Sprains and Strains in Children

The majority of sports injuries are caused by minor trauma involving muscles, ligaments, and/or tendons, including:

  • Contusions (bruises)

  • Sprains

  • Strains

The most commonly sprained or strained joint is the ankle.

The 3 ligaments involved in ankles sprains or strains include the following:

  • Anterior talofibular ligament

  • Posterior talofibular ligament

  • Calcaneofibular ligament

Illustration demonstrating the three ligaments involved in ankle sprains/strains

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.

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 sprain?

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

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 or strain diagnosed?

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.

What are the symptoms of a sprain or strain?

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

  • Pain in the injured area

  • Swelling in the injured area

  • Difficulty using or moving the injured area in a normal manner (Your adolescent may have limited use or may not use the injured area at all. Your adolescent may walk with a limp if the injury occurred in the hip, leg, ankle, or foot area.)

  • Warmth, bruising, or redness in the injured area

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

Treatment for sprains or strains

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.

What is an overuse injury?

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 4 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

Prevention of overuse injuries

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.

Long-term outlook for an adolescent with a sprain or strain

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.


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