Sprains and strains occur when ligaments, tendons or muscles are injured, causing swelling. In most cases, this swelling occurs around a joint. Although uncommon in children, these injuries occur in some cases.

Muscle sprains and strains differ slightly. Sprains involve a stretching or tearing of ligaments, the bands of fibrous tissue that stabilize joints and connect bones to each other. Strains involve a stretching or tearing of muscle or tendon. Muscle is tissue made up of bundles of specialized cells that contract and produce movement when stimulated by nerve impulses. Tendons are fibrous cords of tissue that connect muscle to bone.

Ankle, wrist and knee sprains are the most common types of ligament sprains. For example, a child may sprain an ankle while sliding into a base during softball or sprain a wrist when falling and landing on an outstretched hand while ice-skating. Children can suffer a strain to a muscle or tendon while running, jumping, throwing or lifting a heavy object. Hamstring, back and elbow strains are most common.

Children who play certain sports – including football, soccer, gymnastics and others – are at increased risk of sprains and strains. However, experts generally agree that the physical and social benefits of participating in sports usually outweigh the risks associated with these activities.

The signs and symptoms associated with a sprain or strain will depend on the nature of the injury to the child. Pain, swelling and bruising are common. Minor sprains or strains often do not require a visit to a physician and will heal on their own with basic home treatment. However, more significant injuries often require medical care.

In diagnosing a sprain, a physician may have to perform an x-ray to rule out a broken bone or use a procedure such as magnetic resonance imaging (MRI) to determine the extent of damage caused by the sprain or strain. Treatment involves reducing swelling and pain, and following up with rehabilitation of the injured joint.

Parents are urged to encourage their children to take steps to lower the risk of sprains or strains. These include stretching and warming up before activity, eating a healthy diet that can strengthen muscle tissue, and making sure children wear proper footwear and athletic equipment.

Children who play too hard or who overexert themselves physically may experience a sprain or strain that causes swelling around a joint or muscle. This occurs when a ligament, tendon or muscle is injured.

Muscle sprains and strains differ slightly. Sprains involve a stretching or tearing of ligaments, the bands of fibrous tissue that stabilize joints and connect bones to each other. One or more ligaments can be injured in this process. Quick changes in direction, collisions, and falling and landing awkwardly are common sources of sprains.

Sprains are uncommon in young children because their ligaments tend to be stronger than the bones and cartilage to which ligaments are attached. As a result, a child is more likely to break a bone than to strain a ligament. However, sprains do occur in children, particularly as they get older. For example, a child may sprain an ankle while sliding into a base during softball or sprain a wrist when falling and landing on an outstretched hand while ice-skating. Ankle sprains are the most common injury in the United States, according to the National Institutes of Health. They usually occur when the foot turns inward suddenly. Wrists and knees are other common areas of sprains.

Strains involve a stretching or tearing of muscle or tendon. Muscle is tissue made up of bundles of specialized cells that contract and produce movement when stimulated by nerve impulses. Tendons are fibrous cords of tissue that connect muscle to bone.

Strains can occur as the result of two types of injury. An acute strain occurs when a muscle suddenly contracts or when a muscle is stretched too far. Children can suffer an acute strain while running, jumping, throwing or lifting a heavy object. A chronic strain occurs as the result of overuse of a muscle over a period of time.

Hamstring and back injuries are common examples of a muscle strain, which is often referred to as a “pulled muscle.” Elbow strains may occur as well, particularly in children who play racquet sports such as tennis or who throw a ball, such as in football or baseball.

Some of the differences between sprains and strains are as follows:

In cases of minor sprains or strains, parents may be able to treat the child with basic therapy measures. However, more significant injuries may require professional medical attention. In addition, parents should never move any child who has suffered an injury to the neck or back, because movement can cause serious nerve damage and possible paralysis. Children with these injuries must be immobilized before they are moved, and this is best left to medical professionals.

Sprains and strains both result from pushing the body too far beyond its natural limits of flexibility and range of motion. Children who play certain sports are at increased risk of sprains and strains. These include football, basketball, soccer, baseball or softball, gymnastics, wrestling, cheerleading, track and field, and hockey. Despite the increased risk, experts generally agree that the physical and social benefits of participating in sports usually outweigh the risks associated with these activities.

The signs and symptoms associated with a sprain or strain depend on the nature of the injury to the child. In general, the more serious the injury, the greater the pain and swelling is likely to be. A child may hear a pop or tear when the injury occurs, but this does not always happen.

Mild sprains occur when the ligament is stretched or slightly torn. The area may be tender and somewhat painful when moved. Typically, swelling is minimal and the joint is able to bear weight without a problem. A more significant sprain may be indicated by swelling and discoloration due to bleeding in the region. This likely indicates a tear in the fibers of the ligament. The joint may be difficult to move, and pain may be evident. The child may have difficulty putting weight on the joint. Severe sprains occur when a ligament completely ruptures. Significant swelling and discoloration are likely, and it may be impossible to put weight on the joint without feeling great pain.

Mild strains cause pain and stiffness during movement that usually disappears within a few days. A more significant strain involves a muscle tear that causes increased pain and swelling and bruising. Symptoms may last for up to three weeks. A muscle rupture results in a severe strain. Swelling, bruising and pain may be significant, and the muscle may completely cease to function.

