Sports injuries part 2: Treatment

The Pediatric Insider

© 2010 Roy Benaroch, MD

It’s impossible to summarize all of sports medicine in a 500-word post. Of course, that’s never stopped me before! Here’s a quick and easy guide to the initial treatment of ordinary sports injuries in children and teenagers. As usual, this isn’t meant to be any sort of comprehensive advice, and I’m not your doctor (unless I am your doctor, in which case this kind of advice is still not specifically for you. Got it?) These are just meant to be some broad, informative guidelines—not specific medical advice that anyone could actually use. In fact, you should probably just stop reading this now, just in case any of this can be misconstrued in a way that gets me sued.

Still reading? What’s wrong with you?

Anyway:

First question: was the injury acute (sudden) or gradual? Can the athlete remember exactly when it started to hurt, as if something happened all at once—or is this a pain that kind of crept up slowly? The best way to handle injuries is different for these two scenarios. We’ll cover a sudden injury first. Hypothetically.

If an athlete suddenly complains of pain, start by ensuring safety: the game ought to stop, so further injuries don’t occur. For neck injuries, do not move the child until professional help arrives. For other kinds of injury, try to protect the injured part with some kind of temporary splint, or hold it still while the child gets off the field. If there is an obvious fracture (that is, the limb isn’t shaped like it’s supposed to be), don’t move the affected area, and head straight to the emergency room. Otherwise, apply ice and raise the extremity if possible to help with swelling. If the pain subsides without residual problems in an hour or so, the child can return to play. If there is still a lot of pain in an hour, contact the child’s doctor for the best resources to use in your community—it may be an ER, or urgent care center, or the pediatrician’s office.

Many injuries are more gradual, where a mild pain increases in intensity over the course of a game, even without one specific instant when the pain started. This is often an “overuse” type of injury, caused by repetitive motions and loads on the same joint or extremity, over and over. Look for clues—there is a good chance that this kind of pain started a few weeks after a new exercise routine or style of play. If that’s the case, the athlete can often figure out what motion or activity had led to the pain, and might be able to avoid it. You know that old joke: “Hey doc! It hurts when I do this.” Take the punch line’s advice for an overuse injury: stop doing what led to the pain. Take a break from that specific action while working on other kinds of movement and exercise. There is controversy over whether ice or heat is most appropriate for these kinds of injuries; certainly, if something is swollen, ice is the way to go. Apply ice or a cold pack for 15 minutes out of every hour. For sore muscles without swelling, gentle warmth seems to be more effective. Some sports trainers recommend alternating heat and ice, which doesn’t make a whole lot of sense to me, but it’s safe to try either way and continue to use whichever works.

The most important treatment for any sports injury, acute or chronic, is rest. Rest should be active—if an ankle is twisted, the athlete should continue to do upper body exercises. What needs to be rested is the injured part, not necessarily the whole body. Sometimes, changing a player’s position (from, say, pitcher to outfielder) can provide the needed rest from throwing. A good rule of thumb is that if the injury continues to hurt, the athlete isn’t resting it adequately.

Continued pain means that your child needs to see the pediatrician, an orthopedist, or a sports-medicine physician. Whether x-rays or fancier tests are needed depends on the nature of the injury, and once a diagnosis is made the physician ought to be able to more-specifically discuss treatment, a rehab plan, restrictions, and follow-up.

Related post: Sports injuries part 1: Prevention

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