Injuries in children and adolescents: a general approach

After a child gets hurt or injured playing sport, it is usually a combination of rest and exercises (at home or with physical therapy) that help them get back to physical activity. The main phases of healing are: 

  • Inflammatory phase (first 3 days)
  • Repairing phase (3 days to 3 weeks)
  • Remodeling phase (3 weeks+)

How an injury is treated depends on the specific type of injury, what the child is hoping to do when recovered and at what stage of the healing process the injury is at. 


During the first 72 hours after injury, initial management can often be remembered with the acronym PRICE:

  • Protection of the injured area
  • Relative rest
  • Ice
  • Compression
  • Elevation

Some of these treatments can also be used beyond the first 72 hours, especially if pain and swelling worsen during rehabilitation.

Protection – this helps prevent further injury. The type of protection depends on the injury but can include crutches, shoe inserts or a brace. We also ‘protect’ the injury from happening again by doing a gradual return to play (RTP). This helps the tissue heal faster and lessens the chance of overuse. 

Relative rest – during the inflammatory phase, we usually want relative rest, which is different from complete rest. Any immobilization or bracing should be as brief as possible and only apply to the specific joint or area. Most daily activities (such as walking, showering, etc.) can be done providing it does not cause worsening swelling or pain. If pain or swelling do happen, this is a sign that the injury is being pushed too hard. When resuming sport or activity, if it is not done gradually, it can result in a worse injury such as a ligament tear. 

Although immobilizing an injury can help with pain or swelling, it can also be bad for a muscle. If it is done for more than 6 weeks, a muscle can lose half its usual strength!

Ice – this is often used to help with swelling and pain for up to 7 days after the initial injury. This should begin as soon as possible after injury, either for 20 minutes at a time or for 10 minutes, 2 times, with 10 minutes rest in between. Most of the time, doing this 4 times a day is enough (and more doable) although it can be done every hour if needed. The more it is used, the more effective it will be at reducing the swelling. Please note that there are some situations when cold therapy should not be performed, such as with children who have Raynaud’s or other circulation problems (like those associated with diabetes). 

Compression and elevation – these two treatments are usually combined to help with circulation. Moving the injury or joint in a range of motion that does not cause pain can also improve drainage and help restore the correct balance of fluid. Adding ice with compression helps with swelling even more.

Something to avoid – Heat

Application of heat or heat packs should generally be avoided during the acute inflammatory phase. This can worsen the swelling and increases the blood flow, both of which can slow down healing. 


Around 3 days to 3 weeks after injury, this phase starts after the swelling is decreased and the injury or body part can be moved with little or no pain. 

This could be a child with an ankle sprain that happened one week ago who has mild pain, which is improving. They might still say they have pain with walking and may even limp a bit. They still can’t return to their usual sport or activity because of it or might try but still move very cautiously.

Goals of this phase

  • Protection of the injury or area (as mentioned during inflammatory phase)
  • Full movement of the joint
  • To get back to normal function including strength and co-ordination

Sometimes pain and swelling can worsen during this phase. You can still do the treatments mentioned above (e.g., ice and compression) in addition to reducing the intensity and length of any exercises or stretches provided. 

Range of motion and flexibility

Most of the time, these need to be back to normal before your child can return to daily activities and sports safely. Generally, the more intense the activity, the more range of motion is needed. For example, walking (without a limp) requires much less range compared to something like running or sprinting. 

Additional treatment

Heat and cold packs can be used as part of a stretching exercise program. Warming up muscles before stretching improves the overall benefit of stretching exercises. This can be done by either doing gentle warm-up exercises or by applying heat. Applying ice when a muscle is fully stretched helps to increase range of motion too. 


Proprioception is the awareness of the position and movement of the body. As well as range of motion and flexibility, your child needs to get back to normal proprioception so they can return to their sport. Physical therapists often use drills such as weight bearing exercises and balancing on mini-trampolines and balance boards to help with this. Sometimes, wearing an elastic bandage (neoprene sleeve) can help improve proprioception but only in certain activities, therefore it is important to discuss this with the medical provider before wearing one. 


During this phase, the tissues and/or bone start to build and get back to their normal power and structure. Once this phase has been completed, the goal is to get your child back to their usual physical activity level or sport. 

Sport-specific activities

For a child to return to their sport, they must get back to their normal level of power, speed and agility. When a particular movement is performed over and over again, the muscle develops a ‘memory pattern’ that it learns after many thousands of repetitions. The muscle needs to be able to show that it is ready to progress from physical therapy or rehabilitation to game readiness. This can be shown by meeting several criteria: 

  • Clearance from a provider, physical therapist or athletic trainer that your child can use the previously injured body part as well as they usually do
  • Child’s ability to participate fully without any pain, swelling or giving out of the muscle or joint
  • Sport-specific movements without needing to alter the technique or compensate

The provider can examine the child’s readiness by performing certain screening tests in the office such as single leg squats, hop tests, push up or throwing tests. 

Sport-specific drills

These are usually the final stage of healing or physical therapy that show the child is ready to return to their usual activity or sport. The drills are usually the equivalent to what they would do during a regular practice session and should copy what they would do in full competition or performance. Some sports have specifically designed programs such as a throwing program for baseball.

Getting the clearance to return to sport

To be cleared to return to sport, your child must:

  • Have fully recovered from all symptoms and signs of injury. They must have full power and range of motion of the injury or joint
  • Be able to complete sport-specific movements without showing any compensation or altered technique

Your child can then return to sport with confidence and perform as well as possible without worrying about getting reinjured again! 

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