Over the past two decades, the rate of musculoskeletal sports injury, including soft tissue injury, in children has risen. This increase has also made it increasingly important that pediatricians be able to recognize and treat effectively soft tissue musculoskeletal injuries, including sprains, strains, subluxations, and dislocations.

To accurately diagnose a soft tissue musculoskeletal injury, one must be able to distinguish one injury type from another. Sprains are caused by the overstretching and partial tearing of a ligament. Excessive stretching of a muscle, resulting in pain and swelling, is a strain. A subluxation is the partial separation of a joint with some continued union between the two bones’ articular cartilages. An example of a common subluxation in young children, often associated with a sudden pull to an outstretched arm, is the “nursemaid elbow.” Complete separation of the articular cartilages of two bones in a joint is a dislocation, relatively uncommon in children and associated with major trauma and fractures.

In general, there are four phases of recovery for an athlete with soft tissue injury. The goal of the first phase is to limit additional injury and to control pain and swelling. The next phase begins the athlete’s active rehabilitation with the gradual improvement in the strength and flexibility of the injured area. The third phase of rehabilitation progresses from the second, with the addition of proprioception and endurance training to the strength and flexibility work. This third phase will continue until the athlete has nearly regained his normal function. The fourth and last phase of rehabilitation begins at the athlete’s return to his or her sport. Initial phases of rehabilitation should be supported with adequate analgesics, so as to avoid disuse during recovery. Attention should also be paid to the strength, flexibility, and fitness of noninjured areas during the athlete’s rehabilitation, as well as to the athlete’s general psyche. To avoid separation from his team, the athlete should be encouraged to attend games and practices with teammates.