My child is limping. Could she have sprained or strained something?
It's possible. It's uncommon for a very young child to suffer a sprain or strain. But these injuries become more likely at age 6 or so, once a child begins playing sports. They're also more common in very active children.
Kids may sprain their ankle or knee, for example, while playing soccer or basketball or by jumping off a swing at the playground. They may sprain a wrist or elbow if they try to break a fall with an outstretched arm.
Constant use of particular muscles – like their calves while running or their back while bending over on a bike – can cause a strain in those muscles.
What's the difference between a sprain and a strain?
A sprain happens when the ligament – the elastic tissue that connects the bones across a joint – stretches too much or tears. Ankles, knees, wrists, and elbows are the most vulnerable to sprains, especially when twisted sharply.
Because children's ligaments are typically stronger than the surrounding bones and cartilage, though, they're more likely to suffer an injury to the bone than to the ligament.
Strains or "pulls" happen when muscles – or the tendons that connect muscles to the bone – are stretched excessively or torn. Muscle strains can happen suddenly or develop over time. They can happen as the result of overuse (in sports, for example) or overexertion (like in heavy lifting).
The neck, back, thigh, and calf muscles are the ones that are strained most often.
What are the symptoms of a sprain or strain?
Both will hurt. A sprain or bad strain is more likely to cause sharp, immediate pain. A mild strain may not hurt until hours after the injury occurs.
Both strains and sprains can cause bruising if blood vessels were ruptured. A sprain is more likely to cause swelling than a strain, but a severe strain could also result in swelling.
Your child may not be able to put weight on (or use) the sprained or strained body part. There may be warmth or redness in the area that was hurt.
How sprains and strains are categorized
Both are assigned one of three "grades," depending on the severity of the injury.
Sprains are described like this:
- Grade 1: A mild sprain, in which the ligament is overstretched. There's probably minor pain and bruising with tenderness but no great difficulty using the body part.
- Grade 2: Involves some tearing of the ligament, resulting in moderate pain.
- Grade 3: The ligament has completely torn, resulting in severe pain, swelling, bruising, and an inability to use the area. If the sprain is a bad one, you may hear a pop or snapping sound as the ligament tears.
Strains are described like this:
- Grade 1: A mild strain in which some muscle fibers are damaged.
- Grade 2: A moderate strain with more extensive muscle damage.
- Grade 3: The worst, with complete rupture of a muscle. This kind of strain can take months to heal.
Should I take my child to the hospital?
If your child is in intense pain or is unable to put any weight on an injured joint or limb, take him to the emergency room. He may have a severe sprain or a fractured bone.
If you think that the injury is milder, like a strain or mild sprain, call the doctor. The doctor may want to check out the injury to make sure it isn't severe, or — if it sounds like a minor strain or sprain – you may be instructed to treat it at home, watching for signs of something more serious.
Also get in touch with your child's doctor if your child is limping and you don't remember him getting hurt or if a limp from an injury isn't getting any better. It's possible (though not likely) that something else is to blame, such as arthritis, a systemic illness, or a hip problem.
What will happen at the hospital?
An X-ray, an MRI, or a CT scan may be done to get a clear picture of what's going on in your child's tissues, bones, and organs. The doctor will want to make sure your child hasn't fractured a bone.
To keep a sprain immobile, an elastic bandage or a splint on the joint may be used. If it's an ankle or leg injury, you may be advised to keep your child from putting any weight on it, to give it a chance to heal. If she's old enough, your child may be able to use crutches to keep her weight off it.
If the sprain is really severe, surgery may be needed, but that's unlikely.
How should I treat a strain or sprain?
It's important to help your child heal from a strain or sprain so he doesn't do further damage – possibly long term – to the joint.
To reduce the pain and swelling, remember the acronym RICE, for rest, ice, compression, and elevation.
Keep the affected area as immobile as possible for 24 to 48 hours. When your child is sitting or lying down, prop up the injured area on pillows to keep it above the level of the heart.
Apply a cold pack (a bag of frozen peas will work in a pinch) for 15 to 20 minutes at a time, wrapping it in a damp towel first to protect your child's skin. Do this as soon after the injury as possible, and repeat at least three times a day for a day or two.
When not icing the area, wrapping it with an elastic bandage will provide stability and reduce swelling and discomfort. Wrap firmly but not tightly. You don't want to cut off circulation to the area.
You can also give your child an anti-inflammatory pain reliever such as ibuprofen.
It may take a week or two for the pain and swelling to subside – or even longer for a serious injury. Your child can then slowly start resuming normal activity. Have him try moving the joint around first, stopping if it hurts.
Once he can move it without pain, he'll need to start strengthening the muscles around the injury if he's been off his feet for a while. A physical therapist can tell you which exercises are best.
During the recovery, call the doctor if your child doesn't seem to be getting better or if he develops a fever, which may be a sign of an infection.
Once my child has sprained a joint or strained a muscle, is it more likely to happen again?
Yes. A sprain weakens the ligaments, so it's easier for a joint to twist out of place again. And once a muscle has been strained, it will be weaker than usual for some time, until it's completely healed.
Ensuring that your child's sprain or strain heals properly makes re-injury less likely.
How can I protect my child from these injuries?
If your child is still a toddler, she needs constant supervision. It's easy for toddlers to climb to a place from which they can fall and get hurt, for example. For kids of any age, check to make sure play areas are safe to romp in – that playgrounds have padded surfaces beneath the equipment, for example.
As your child starts playing sports, make sure she wears the right shoes and protective gear. Running shoes, for example, aren't good for hiking or tennis because their extra cushioning makes the base slightly more elevated and less stable. For hiking, have your child wear boots that lace up over the ankles to support them, especially if she's carrying a backpack.
If your child gets into in-line skating or snowboarding, she's likely to take a few spills. Have her wear protective wrist, elbow, and knee pads (along with a helmet) to protect those joints.
It can also help to warm up before playing a sport – for instance, by jogging for a few minutes. Light aerobic activity literally heats up the muscles and ligaments, making them more pliable and less prone to tearing.
Spending a few minutes stretching after a workout is helpful, too. It improves the flexibility of the joints and muscles, which can get stiff from exertion.
In the long run, regular exercise can help kids avoid strains and sprains by strengthening muscles, keeping joints limber, and improving balance and coordination so they're less likely to twist an ankle or take a fall.
If your child is just beginning a new sport, have him start out slowly and increase the intensity as he builds strength and endurance.
It's also a good idea for children to take a break from sports and training for a day or two each week, to allow their body to rest and recuperate.