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Sprains and Strains

What is a sprain?

A sprain is a wrenching or twisting injury to a ligament. It occurs when a violent twist or stretch causes a joint to move outside its normal range of movement. Sprains often affect the ankles, knees, or wrists but the most commonly sprained or strained joint is the ankle.

Ankle sprains injure the ligaments that connect bones to one another in the ankle. The three ligaments involved in ankles sprains/strains include:

Illustration demonstrating the three ligaments involved in ankle sprains/strains

A mild sprain involves tenderness but no significant stretching of the ligaments. More severe sprains involve stretching, and at times, tearing of the ligaments. Sometimes a nerve can be affected. If young athletes with sprained ankles walk in a way that overuses the tendons on the outside of the ankle, inflammation can occur. This is called peroneal tenosynovitis.

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. Ankle sprains primarily will occur in older children whose growth centers have already closed. Pain usually occurs over the outside area of the ankle.

What is a contusion?

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.

What is a strain?

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

How is a sprain/strain diagnosed?

Your child's physician makes the diagnosis with a physical examination. During the examination, the physician obtains a complete medical history of the child and asks how the injury occurred.

Diagnostic procedures may also help evaluate the problem. Diagnostic procedures may include:

Picture of a patient in a scanner

What are the symptoms of a sprain or strain?

The following are the most common symptoms of a sprain or strain. However, each child may experience symptoms differently. Symptoms may include:

The symptoms of a sprain or strain may resemble other conditions. Always consult your child's physician for a diagnosis.

Treatment for sprains or strains:

No matter how severe the sprain, rehabilitation is likely to be the first choice of therapy. It is more effective than early surgery to ensure that you rapidly return to appropriate levels of strength, function and comfort. The strain will probably be treated with "RICE":

Orthopaedic surgeons at The Children's Hospital of Philadelphia may suggest following this treatment with progressive weight bearing — if you can tolerate it — and medial and lateral (middle and side) stabilizing bracing to provide support. Bracing or casting may also be useful for patients with special needs such as neurologic dysfunction, or for severe sprains in younger adolescent patients.

If you have recurrent ankle sprains, we may suggest evaluation to find out the underlying reason. Ankle balance exercises may reduce the likelihood of ankle sprains. The exercises will be done on both the injured and noninjured ankle to help prevent future ankle injuries. Our trained rehabilitation staff will provide information about the exercises.

Long-term outlook for a child with a sprain or strain

Contusions, sprains, or strains heal quite quickly in children. It is important that the child adhere to the activity restrictions and/or stretching and strengthening rehabilitation programs to prevent re-injury.

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.

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