When Your Child Has a Strain, Sprain, or Contusion

Strains, sprains, and contusions are common injuries in active children. These injuries are similar, but they involve different types of body tissue. Most of these injuries happen during sports or active play. But they can happen at any time. A strain, sprain, or contusion can be painful. With the right treatment, most heal with no lasting problems.

What is a strain?

A strain is an injury to a muscle or a tendon (tissue that connects muscle to bone). It is sometimes called a “pulled muscle.” A strain happens when a muscle or tendon is stretched too far or is partially torn. Symptoms of a strain are pain, swelling, and having a problem moving or using the injured area. The hamstring (thigh muscle), calf muscle, and Achilles tendon are commonly strained.

What is a sprain?

A sprain is an injury to a ligament (tissue that connects bones to other bones). Joints contain many ligaments. A sprain results when a joint is twisted or pulled and the ligament stretches or tears. Symptoms of a sprain are pain, swelling, and having a problem moving or using the injured area. Ankles, knees, and wrists are the joints most commonly sprained.

What is a contusion?

A contusion is commonly called a bruise. It is injury to tissue that causes bleeding without breaking the skin. It is often a result of being hit by a blunt object such as a ball or bat. Symptoms of a contusion are discoloration of the skin, pain (which can be severe), and swelling. Contusions usually aren't serious and often don't need medical attention. But a large, painful, or very swollen bruise, or a bruise that limits movement of a joint, such as the knee, should be seen by a doctor.

The doctor asks about your child's symptoms and medical history. An exam is also done. An X-ray (test that creates images of bones) may be done to rule out broken bones.

• Strains and sprains can take up to months to heal. If not treated and allowed to heal, a strain or sprain can lead to long-term problems. These include lasting pain and stiffness. So it is important to follow the doctor's instructions.
• The pain of a contusion often goes away within the first week or two. But the swelling and discoloration may take weeks to go away.

Treatment consists of one or more of the following:

• RICE. This stands for rest, ice, compression, and elevation.
  • Rest. Your child should rest the injured area as advised by their doctor. After 10 days based on the type of injury, gentle movement with weight-bearing, as tolerated, may also be advised. In some cases, your child may be given a brace or sling to support the injured joint. Your child may also be given crutches to keep some weight off a strain to the leg or a sprain to the ankle or knee.
  • Ice. Put ice on the injured area 3 to 4 times a day for 20 minutes at a time. To make an ice pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put ice directly on the skin.
  • Compression. If instructed, wrap the area to keep swelling down. Use an elastic bandage. Do this as instructed by your child's doctor.
  • Elevation. Have your child raise the injured body part above the level of the heart.
• Medicines to relieve inflammation and pain. These will likely be acetaminophen or NSAIDs (nonsteroidal anti-inflammatory drugs). NSAIDs include ibuprofen and naproxen. Give these medicines to your child only as directed by your child's doctor.
• Physical therapy (PT). This is done to make the injured area stronger. This is especially helpful for moderate to severe strains or sprains.
• Cast. Casting or splinting the affected area is done to keep it still and let the strain or sprain heal.
• Surgery. This may be needed if the strain or sprain is severe and there is tearing. During surgery, the torn muscle, tendon, or ligament is repaired.

If allowed to heal, most strains, sprains, and contusions cause no further problems. Strains or sprains that are not treated and don't heal correctly can lead to pain or stiffness that doesn't go away. Be sure to follow your child's treatment plan. Your child's doctor can tell you more about the expected outcome based on your child's injury.

If playing sports or doing other athletic activity, be sure your child:

• Has correct training.
• Wears protective gear.
• Warms up before activity and cools down afterward.
• Uses correct equipment.
• Doesn't play when they have an injury.