When Your Child Has a Strain, Sprain, or Contusion

April 03, 2018

When Your Child Has a Strain, Sprain, or Contusion

Strains, sprains, and contusions are common injuries in active children. These injuries are similar, but 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.   

Side view of lower leg showing leg and heel bones, muscle, and tendon. Closeup shows strain (damage) in muscle near tendon.


Side view of lower leg showing leg and heel bones and ligaments. Closeup shows sprain (damage) in ligament.


Side view of lower leg showing contusion on skin.

What is a strain?

A strain is an injury to a muscle or to 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 usually 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 healthcare provider.

How are strains, sprains, and contusions diagnosed?

The healthcare provider 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.

How are strains, sprains, and contusions treated?

  • 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 healthcare provider’s instructions.

  • The pain of a contusion often resolves within the first week. But the swelling and discoloration may take weeks to go away.

Treatment consists of one or more of the following:

  • RICE (which stands for Rest, Ice, Compression, and Elevation)

    • Rest. As much as possible, the child should not use the injured area. In some cases, your child may be given a brace or sling to keep an injured joint still. 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. Use an ice pack or bag of frozen peas wrapped in a thin towel. Never put ice directly on your child's skin.

    • Compression. If instructed, wrap the area to keep swelling down. Use an elastic bandage. Do this only as instructed by your child’s healthcare provider.

    • Elevation. Have your child raise the injured body part above the level of his or her heart.

  • Medicines to relieve inflammation and pain. These will likely be NSAIDs (nonsteroidal anti-inflammatory medicines). NSAIDs include ibuprofen and naproxen. Give these medicines to your child only as directed by your child’s healthcare provider.

  • Physical therapy (PT) to strengthen the injured area. This is especially helpful for moderate to severe strains or sprains.

  • Casting of the affected area to keep it still and allow the strain or sprain to heal.

  • Surgery may be needed if the strain or sprain is severe and there is tearing. During surgery, the torn muscle, tendon, or ligament is repaired.

What are the long-term concerns?

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


Preventing strains, sprains, and contusions

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

  • Has proper training.

  • Wears protective gear.

  • Warms up before activity and cools down afterward.

  • Uses proper equipment.

  • Doesn’t play hurt (with an injury).


April 03, 2018

Reviewed By:  

Bass, Pat F. III, MD, MPH,Joseph, Thomas N., MD