The Sprains and Strains of Sporting Injuries

Sprains and strains are some of the most common types of injuries in any sport. They involve the stretching or tearing of tissue. Sprains occur to ligaments (which connect bone to bone), while strains involve muscles or tendons (which connect muscle to bone).

How Are Sprains and Strains Classified?

Sprains and strains are placed into three categories according to severity. They are classified as follows:

Grade I (Mild): Tissue is stretched.

  • Slight swelling (hardly noticeable)
  • Mild loss of range of motion (ability to move in various directions) and strength (0 – 25%)
  • No decrease in stability

Grade II (Moderate): Involves stretching and some tearing of tissue.

  • Moderate swelling (may look “baseball” size)
  • Usually includes some bruising
  • Moderate loss of range of motion and strength (25 – 75%)
  • Some decrease in stability

Grade III (Severe): Complete tearing of tissue.

  • Significant swelling and bruising
  • Near complete loss of range of motion and strength (75 – 100%)
  • Marked decrease in stability

Range of motion and strength percentages are determined by comparing the injured body part to the uninjured side. Severity of injury is best determined by a physician or athletic trainer. Immediate first aid for all sprains and strains is Rest, Ice, Compression, and Elevation or R.I.C.E. After initial first aid is administered, prompt referral to an appropriate medical professional should be sought to ensure proper injury treatment.

“It’s Just a Sprain…What’s The Big Deal?”

Sprains and strains can be a big deal and lead to prolonged time away from sport, especially if not treated appropriately. Additionally, sprains and strains can mimic other more serious injuries. For example, young athletes are prone to growth plate injuries called Salter-Harris fractures.

“Growth plates are located near the ends of long, growing bones in children and gradually close as a child reaches skeletal maturity,” explains John Kean, M.D., Orthopedic Surgeon at Nationwide Children’s Hospital. “The growth plate in growing children is weaker than the nearby ligaments and tendons. Therefore, the growth plate will become injured under lower forces than those that would injure a tendon or ligament.” 

Young athletes with Salter-Harris fractures will be very tender over the growth plate. They may have bruising and are often reluctant to bear weight. A careful physical exam is the best way to confirm this diagnosis although x-rays are often helpful as well. Even if the initial x-rays are negative, repeat studies can sometimes reveal subtle fractures. There are complications of growth plate injuries that are undiagnosed, untreated, or treated incorrectly. This confirms the importance of seeking the advice of a qualified medical professional with experience in dealing with these injuries even when it looks like it is “just a sprain.”

When Should You Be Concerned About an Injury?

Initially, the inability to bear weight (about 4 steps) after the injury or tenderness over any bone should prompt an evaluation that includes x-rays.

“Within a few days, any continued significant pain, continued reluctance to bear weight, or significant swelling and/or bruising may warrant re-evaluation and possibly an x-ray. Any other unusual symptoms such as numbness, loss of pulses near the injured area, discoloration, out of proportion pain, or rashes would indicate the need for further evaluation,” states Dr. Kean.

If your child is unfortunate enough to sustain an injury, remember that quick and proper treatment is the key to limiting time on the sideline.

Nationwide Children’s Hospital Sports Medicine specializes in diagnosing and treating sports-related injuries in youth, adolescent, and collegiate athletes. Services are available in multiple locations throughout central Ohio. To make an appointment, call 614-355-6000 or request an appointment online

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