Pediatric Sprains and Strains

A contusion (bruise) is an injury to the soft tissue often produced by a blunt force such as a kick, fall or blow. The immediate result will be pain, swelling and discoloration.

A sprain is a wrenching or twisting injury or tear to a ligament. Sprains often affect the ankles, knees or wrists.

A strain is an injury to a muscle or tendon, and is often caused by overuse, force or stretching.

According to the American Academy of Pediatrics Council on Sports Medicine and Fitness, children and adolescents who regularly participate in sports activities may develop microtraumatic damage to a muscle, bone, or tendon that is repeatedly stressed and does not have time to heal naturally. This cumulative damage is known as an overuse injury. The injury is called microtrauma because it may not appear on X-ray, but it can affect the overall health and development of the child or adolescent. Overuse injuries are classified in four stages:

• Pain in the affected area after physical activity
• Pain during the activity, without restricting performance
• Pain during the activity, with restricted performance
• Chronic pain that does not go away

The American Academy of Pediatrics includes the following in its recommendations to prevent overuse injuries in young athletes:

• Reserve one to two days per week for rest from competitive sports and training.
• Take breaks of at least two to three months away from a specific sport during the course of a year.
• Emphasize that sports participation should be focused on fun, skill-building, safety and sportsmanship.

Your adolescent's doctor makes the diagnosis with a physical examination. During the examination, the doctor obtains a complete medical history of your adolescent and asks how the injury occurred. Diagnostic procedures may also help evaluate the problem. Diagnostic procedures may include:

• X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.
• Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays.

Specific treatment for a sprain or strain will be determined by your adolescent's doctor based on:

• Your adolescent's age, overall health and medical history
• Extent of the injury
• Your adolescent's tolerance for specific medications, procedures or therapies
• Expectations for the course of the condition
• Your opinion or preference

Initial treatment for a sprain or strain includes R.I.C.E. (rest, ice, compression and elevation). Other treatment options may include:

• Medications such as ibuprofen
• Activity restrictions
• Splint or cast
• Crutches or wheelchair
• Physical therapy (to stretch and strengthen the injured muscles, ligaments and tendons)
• Surgery (especially if the injury is reoccurring or if a muscle, tendon or ligament is badly torn)

Be sure to consult your adolescent's doctor if there is a prolonged, visible deformity of the affected area, or if severe pain prevents use of arm, leg, wrist, ankle or knee.

Contusions, sprains or strains heal quite quickly in children and adolescents. It is important that your teen adhere to the activity restrictions and/or stretching and strengthening rehabilitation programs to prevent reinjury.

Most sports injuries are due to either traumatic injury or overuse of muscles or joints. Many sports injuries can be prevented with proper conditioning and training, wearing appropriate protective gear and using proper equipment.