Pediatric Sports Sprains & Strains

The majority of sports injuries are a result of minor trauma to muscles, ligaments, and/or tendons. These injuries are often recognized by the onset of immediate localized swelling, pain, and/or discoloration. The three most common injuries are contusions (bruises), sprains, and strains.

What are sprains and strains?

Sprains

A sprain is an injury to a ligament--a stretching or a tearing. One or more ligaments can be injured during a sprain. The severity of the injury will depend on the extent of injury to a single ligament (whether the tear is partial or complete) and the number of ligaments involved. The most frequently sprained ligaments are in the ankles, knees and wrists. A strain is an injury to either a muscle or a tendon generally caused by overuse, force, or stretching. Depending on the severity of the injury, a strain may be a simple overstretch of the muscle or tendon, or it can result in a partial or complete tear.

Strains

A strain is an injury to either a muscle or a tendon generally caused by overuse, force, or stretching. Depending on the severity of the injury, a strain may be a simple overstretch of the muscle or tendon, or it can result in a partial or complete tear.

Two common sites for a strain are the lower back and the hamstring muscles (located in the back of the thigh/knee). Contact sports such as soccer, football, hockey, boxing, and wrestling put people at a higher risk for strains. Strains are also common overuse injuries seen in long distance running, swimming and other endurance sports. Gymnastics, tennis, rowing, golf, and other sports that require extensive gripping can increase the risk of hand and forearm strains. Elbow strains sometimes occur in people who participate in racquet sports, throwing, and contact sports.

Sprains or strains are uncommon in younger children because their growth plates (areas of bone growth located in the ends of long bones) are weaker than the muscles or tendons. Instead, children are prone to fractures.

How do I treat a sprain or strain?

To speed up recovery, think P.R.I.C.E (Protection, Rest, Ice, Compression, Elevation):

• Protection- You may be splinted, taped or braced to prevent further injury.
• Rest- from all activities that cause pain or limping. Use crutches/cane until you can walk without pain and limping.
• Ice - Ice the affected area for 15-20 minutes, 3-5 times/day for the first 24-72 hours to reduce swelling. Leave ice off at least 1 ½ hours between applications.
• Compression- Wrap affected area starting with the area FARTHEST from the heart, using even pressure. Wear until swelling decreases, loosen if there is any coolness or discoloration of extremity.
• Elevation- the ankle above heart-level to decrease swelling.

How do I know if I need to see a doctor?

See a doctor if:

• You have severe pain and cannot put any weight on the injured joint.
• The area over the injured joint or next to it is very tender when you touch it.
• The injured area looks crooked or has lumps and bumps (other than swelling) that you do not see on the uninjured joint.
• You cannot move the injured joint.
• You cannot walk more than four steps without significant pain.
• Your limb buckles or gives way when you try to use the joint.
• You have numbness in any part of the injured area.
• You see redness or red streaks spreading out from the injury.
• You injure an area that has been injured several times before.
• You have pain, swelling, or redness over a bony part of your foot.
• You are in doubt about the seriousness of the injury or how to care for it.

What should I expect at my doctor’s appointment?

Your child's orthopaedic surgeon will perform a comprehensive physical examination to assist in diagnosis. During the examination, the physician obtains a complete medical history of your child and asks how the injury occurred (mechanism of injury). Diagnostic procedures may also help evaluate the problem.

Diagnostic procedures may include:

• X-Rays:a diagnostic test which 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.
• Computerized 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 cross-sectional images (often called slices), both horizontally and vertically, 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.

After the necessary tests have been completed, the physician will evaluate the results and take the appropriate course of action, taking into account the child's activities and lifestyle as well as his/her specific injury. Follow-up visits will most likely be needed for the physician to ensure that progress has been made and treatment is working properly.

Myths and misconceptions

Bracing can replace strengthening exercises - FALSE! Strong lower leg muscles provide support to injured ligaments.

Wearing a brace make an ankle weaker - FALSE! As long as you continue your strengthening exercises. Plus, a brace can help improve your balance, thus preventing further injury.

Braces won't fit in shoes - FALSE! Professional and college athletes wear them all the time, and new unobtrusive braces are becoming more and more common.

Can sprains and strains be prevented? YES. There are many things people can do to help lower their risk of sprains and strains:

• Maintain a healthy, well-balanced diet to keep muscles strong.
• Maintain a healthy weight.
• Practice safety measures to help prevent falls (for example, keep stairways, walkways, yards, and driveways free of clutter, and salt or sand icy patches in the winter).
• Wear shoes that fit properly. Replace athletic shoes as soon as the tread wears out or the heel wears down on one side.
• Do stretching exercises daily.
• Be in proper physical condition to play a sport.
• Warm up and stretch before participating in any sports or exercise.
• Wear protective equipment when playing.
• Avoid exercising or playing sports when tired or in pain.
• Run on even surfaces.