Minor sprains or strains often do not require a visit to a physician and will heal on their own with basic home treatment. However, more significant injuries often require medical care. Parents are urged to schedule a visit with a physician if they are unsure of the seriousness of a child’s injury, or if the child displays any of the following symptoms:

• Severe pain
• Inability to place weight on a joint
• Crookedness or significant bumps or lumps in a joint
• Inability to move a limb, joint or other body part
• Loss of muscle function
• Numbness in the injured area
• Redness spreading from the injury site
• Injury to area that has previously been injured

A physician will perform a physical examination and compile a thorough medical history of the child. The physician may touch the injured area to feel for abnormalities or for warmth or cold in the injured region. The physician also will look for signs of swelling or tenderness and changes in color of the skin.

When diagnosing a sprain or strain, a physician may need to take an x-ray to rule out a broken bone. Imaging tests such as magnetic resonance imaging (MRI) may be used to help the physician determine if a ligament or muscle has been partially or completely torn.

Treatment for a sprain or strain depends on the extent of the injury and generally comes in two stages. In the first 24 to 48 hours following the injury, the goal is to reduce both swelling and pain. A sprain or strain should be treated using the formula known as RICE - an acronym used to remember how to take care of injuries that stands for:

• Rest. The child should not use the injured area for 48 hours to give it a chance to properly heal. For leg injuries, this may mean staying off the feet completely.
  
  
• Ice. An ice pack should be applied to the area of the child’s injury for 20-minute periods four to eight times a day. Ice should not be applied directly to the skin. Cold packs or ice in a plastic bag covered with a towel are good ways to apply this therapy. Heat should never be applied to an injury for at least 24 hours, because it is likely to increase both swelling and pain.
  
  
• Compression. Elastic wrap bandages, splints, air casts or special boots should be applied around an ankle, knee or wrist that has been injured. This can help reduce swelling.
  
  
• Elevation. When possible, the injured area should be elevated above the level of the heart.

Minor injuries may require nothing more than RICE therapy and over-the-counter pain relief medications, such as ibuprofen or acetaminophen. However, children who have suffered a moderate-to-severe sprain or strain usually require care from a medical professional.

In some cases, a hard cast will be applied to aid healing. More severe sprains may require a brace to stabilize the joint or even surgery to repair the ruptured ligament. Severe strains also may require surgery, especially if the muscle or tendon experiences significant damage.

Children typically recover more quickly from sprains or strains than adults. A strain usually takes about one week to heal, while a sprain can take up to several months, depending on the severity of the injury that is present.

After a sprain or strain has healed, the child may be urged to undergo rehabilitation (e.g., physical therapy), particularly following severe injuries. This helps to prevent stiffness and to restore the strength and flexibility of the injured area. Visits with a physical therapist may be part of this process. Such therapy may continue for several weeks, and after particularly severe injuries can take up to a year.

There are several steps that children can take to reduce the risk of a sprain or strain. Stretching and proper warm-up, such as a short jog before exercising, are among the most important preventative measures. These activities warm up the body’s tissues, increasing the flexibility of muscles and ligaments. After intense activity, children should gradually “cool down” by exercising more moderately for several minutes, followed by a second round of stretching.

Children who eat healthy, well-balanced diets are more likely to have strong muscles and to maintain a healthy weight, which puts less stress on body tissues and joints.

Other tips for reducing the risk of sprains and strains include:

• Keep clutter from stairways, walkways, yards, driveways and other areas where children walk and play.
  
  
• Purchase new athletic shoes for children as soon as the tread wears down or the heel wears on one side. This will help prevent falls and twisting of the ankle.
  
  
• Insist that children wear proper protective equipment when playing certain sports. Children also should be in good shape before participating in strenuous sports. Encourage older children to participate in organized sports that are supervised by an adult, preferably one who is knowledgeable about the sport (e.g., soccer coach).
  
  
• Discourage children from engaging in strenuous activity when they are tired. Muscles that are fatigued are less likely to provide strong support to joints, leaving them more vulnerable to injury.
  
  
• Instruct children to stop using any body part that hurts. This can help restrict the damage associated with a sprain or strain.
  
  
• Encourage children to practice good posture. This can help reduce the risk of back sprains or strains.

Preparing questions in advance can help parents and children have more meaningful discussions with their physicians on treating and preventing injury. The following questions related to sprains and strains may be helpful:

1. How will I know if my child has experienced a sprain or strain?
   
   
2. Where do sprains and strains usually occur?
   
   
3. What treatment methods should I use to reduce my child’s pain and swelling?
   
   
4. Should I give my child an over-the-counter pain reliever?
   
   
5. When should I bring my child in for an examination?
   
   
6. Are there other conditions that may be causing my child’s symptoms?
   
   
7. What are my child’s treatment options?
   
   
8. How long will it take my child to recover?
   
   
9. Will the site of injury fully recover, or will it be prone to injury again?
   
   
10. Will my child need rehabilitation?
    
    
11. How can I help prevent sprains and strains in my child?
    
    
12. Should I discourage my child from playing certain sports that may increase the risk of a sprain or strain?
    
    
13. Where can I find more information about sprains and strains?