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My kid got hurt playing sports, should I go to the ER, urgent care, or wait to see my child’s PCP?

Dr. Levi Merritt DC, NBC-HWC, CPT

Updated: Oct 28, 2024

If you're like me and have kids involved in sports, injuries are inevitable. It's just part of the game. While there aren't strict rules on where to take your child for an injury, the general guidelines below can help determine the appropriate level of care. Of course, if your child gets hurt, I recommend following the advice of the team's trainer or medical personnel, if available.


When dealing with musculoskeletal (MSK) injuries, it’s important to understand the severity of the issue to decide the appropriate level of care. Emergency Room (ER) visits are warranted when the injury involves severe trauma, such as compound fractures, dislocations, or large, deep lacerations. Other reasons to head to the ER include sudden loss of sensation, inability to move the injured area, or signs of a life-threatening condition like a spinal injury.


On the other hand, urgent care is suitable for less severe injuries that still need prompt attention, such as sprains, strains, minor fractures, or moderate swelling and pain that doesn’t improve with basic care. Urgent care can be a better option than the emergency room for non-life-threatening conditions because it offers quicker, more convenient care with shorter wait times and lower costs. For injuries that don’t pose an immediate risk to health or life, urgent care can be the ideal middle ground between emergency services and your primary care provider (PCP).


If the injury seems mild, such as minor sprains or strains, and the pain can be managed with rest and ice, it’s often okay to wait and consult your PCP. They can provide a longer-term treatment plan, and can make referrals to specialists if needed.


Ultimately, the key is to evaluate how serious the symptoms are to make an informed decision.

Here’s a general guide:


1. Go to the ER if your child experiences any of following:

  • Severe pain that’s unbearable or significantly worsening.

  • Open fractures (bone protruding through the skin).

  • Loss of sensation or inability to move a limb (could indicate nerve or spinal damage).

  • Major trauma (e.g. high falls, sports collisions with forceful impact).

  • Visible deformity in a joint or limb (e.g., dislocated joint or visibly displaced fracture).

  • Inability to bear weight on an injured leg, knee, ankle, or foot, especially if accompanied by swelling and deformity.

  • Signs of compartment syndrome, like severe pain, swelling, and a feeling of tightness, often following a fracture or crush injury (can lead to permanent muscle damage if untreated).

  • Severe or sudden back pain accompanied by bowel or bladder dysfunction, numbness in the groin, or leg weakness (signs of cauda equina syndrome).


2. Go to Urgent Care for:

  • Fractures (e.g., finger, wrist, or toe) that are not obviously displaced (these fractures may not be evident upon inspection).

  • Sprains or strains with moderate pain, swelling, and difficulty moving the joint but no severe deformity.

  • Mild back or neck pain following a fall or mild trauma, as long as there is no loss of sensation or severe weakness.

  • Contusions or bruises from trauma, particularly if swelling is significant, but there are no signs of a fracture or dislocation.

  • Suspected tendon injuries (e.g., minor Achilles tendon strain or patellar tendinitis).

  • Minor dislocations like a finger or toe that cannot easily reduce (pop back into place).


3. Wait to see your PCP if your child has:

  • Chronic pain or discomfort from overuse injuries (e.g., tendinitis, mild arthritis, or repetitive strain injuries).

  • Mild sprains or strains with no major swelling, bruising, or functional limitations.

  • Joint or muscle pain that has been gradually increasing over time but is not debilitating.

  • Recurring injuries that flare up but aren’t accompanied by new symptoms (e.g., recurring low back pain or an old knee injury that occasionally causes discomfort).


Red Flags to Watch For:

  • Loss of function, numbness, or tingling in the injured area can be signs of nerve damage.

  • Severe swelling, bruising, or changes in skin color around the injury may indicate more serious internal damage.

  • Joint instability or the feeling that a joint may "give out" can be a sign of significant ligament damage.


When in doubt, if you suspect a serious injury or are unsure of the severity, it’s safer to visit urgent care or the ER for an evaluation.


Return-to-Play

While there are specific return-to-play guidelines for certain conditions, not all injuries have clear-cut protocols. In many cases, recovery varies based on the individual and the severity of the injury. Below are some general guidelines to follow for a safe return to play to prevent re-injury and ensure full recovery.


First, persistent swelling and inflammation indicates incomplete healing and should be fully resolved before return to play can be considered.


Secondly, your child should be able to execute (near) pain-free movement. Your child should be able to perform daily activities and sports-specific movements without much discomfort. Additionally, your child should be able to perform (nearly) a full range of motion and strength in the injured area, comparable to the uninjured side. Why aim for near, and not 100%? I’ll explain…


In sports, there's an important distinction between being hurt and being injured, and understanding the difference is important. Being hurt generally refers to experiencing discomfort, soreness, or minor aches that often come with the physical demands of sports. These are typically manageable and don’t require time off from play.


On the other hand, being injured involves damage to muscles, tendons, ligaments, or bones that impairs function to a significant degree. Recognizing the difference matters because playing while hurt might be part of the sport, but pushing through an injury can lead to worsened damage and a longer recovery. When the body is dealing with injury, its ability to perform at peak levels is compromised. Reaction times may be slower, coordination can be off, and muscles may not function optimally, leading to poor movement patterns that can cause an athlete to compensate by overusing other muscles or joints, which can further increase the likelihood of injury. These factors increase the chances of strains, sprains, or more serious injuries.


Lastly, a gradual return to activity should be implemented.  Organizations like the American Academy of Pediatrics (AAP), National Athletic Trainers' Association (NATA), and the Centers for Disease Control and Prevention (CDC) help define return-to-play guidelines. These guidelines typically include a gradual, step-by-step approach, requiring athletes to progress from light activity to full participation only when symptom-free. They emphasize the importance of medical clearance, particularly following injuries like concussions, and close monitoring to prevent complications.


For further details, visit the CDC’s guidelines here https://www.cdc.gov/heads-up/guidelines/returning-to-sports.html.



If you would like more information, feel free to call (304-840-2820) or stop by the office. No appointments are necessary, and consultations are free.  You can also email me at DocLeviChiropractic@yahoo.com.

 

Yours in Health,

Dr. Levi G. Merritt, D.C., NBC-HWC, CPT

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