascular an area (more blood vessels) the more prone an area would be to bleeding/bruising such as the arms, the face and the shins.
When impact occurs and a capillary is broken, the body goes into a process to repair the break in the capillary (releasing endothelin to narrow blood vessels = preventing more bleeding) VWF (Von Willebrand Factor) a glycoprotein is then released to begin coagulation of the blood, plugging the wound and thus repairing the capillary.
What happens after this initial response is a chemical breakdown of the blood that has seeped into the interstitial space and this attributes to the variations in colouring and changing nature of a bruise. Once the capillaries have been broken and blood has seeped out, the blood cells need to be broken down and disposed of. The first stage is the breakdown of hemoglobin in the red blood cells to biliverdin (bile pigment) which is then further broken down to bilirubin and then to hemosiderin. Each stage of the breakdown brings with it a unique colouring from red/blue to green, to yellow and finally golden brown.
But why do others bruise more easily than others? Some of us may be more prone to bruising than others due to the nature of our capillary walls. If the integrity of our capillary walls is not adequate then it stands to reason that the potential for bruising more readily would occur in someone with compromised capillary structure than those with more sound capillaries. Many factors can effect the walls of the blood vessels (capillaries) and in turn the ability for blood to seep into other spaces. Like a burst laundry pipe, the smallest leak can create major issues.
Certain factors such as exposure to sun which has a direct effect on the firmness of the skin owing to the breaking down of the firmness and the supportive matrix that holds blood vessels together. Older persons who haven’t used much sunscreen may experience more bruising as they age as like with all things, our skin ages and loses integrity and the same follows for the blood vessels.
Similarly taking certain medications can also have an effect on the supportive matrix such as Corticosteroids. These topical medications have a direct effect on collagen, thinning this fibrous matrix that supports many of the structures in our body and are the basis of many of our connective tissues. There are certain blood thinning medications (such as Warfarin) that make the blood thinner, also makes the blood vessel walls thinner and thus you can be prone to more bruising once you have been taking this type of medication.
Nutritionally there can also be a link between thin vessel walls and certain vitamin deficiencies in the diet. Micro and Macro nutrients whilst not entirely responsible for a predisposition to bruising or internal damage can have an effect on the strength and presence of substances in the blood that influence bruising.
· Bioflavinoids are micronutrients (which include rutin and hesperidin) that have a direct correlation on blood vessel wall integrity by protecting vessel walls from pathogens as well as acting on the permeability of blood capillaries.
· Vitamin C is vital for the production of collagen in the body. It also serves as a valuable antioxidant which combats free radicals that may have an effect on capillaries integrity.
· Vitamin K is indicated as it is a co factor of coagulation of the blood or blood clotting. Without the ability to clot the blood will continue to escape any integrity breach and the wound will cause further bleeding and the appearance of bruises.
· B9 and B12 are also vitamins to be aware of as a deficiency here can create elevated levels of homocysteine (a corrosive of long living proteins) which can damage capillary walls. Similarly to Bioflavinoids, they help to protect the structure of the vessel wall.
Now a bit of a talking point with some clients is when they have bruised after a massage treatment. When is too hard too much. It is true that deep massage is needed to work through certain adhesions in muscles and soft tissue and with this deep and consistent pressure to make fibres yield to realignment, some bruising can result. This is usually from a broken arteriole that lies deep within muscle layers. This is not necessarily a bad thing as sometimes it is necessary to get fresh blood flowing in area that has been ‘closed off’ from local pressure that can be created from fascial adhesions and muscle fibres that have become adhesions. With fresh blood and flow comes fresh nutrients and the removal of waste products. Due to the fact that all people have different levels of resistance to bruising, it cannot be guaranteed that with a new therapist or client that the pressure required will result in a bruise or not.
As a therapist that does deep tissue work, this is the bargaining stage. Getting to know what will work for ‘your’ body and not just a generic approach. A little discolouration after particularly aggresive work on areas that are in need of specific and calculated release is common. This can even happen from other treatments such as acupuncture. But the benefits gained from soft tissue release can sometimes be greater than the smaller micro-trauma of some broken arterioles. It is NEVER the intention to cause bleeding or bruising from a massage. The result of discolouration does factor in at times but it is never a proposed outcome of a treatment.
So the integrity of the blood capillaries and the permeability of the blood have a lot to do with whether someone is more prone to bruising than others. However, as we all age and we wreak damage on our tissues or our skin, we become a little more prone to bruising. So it doesn’t always stand true that bruising is an indication of deficiencies or diseases. With that said, if bruising becomes an issue for any unexplained reason, medical advice is warranted and the above mentioned conditions should be explored before dismissing the appearance or regularity of bruises.
Essentially though, the best way to avoid bruising is to not walk into coffee tables! Ideally, we bruise because we do things to ourselves. Our blood flow and our quality of connective tissue and blood coagulation all affect bruising and how our bodies deal with trauma. We are all unique in how we respond to these small traumas so if you both do the exact same fall, don’t be surprised if you bruise more than your friend. Bruising is a normal process and with different colourings occurring, this means your system is dealing with the issue. Just another wonderful way the body can recover from the crazy things that we do to it.