Kids climb, jump, bounce, skip, slide, hit, skidaddle, run, hurdle, hurl, ride, slip and boogy!  It is no wonder muscle injuries in kids are common.  So, is there a broken bone?  Should I see my doctor?  Strains and sprains typically represent mild injuries of muscles, ligaments and tendons.  It is often difficult to determine the extent of the injury without an evaluation by a physician or X-rays.  Mild ligament injuries involving abnormal motion of a joint are called sprains.  Ligaments are the fibrous bands that connect bones to other bones.  Strains involve mild injury to a muscle/tendon unit.  Tendons connect muscles to bones.  Most strains and sprains can be treated with ice, elevation and pain medications.  Some more serious injuries require splints or braces to immobilize the joint.  Severe injury may require surgery.

What is a sprain?

A sprain is an injury to a ligament, a fibrous band that connects bones to other bones.  A sprain may be mild or severe.  The most severe ligament injury is a "torn" ligament, when the ligament breaks completely.  Some doctors use a grading system to classify the severity of injury.

Grade 1 - some fibers are torn but the ligament remains strong

Grade 2  - more fibers are torn, the joint is loose but stops at the normal position

Grade 3 - all the fibers are torn and the joint moves further than expected

What is a strain?

A strain is an injury to a muscle or a tendon.  Tendons connect muscles to bone.  There is a grading system for strains also.

Grade 1 - mild pain and little or no weakness of the muscle

Grade 2 - moderate pain and moderate weakness of the muscle

Grade 3 - complete break of the tendon or muscle

What is a contusion?

A contusion is a crush-type injury to any type of soft tissue (i.e., muscle, skin, organs).  Bruises often develop after a contusion.

I twisted my ankle...  How do I know if it is broken?

Only your doctor can tell for sure if an injury has broken or damaged a bone.  A physical exam and possibly an X-ray may be helpful.  Different joint injuries may feel and look the same.  A "twisted" ankle (i.e., an ankle sprain) may cause pain, swelling and instability of the joint.  A fracture or torn ligament will likely cause the same symptoms but the symptoms are often worse and last longer.  Severe pain with weight bearing may indicate a more severe injury.

Some signs of a possible fracture.

• the broken bone is poking out (okay, this one is obvious)
• the body part is bending the wrong way (obvious again)
• severe pain with weight bearing (i.e., standing on an injured ankle)
• a crunching sound when the joint is moved (if you can hear this over the scream of pain)
• an abnormal bump or "step off" felt under the skin
• rapid onset of severe swelling
• a known high impact or severe injury (i.e., car accident)

How do I treat a sprain?

If practical, the injured area should be treated with the RICE strategy.  RICE stands for R (rest), I (ice), C (compression), and E (elevation).  The RICE method should be used immediately after an injury and up to 72 hours after the injury.

Rest - It is important to reduce the risk of further injury.  For example, use crutches for leg injuries and a sling for arm injuries.  Pain-free movement of the joint should be started as soon as possible to improve the time of recovery.

Ice - Ice applied to an injured joint helps reduce swelling and pain.  Ice should be placed in a plastic bag or wrapped in a towel and applied to the skin of the injured area for 20 minutes.  This can be repeated 4 times daily until the swelling is minimal.

Compression - Using a brace or a compression bandage will help control swelling and reduce the risk of repeat injury.  The brace or bandage should be "snug" but should not cut off the blood supply to the area.  If your fingers or toes start turning blue, tingle or feel numb, loosen the bandage!

Elevation - It is difficult to walk with your ankle elevated... but, when lying down, raising the injured ankle will help control swelling and pain.

When can I exercise again?

The injured area should be slowly exercised and stretched as long as there is no pain.  When the injured joint has regained near-normal flexibility and strength, a trial of exercise or sport play may be attempted.  A joint with a prior injury should be tested with short term exercise before attempting full strength long-term exercise.

Can I injury the area again?

Of course.  In fact, injured ligaments, muscles and joints are more prone to injury when they have been injured before... so be careful!

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