Sports Injuries in Children

W. Steven Pray, PhD, DPh; Joshua J. Pray, PharmD candidate

Disclosures

US Pharmacist. 2004;29(10) 

In This Article

Prevention and Treatment of Sports Injuries

The best method of dealing with pediatric sports injuries is prevention, using a multipronged approach aimed at high-risk sports.[3,17] Children should wear protective gear at all times. However, an often neglected source of injury is the coach­athlete interaction (see this month's patient leaflet).[2,18]

The pharmacist must be extremely cautious in allowing patients to self-treat a trauma-related sports injury. It is often more prudent to request that the patient see a physician for appropriate care, which may include x-ray and palpation, among other physician-initiated diagnostic methods. For minor sports injuries, the pharmacist can recommend one or more therapies.

Internal analgesics are often helpful for sports injuries. However, the pharmacist should use prudence in recommending them because of their many precautions. Several warnings specifically pertain to use in children. For instance, naproxen (Aleve) should not be used by those younger than 12, while ketoprofen (Orudis KT) should not be used by those under 16.

Topical cryotherapy using ice packs, reusable gel packs, or disposable one-time use packs is best used for acute injuries (e.g., a strain or sprain), especially during the first 48 to 72 hours postinjury, as a component of the PRICE traumatic injury care regimen (protection, rest, ice, compression, elevation). Its usefulness declines after this period.

Once the 48- to 72-hour cryotherapy-treatment period has elapsed, thermotherapy devices are useful in treating overuse syndromes and relieving pain from acute injury. Several therapeutic options exist. Hot water bottles require the patient to fill and refill a rubber bag with warm water. The continual cooling and refilling process does not allow the patient to experience constant low-level heat. The weight of the bag is problematic since the injured area is usually painful to pressure. Further, the patient cannot secure a heavy hot water bottle to the body and carry out the normal activities of daily living.

Other heating devices, which may contain clay, beads, or other materials, are warmed in a microwave oven and placed on an injured area. Since they cool and must be reheated, constant low-level heat cannot be achieved. Also they depend on microwave access. Use during activities of daily living is questionable at best since most cannot be secured to a moving body.

Electric heating pads are ubiquitous but fraught with problems. Their thermostats allow the temperature to rise sharply at first, cool somewhat, and then reheat. This continual heating and cooling does not allow these products to deliver a constant low-level heat. Further, heating pads are the least portable thermotherapy devices, since they are electricity-dependent. Finally, heating pads do not eventually cool down as hot water bottles do but deliver heat as long as they are plugged in. A patient falling asleep while lying on a heating pad risks serious burns because of this inherent design flaw. The Consumer Product Safety Commission has logged many deaths and serious burns from heating pads.

In contrast to these older modalities, patients may find that the safest and most useful thermotherapy device is the therapeutic heat wrap (ThermaCare). When the package is opened, iron powder oxidizes in combination with the moisture and room air, producing heat at a constant temperature of 104°F, rather than in constantly fluctuating patterns as the older options do. Patients may sleep with the wrap in place. It is thin enough to be worn while carrying out all activities of daily living. The eight-hour wearing time provides 24 hours of pain relief. A recently introduced knee wrap provides safe low-level heat to the knee.

External analgesics are overused and are poor choices for care of sports injuries, whether the injury is due to trauma or overuse. These topical products provide a sensation of warmth (e.g., methyl salicylate) or cold (e.g., menthol, camphor). Thus, they have long been known as counterirritants (producing a surface irritation that counters pain in deeper tissues). Their use may actually be counterproductive for two reasons. First, there is a widespread misconception that these products are beneficial to the injury in some way; however, there is no evidence that they can improve injured tissues by materially increasing temperature to any extent. Using them gives a false sense that an effective therapy has been applied, and the patient will not choose a wiser option. Second, applying a product that does little but provide a surface sensation of warmth and/or cool may mask pain arising from injury. Thus, the child may feel that the injury has improved and continue the activity when he or she should have rested or sought medical help. Playing sports while injured can further the extent of the injury and greatly prolong the period of rehabilitation. To comment on this article, contact editor@uspharmacist.com.

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