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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 three ligaments involved in ankle sprains or strains are:

  • The anterior talofibular ligament

  • The posterior talofibular ligament

  • The calcaneofibular ligament

Ligaments involved in ankle sprains: Anterior talofibular ligament, Posterior talofibular ligament, Calcaneofibular ligament
Click Image to Enlarge

Sprains or strains are uncommon in younger children. This is because their growth plates (areas of bone growth located in the ends of long bones) are weaker than the muscles or tendons. Instead, young children are more prone to fractures. Sprains and strains are more common in older children, especially young athletes.

Contusions

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

Sprains

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

Strains

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

Diagnosing a Sprain or Strain

Your child's health care provider makes the diagnosis with a physical exam. During the exam, the health care provider takes your child’s complete medical history and asks how the injury happened.

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

  • X-ray: A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film

  • 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

  • CT (or CAT) scan: An imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat and organs. CT scans are more detailed than general X-rays.

Symptoms of a Sprain or Strain

The following are the most common symptoms of a sprain or strain. However, each child or 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 child may have limited use or may not use the injured area at all. He or she may walk with a limp if the injury happened 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 talk with your child's health care provider for a diagnosis.

Treatment for Sprains or Strains

Specific treatment for a sprain or strain will be determined by your child's health care provider based on:

  • Age, overall health and medical history

  • Extent of the injury

  • Your child's tolerance for specific medicines, 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 choices may include:

  • Medicines, 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 talk with your child's health care provider if there is a prolonged, visible deformity of the affected area or if severe pain prevents use of arm, leg, wrist, ankle or knee.

Overuse Injuries

Children and adolescents who regularly participate in sports activities may develop microtraumatic damage to a muscle, bone or tendon. When it is repeatedly stressed, it 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

Prevention of Overuse Injuries

To prevent overuse injuries in young athletes:

  • Reserve one to two days per week for rest from competitive sports and training.

  • Take breaks 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.

More Information About Sports Injuries from Johns Hopkins Medicine

Dance Injuries: Diagnosis, Treatment and Prevention

Johns Hopkins orthopedist Raj Deu, M.D., and physical therapists Andrea Lasner and Amanda Greene discuss dance injuries, treatments and the preventative measures dancers can take to stay at the top of their performance in this online webinar.

Long-term Outlook for a Child or Adolescent with a Sprain or Strain

Contusions, sprains or strains heal quite quickly in children and adolescents. It is important that your child follow 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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