Sprain or Strain? How to Know the Difference Monday, June 9, 2014

Whether your child is a member of a sports team or just running around the playground, at some point he or she may suffer a strain or a sprain. We’ve got the tips to help you identify and treat these injuries.

Sprain or Strain?
Sprains and strains can occur from the same mechanism of injury. The difference is in the part of the body that is affected.

• A sprain is due to the sudden extension of an overloaded ligament. Commonly sprained joints include the ankles, knees, and wrists.
• A strain is due to a sudden contraction of an unprepared muscle or tendon. Common strains include the hamstrings and the adductor muscles in the legs.

A strain or sprain can happen whether a child trips while walking on the sidewalk or while running in a race. There are several signs and symptoms to keep in mind, besides the initial pain, to help identify this injury.

Symptoms of a Sprain or Strain:

• Pain in the injured area
• Swelling in the injured area
• Warmth, bruising, or redness in the injured area
• Difficulty using or moving the injured area in a normal manner; for example, your child may limp instead of walking with a normal gait

There are three grades of sprains, depending on the severity of the injury and how much of the ligament has been injured. The higher the grade of sprain, the more likely your child will have difficulty with normal activities and will require medical attention.

• Grade 1 (also called first degree): less than 25 percent of fibers involved; a mild injury with preserved joint stability and function and minimal pain, and disability
• Grade 2 (also called second degree): 25 – 75 percent of fibers involved; a more severe injury with immediate swelling, decreased function, and joint laxity
• Grade 3 (also called third degree): a near-complete or complete tear with immediate pain, swelling, disability, and loss of function.


If you suspect your child has suffered a strain or a sprain, tell your child’s doctor immediately. By asking important questions about the injury, performing a physical exam, and occasionally ordering additional tests, your child’s doctor will be able to determine, whether or not the injury is a sprain or a strain. The pediatrician will assign a specific treatment based on the evaluation of the injury, your child’s age, and medical history.

There is, however, one way you can begin treating the injury right away. Just remember PRICE:

Protect – Protect the area, so that it does not suffer another injury or worsen.
Rest – The injured area should be moved as little as possible.
Ice – Apply ice immediately to reduce inflammation. Cover the injured area with an icepack for 10-20 minutes, three or four times a day. Place a towel in between the ice and the skin to avoid a cold burn.
Compression – Wrap the injured area firmly but not so tightly that blood supply is cut from the area.
Elevation – Raise the injured area above the level of the heart.

Make sure to do all five elements of PRICE treatment at the same time.

There is no way to prevent all sprains and strains, but there some measures parents can take to help reduce this injury:

• Warm up before any sports activity, including practice
• Stretch daily
• Always wear properly fitting and sports-appropriate shoes and equipment
• Participate in a conditioning and strengthening program
• Eat a well-balanced diet and stay hydrated
• Get plenty of sleep
• Follow the rules of the sport and ensure the coaches and referees follow the rules, too

At Children’s National, our orthopaedic and sports medicine specialists are leaders in the field, treating conditions from simple sprains and strains to complex orthopaedic conditions. It is important to find a pediatric orthopaedic or sports expert, who has experience caring for the ever-changing needs of the growing and developing child.


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