Children's health: Is it a sprain, strain or break?

Whether it’s a slip up on the baseball field or a fall in the backyard at home, young children are prone to injuries. And the type of injury your child has depends on whether the trauma involved a ligament, muscle or bone.

Board certified pediatric sports medicine specialist, Rachel Brewer, MD of HCA HealthONE Rocky Mountain Children's at Presbyterian St. Luke's in Denver, Colo. says that if you think your child has a sprain, strain or break, it is best you head to your healthcare provider for proper testing. An X-ray can rule out or confirm a broken bone, and a doctor can help detect other injuries like sprains or strains. 

“If kids aren’t using an arm or leg, or they’re limping, they’re telling us that they have an injury that needs to be evaluated,” says Dr. Brewer.

But how do you know what type of injury it is? Brewer explains the different injuries, the common causes of each injury, signs to watch out for and treatment options. 

Sprain

What it is: A sprain is a stretched or torn ligament, and a ligament is tissue that attaches two bones together. Ankle sprains are the most common types of sprains when it comes to kids, Brewer says. You can sprain other parts of your body like your wrist and elbow, too. “The majority of the sprains we see in kids are going to be ankle sprains. We see it so commonly, and your risk of recurrent sprains are high after an initial ankle injury,” she adds. 

Causes: Brewer sees a lot sprains in kids who play sports that require jumping and landing—basketball and volleyball especially. Falling and landing on an arm, falling on the side of a foot or twisting a knee can all cause a sprain. 

Signs and symptoms: Mild, moderate or severe pain, swelling, bruising, difficulty moving your joint, and even a pop or tear when if a severe injury like a tear of the tendon happens  

Treatment options: Your child will most likely need to rest the sprained extremity, and you’ll want to practice standard RICE therapy: rest, ice, compress and elevate.

“Depending on the extremity that’s involved, your child may need rehab, physical therapy or a period of immobilization with something like a walking boot if the ankle is involved,” says Brewer. It’s important to seek treatment, as a sprain can cause more problems if not treated.

“You can lose function and range of motion and strength in the extremity that’s affected,” says Brewer. Persistent pain, swelling and reduced balance, motion and strength may accompany sprains that are left untreated. 

Strain

What it is: Strains are stretched or torn muscles or tendons. Tendons are tissues connecting muscle to bone.

Causes: Strains normally occur when there is some sort of acceleration where you’re taking off or stopping quickly, adds Brewer.

Signs and symptoms: Pain, muscle spasms, swelling and difficulty moving the muscle

Treatment options: While treatment is typically the same for both sprains and strains, Brewer says it’s important for a medical professional to evaluate a strain to determine if growth plate attachments may be involved with the problem.

 "It’s important to note that a pediatric sports medicine provider should evaluate any child suspected of having a strain with an X-ray because a growth plate injury can be involved.” 

The first step in treating a strain will always include rest, icing and elevation. Banding that compresses the area may be suggested, too. Like sprains, physical therapy and exercise may be needed to help the muscle or tendon heal. If a growth plate injury is involved, further treatment may be necessary. 

Fracture 

What it is: A fracture is a broken bone. There are different types depending upon whether or not the bone is completely fractured or partially fractured. 

Causes: Fractures in kids are normally triggered by falls, says Brewer. “We see a lot of falls on outstretched arms that end up causing fractures of the upper extremity. The most common fractures we see are wrist fractures, arm fractures and finger fractures.” And stress fractures can occur when muscles are fatigued. Muscles become tired if they are overused, placing more pressure on the bones. 

Signs and symptoms: Pain, deformity, swelling, bruising, tenderness around the affected area, numbness and tingling, difficulty moving the limb. 

Treatment options: Fractures usually require casting and immobilization, says Brewer.

Most fractures require casts or splints, and for more serious cases, surgery. If not treated properly, bones and growth plates may not heal correctly. 

If you think your child has a sprain, strain or fracture, it’s best to head to your healthcare provider. Until you can get there, ice and anti-inflammatory medications like ibuprofen can keep your child comfortable.