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Sprains and Strains

What is Sprain?

Active children and teens make many demands on their growing bodies. In particular, their bones, muscles, tendons, and ligaments get a major workout as kids test their own limits. During rapid growth spurts, children and teens’ coordination often doesn’t keep up with their growth. This can make sprains and strains more likely.

Sprains are injuries to the ligaments, the thick, fibrous strips of tissue that hold bones together across a joint. Each ligament has a special job to hold one specific part of a bone next to one specific part of another bone. Ligaments normally work very well to keep bones lined up with each other, as long as the joint only moves the way it is supposed to. If a joint suddenly gets moved or twisted in an abnormal way, the ligament can stretch too much, tear, or even break in two. Because ligaments are made of living tissue, this injury causes immediate pain, swelling, and sometimes bleeding under the skin. A joint with a stretched or torn ligament can become “unstable,” which means that it might not be able to support weight or pressure.

A person with a sprain usually feels a “pop” or “snap” at the moment of the injury, along with immediate pain. Within a few minutes s/he develops puffy swelling over the injured joint, and within a few hours there can be a bruise from blood below the skin. If the sprain is in the leg or foot, the person may not be able to bear any weight on the injured leg.

Strains are injuries to muscles or tendons. Tendons are the strong cord-like sinews that attach muscles to the bones they move. A strain involves a stretch or tear of either the muscle or its tendon. Strains can hurt as soon as the person injures himself or herself, or the pain can develop gradually. Many people don’t notice a strain until the day after they hurt themselves. Because there are usually many different muscles and tendons that help to move and stabilize a joint, a strain does not usually make the joint unstable, as with a sprain. A person with a strain usually complains of pain and some weakness, without much swelling or bruising.

What is the biggest concern with a Sprain?

The very first concern in any injury to a bone or joint is to get control of the pain. Most doctors and emergency rooms will give some pain medication even before doing any tests. The next concern is to be sure there’s no fracture (broken bone). Your doctor will have done that either by simply examining your child or by doing an X-ray. Most doctors feel comfortable making a diagnosis of a sprain or a strain in many cases without an X-ray, so long as the patient and parent are comfortable too. After ruling out a fracture, your doctor may have done some simple tests on the joint to determine if it is unstable. An “unstable” joint is one that has a completely torn ligament, and can no longer be trusted to support weight. Doctors treat unstable joint injuries much differently than stable ones.

Every teen athlete or performer has legitimate concerns about returning to competition or activity. The answers will depend to a large extent on how severe the injury is and how well the teen can work with your and his/her doctor to get the injury healed.


Sprain treatment

Both sprains and strains are painful, and involve some inflammation of the tissue. Doctors treat both the pain and inflammation with “non-steroidal anti-inflammatory drugs,” or NSAIDs. Ibuprofen (Advil® or Motrin®) is the most effective and safest of the NSAIDs. Please remind your teen that these drugs are not just painkillers. They are very effective at reducing the swelling and inflammation of an athletic injury. This speeds healing and reduces pain at the same time. These medicines only work well if the athlete takes them regularly on a schedule. “As needed for pain” is the worst possible way to use these medicines. Please check with your doctor for the recommended dose. Most athletes over 100 pounds can take 600 – 800 mg of ibuprofen (3 -4 of the 200 mg over-the-counter pills) every 6 hours for at least 5 days without problems. High doses of ibuprofen can cause stomach upset. If this happens please try cutting back the dose, or using an antacid like Maalox or Mylanta along with the medication.

In addition to medication, your doctor will recommend doing some things to hasten the healing of the sprain or strain.

Sprains – A severe sprain or one with an unstable joint may need immobilization in a splint or cast, and in some cases it may require surgery. Doctors treat mild and moderate sprains that have stable joints with a simple combination called “R.I.C.E.” This stands for “Rest,” “Ice,” “Compression,” and “Elevation.”

Rest” means completely resting the injured joint for the first 3 days, with as little use as possible. For example, a child or teen with an ankle sprain should use crutches without weight bearing, and should only walk where and when necessary. You can read our Aftercare Instructions on Crutches. Normal school activities are usually ok, but of course no gym class or sports.

