Pain Relief for Common Pediatric Sports Injuries

Lumps, bumps, sprains and strains can happen while playing almost any sport. Coaches, athletes and parents need to know how to identify an injury, how to it, when to seek medical attention or when it is appropriate for an athlete to return to play. Here are some basic guidelines for initial common sports injury assessment and care: 

What Are Some Common Sports Injuries?

  • Sprain: Any injury to a ligament, which connects bone to bone
  • Strain: An injury to a muscle or tendon, which connects muscle to bone
  • Contusion (bruise): A blunt injury to a soft tissue or muscle, causing damage to the soft tissue or muscle fibers. Usually there is bleeding into the soft tissue, which causes discoloration

What Should You Do in Case of a Mild Pediatric Sports Injury?

When an athlete suffers a mild sports injury, there is usually pain, swelling, limited range of motion and loss of strength. The mnemonic PRICEMM is now used to manage acute sports injuries. The principles in PRICEMM are meant to limit swelling and ongoing tissue damage, maintain range of motion and return the athlete to the playing field quickly and safely as possible.

  • Protection: This simply means remove the athlete from participation to avoid further injury. All too often, young athletes are taught to “suck it up” and “play through the pain.” Athletes take on a “no pain, no gain” attitude. Players and coaches need to realize pain is the body’s way of saying something is wrong, and activity should be stopped immediately.
  • Rest: For the initial 24 hours after an acute sports injury, the athlete should minimize use of the injured body part. This can be done by using a sling, brace, wrap or crutches. Resting the injured body part will minimize further tissue damage. After 24 hours, the athlete may begin mild range of motion exercises, as directed by a physicianphysical therapist or athletic trainer, to prevent stiffness or promote the formation of a strong, flexible scar.
  • Ice: Ice is the universal treatment for acute sports injuries. Crushed ice should be applied directly to the injured body part immediately after the injury occurs, if possible. Ice should be applied for 20 minutes every one to four hours. Crushed ice in a zip-top bag with a small amount of water or bags of frozen peas or corn can be applied directly to the skin. Commercial gel packs should be avoided if possible, because they get much colder than ice. If a gel pack is used, place a cloth or towel between the pack and the skin to prevent frostbite. Ice should be applied for at least 48 to 72 hours after a sports injury occurs and longer if swelling persists. Do not apply heat within the first 72 hours after a sports injury. This will increase blood flow, fluid leakage and worsen swelling.
  • Compression: Direct pressure can limit the amount of swelling. Compression can be applied with elastic wraps, braces or ice bags. One very helpful treatment of ankle sprains is the application of a horseshoe-shaped felt pad, held by an elastic wrap directly over the outside ankle bone. This has been shown to reduce swelling and improve mobility. 
  • Elevation: Elevating the injured body part helps drain extra fluid away from the injury site.
  • Motion: The athlete may begin mild range of motion (non-weight bearing) exercises 24 hours after a sports injury occurs, and to a degree that does not cause severe pain. For example, for a sprained ankle, the athlete should use the big toe to trace all capital letters of the alphabet, while seated in a chair.
  • Medicine: When and if to start medicine is still controversial. Medicines such as ibuprofen and naproxen have anti-inflammatory and pain relieving properties. These medicines can be taken about 72 hours after an injury occurs. Rest, ice, compression and elevation should provide adequate pain control initially.

When Should You Seek Medical Attention?

Seek immediate medical attention for any of the following sports injuries:

  • Anterior cruciate ligament (ACL) injuries and cartilage tears, which most often result from plant-and-twist motions. Teens have a high risk of reoccurrence. If the damage is not repaired, there is also greater potential for premature arthritis. Surgery is often necessary to repair ACL damage.
  • Concussions are caused by a blow to the head. Symptoms may include confusion, short term memory problems and loss of consciousness.
  • Fractures are breaks or disruptions in a bone. They may occur from one blow (acute) or from repetitive use (stress fracture). The severity ranges from mild hairline cracks to compound fractures breaking through the skin.
  • Spine injuries 

The decision to go a doctor or emergency department for an X-ray is ultimately up to the athlete and the parent. Here are some things to consider:

  • Ask a trainer. Certified Athletic Trainers are trained in the initial management and triage of acute sports injuries, which includes first aid and giving advice on when to seek medical attention. Too often the athlete is afraid to notify a coach or trainer for fear of being pulled from competition.
  • If there is severe swelling, an X-ray should be taken to rule out a fracture.
  • If there is pain with palpation directly over a bone, an X-ray should be taken.
  • If there is significant loss of function of the injured area, such as strength or range of motion, it should be evaluated.
  • If the athlete is unable to bear weight, an X-ray should be taken.
  • If there is little or no improvement after 48 to 72 hours of PRICEMM, seek evaluation.