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Sprains, Strains, Breaks: What’s the Difference? If you’ve sprained your ankle before, you know what severe pain is. But that “sprain” could have been a “strain” or possibly even a “break.” The amount of pain in each case can be virtually equal, so if your child suffers an injury, the best way to find out what your child has is to see a doctor, advises Robert Durkin, M.D., pediatric orthopedic surgeon. “The most common reason for an ankle sprain is having had one already,” says Dr. Durkin. “The best prevention of a second sprain is appropriate treatment of the first.” Dr. Durkin offers some helpful facts on common injuries for parents: Sprains Sprains are a stretch and/or tear of a ligament, the tissue connecting two bones. Ligaments stabilize and support the body’s joints. For example, ligaments in the knee connect the upper leg with the lower leg, enabling people to walk and run. A sprain is caused by trauma (a fall, a twist, a blow to the body) that knocks a joint out of position and overstretches or even ruptures supporting ligaments. Some examples are when a person lands on an outstretched arm, slides into a base, lands on the side of the foot or runs on an uneven surface. Though the intensity varies, pain, bruising and inflammation are common to all three categories of sprains: mild, moderate and severe. The child may feel a tear or pop in the joint. With a severe sprain, ligaments tear completely or separate from the bone. This loosening impairs joint function. A moderate sprain partially tears the ligament, producing joint instability and some swelling. A ligament is stretched in a mild sprain, but there is no joint loosening or instability. “The tendency is to think of sprains as a minor injury, but repeated sprains can lead to ankle arthritis, a loose ankle or tendon injury,” cautions Dr. Durkin. Strains Strains are a twist, pull or tear of a muscle or tendon. Tendons are cords of tissue that connect muscles to bones. Acute strains are caused by a direct blow to the body, overstretching or excessive muscle contraction. Chronic strains are the result of overuse — prolonged, repetitive movement — of muscles and tendons. Inadequate rest during intense training can cause a strain. Typical indications of strain include pain, muscle spasm, muscle weakness, swelling, inflammation and cramping. In severe strains, the muscle or tendon is partially or completely ruptured, leaving a person incapacitated. Some muscle function will be lost with a moderate strain, where the muscle or tendon is overstretched and slightly torn. With a mild strain, the muscle or tendon is stretched or pulled slightly. Breaks Breaks are a fracture, splinter or complete break in bone, often caused by accidents, sports injuries or bone weakness. Bone breaks should always be looked at by a physician to ensure proper healing and connection. Treat injuries with RICE In all but mild cases, a doctor should evaluate the injury and establish a treatment and rehabilitation plan, says Dr. Durkin. Robert Durkin, M.D. Meanwhile, RICE (rest, ice, compression and elevation) usually will help minimize damage caused by sprains and strains. Begin RICE immediately after the injury and continue off-and-on for about 72 hours, says Dr. Durkin. RICE relieves pain, minimizes swelling and speeds healing, and it is often the best treatment for soft-tissue injuries, such as sprains and strains. Rest: Avoid moving the injured area to allow healing to begin. Ice: Apply it immediately to reduce inflammation, which causes more pain and slows healing. Cover the injured area with an ice pack (inside a wet cloth) and apply the ice for 10 to 20 minutes intermittently for 48 to 72 hours. Never ice for more than 20 minutes, because that can cause a nerve injury. Compression: Use an elastic, or ACE, bandage to help prevent or reduce swelling. Wrap the injured area without making it so tight that it will cut off the blood supply. Elevation: Prop up the injured area above the level of the heart. You may need to lie down to get your leg above your heart level.