Ice means using an ice pack wrapped in a moist washcloth. Apply the pack over the injured joint for 15 – 20 minutes every hour for the first three days. This helps reduce the inflammation that causes the pain and swelling. Never put ice directly against skin – this can cause serious frostbite.

Compression means using an elastic bandage like an Ace® Wrap. Your doctor will show you how to apply it properly. Remember that the wrap should go on starting away from the body and moving towards it, to avoid cutting off blood flow. Please don’t make the wrap tight; it should be snug enough to gently squeeze the joint. Please be sure your child or teen knows how to unwrap and re-wrap the joint as needed. These elastic bandages and wraps do not provide any support for a weak joint. Please remind your active child or teen of this. A wrapped joint is not “stronger” and your child should not try to use it normally.

Elevation means keeping the injured joint raised up to about the level of the heart. For an arm or wrist sprain, a sling works well. Your child can use a pillow to lift the joint up when s/he is sitting down. For a leg or ankle sprain, this means lying on a couch or bed, or putting the leg up on a piece of furniture to keep it raised. Elevation helps reduce swelling from fluid and blood accumulating around the injury.

Most doctors recommend “R.I.C.E.” treatment for the first three days after the injury. After that, depending on progress, you can usually have your child or teen begin more routine activities. Ice doesn’t usually help much after three days. The wrap for compression should usually stay on until the swelling is nearly gone. Elevation is a good idea also until the swelling has cleared up. If your child needs crutches, your doctor will let you know when you can switch from “non-weight-bearing” to “weight-bearing.”

Your child should not return to competitive activities until your doctor sees him or her in follow up. It is always a bad idea to return to vigorous activity with any remaining swelling or pain – the chance for a repeat injury is very high.


Strains don’t usually require as much specific attention as sprains. Most doctors will recommend ice for the first 3 days after the injury, followed by heat packs if they help. Some people get great benefit from heat, and others don’t, so it’s worth trying it. You can just use a warm washcloth or hot water bottle wrapped in cloth. You may prefer to use an electric heating pad. Please follow the instructions carefully to avoid electric shock. Of course, never let a young child use a heating pad unattended, or allow anyone to use a heating pad while in the bathtub. Most doctors recommend against using the chemical “hot packs.” These can burst and cause serious burns.

Some people get good relief from muscle strains with massage. You can gently massage your child’s injured muscle yourself. Just like with the use of heat, if it helps, keep doing it, but if it makes things worse, stop.

When should I be worried?

Most sprains and strains heal very well within about a week to ten days. They often hurt worse the day after the injury than the day of the injury. This is a normal part of the inflammation. Sometimes there are other injuries instead of or in addition to a sprain or a strain. Here are some things to look out for:




  • Pain that continues to get worse, or doesn’t start getting better, by the second day after the injury
  • New pain that was not present at first
  • Pain in a different joint or muscle than the original injury
  • Fever
  • Worsening redness, swelling, or heat over the joint after the first 2 days
  • Inability to move a joint

If any of these occur, please be sure to call your doctor’s office right away.

Other points of concern

It is often very hard to convince an athletic and competitive teen to stop playing in sports or other activities for long enough to heal the condition. Most team players will understand the idea that for them to give the team their best effort, they have to recover completely first.Professional athletes know that it is better to take a few days or a week off and then come back to the team at a hundred percent. They don’t to try to be a hero and then lose the game because of poor performance related to an injury.

Other Conditions that Might Be Present with a Sprain

Sprains and strains are the most common causes of painful, swollen joints or extremities in childhood and adolescence. There are a few other conditions that can mimic them, however, that could be more serious.

  • A bacterial infection of a bone or a joint, or of the skin overlying it, can cause significant damage. Children and teens with these infections usually have fevers and the joint is very swollen and red. There is often a history of an injury just before the symptoms begin, so it can be easy to mistake an early infection for a sprain or strain.
  • A broken bone that is not displaced can often cause pain similar to a sprain. Fractures don’t get better as quickly as sprains. If your child didn’t have an X-ray the day of the injury, and isn’t getting better over the first few days, please call your doctor.
  • A dislocation is a bone that has slipped completely out of place. A dislocation almost always involves damage to a ligament (a sprain). This means there can be considerable swelling at the joint on the first day, so the dislocation might not be obvious at first. Most dislocations are severely painful, and they reduce the ability of the child to move the joint.