Welcome to PFC’s Doctor’s Corner! 
Here, we have partnered with Dr. Cooper from Princeton Spine & Joint Center (pictured right) to answer some of the most common medical questions that come up during the season. Dr. Cooper is also a member of our Princeton FC family as he has a child currently playing in our club.
An important point -- The purpose of these answers is to address common medical issues that come up during the course of the season. There is nothing in this or any document from PFC that should replace the advice of your child’s doctor. This entire section is meant to offer some general guidelines for you and your family that you can also use as a starting point for a conversation with your doctor.
If you have a question for Dr. Cooper, you can email them to us at: [email protected]
2nd Question: What do I do for my son or daughter’s mild ankle sprain?
An ankle sprain is an overstretch or tear of the ligament(s) in the ankle. Generally, an ankle sprain
occurs in the outside (or lateral aspect) of the ankle as a result of a twisting injury. Ankle sprains, as you
may know, are particularly common in soccer. In the future, I hope we’ll explore ways to prevent ankle
sprains altogether but for the moment let’s dive into what to do if your son or daughter has one.
First, if your child cannot weight bear on the ankle, see a doctor. If there is tenderness over the bones in
the ankle, see a doctor to make sure there is no fracture. If the foot is cold or numb, call a doctor.
Assuming they can put pressure on their foot and walk (albeit with some pain), remember the principles
of PRICE – protection, rest, ice, compression and elevation.
Protection can mean giving the ankle immediate support such as an Aircast stirrup brace or Ace elastic
bandage. Rest the ankle and avoid activities that cause significant pain. Ice for 10-15 minutes every
couple of hours for 2-3 days as a good rule of thumb. Remember to wrap the ice in a thin cloth,
handkerchief or paper towel to protect the skin. Compression with a firm bandage that is not too tight
so as to not stop circulation is helpful. Elevate the ankle above the heart when possible to help reduce
swelling. Again, please see a doctor if the pain is severe with walking as you may need to rule out more
serious injuries and be given crutches to get around.
Using topical diclofenac (such as Voltaren gel) has been shown to increase the speed of recovery from
sprains, strains and bruises and may be something to consider. Assuming no contraindication in your
child, topical diclofenac is available over the counter at any pharmacy and may be a good supporting
measure to take. You can gently massage the gel over your child’s ankle where it is painful two to four
times a day. For those with contraindications to anti-inflammatory medications, Arnica gel is a good natural alternative made from sunflowers without a significant fragrance.
Over the counter oral medications such as acetaminophen (Tylenol) or NSAIDs (Advil, Aleve) can help
with the pain. These medications won’t speed up recovery and should be used sparingly in kids. Some
children cannot take certain medications so always check with your pediatrician to make sure that any
particular medication (including over the counter) is safe for your child.
One of the important aspects of a mild ankle sprain is early mobilization. Ankles (and joints in general)
don’t do well with not moving at all. The tendency when there is pain in the ankle is to immobilize it
since it hurts to move. However, within a reasonable amount of pain, mobilizing the ankle will help to
speed up recovery and reduce the chance for secondary problems such as chronic regional pain
syndrome (CPRS). One of my favorite activities for ankle rehabilitation at home is to use the ankle and
foot to trace the letters of the alphabet from A-Z in the air. This provides for mobilization and also fine
motor control. A less difficult exercise is to draw circles in the air with the ankle and foot. Gentle
stretching of the Achilles/calf muscles is also a good activity and can be done in a seated position using a
towel around the feet and pulling gently on the towel to stretch the back of the lower leg.
What to expect? Generally, by following the above guidelines, your child should make a full recovery in
1-2 weeks. Of course, severe sprains can take much longer than that. Once the ankle’s range of motion
has been mostly restored, it is a good idea to start strengthening the ankle in preparation for a return to
sport. A good way to strengthen the ankle is to use a Theraband that is fixed to an immovable object
(like a table leg) on one end and wrapped around the inside of your child’s forefoot on the other. The
child then sits with knees bent, not moving the knees as much as possible, and your child pulls the foot
inward against the tubing and then return slowly to the starting position. Repeats this 10-12 times as
tolerated for 2-3 sets. Then repeat the exercise with the Theraband in the opposite direction wrapped
around the outside of your child’s forefoot with your child pulling the foot outward against the tubing.
Again, repeat this 10-12 times as tolerated for 2-3 sets. Repeat these exercises with the other foot to
help strengthen the uninjured ankle/foot as well.
Of note, if your child appears to have a mild ankle sprain but the pain has not improved in a week, call
your doctor just to make sure there is nothing else going on and make sure you are on the right path.
Depending on the extent of the injury, physical therapy may be helpful to help speed recovery and offer
tools to prevent future injuries to the ankle. In a simple, mild ankle sprain that resolves in 1-2 weeks,
physical therapy may not be necessary. However, if your child has a more serious ankle sprain, or if your
child has a recurrent ankle sprain, then physical therapy becomes a good option to aid recovery and,
importantly in the case of recurring sprains, address any underlying biomechanical issues that might be
predisposing your child to ankle sprains.
Return to sport can happen when your child has full range of motion in all directions, has good strength
in the muscles around the ankle, has good balance and stability while walking and running, and has no
pain or swelling with activity. Of course, if you are not sure about any of these factors or if you are
concerned about your child’s progression, it is a good idea to check with your doctor.
1st Question : What should I do if my child has foot, ankle, or knee pain after playing soccer?
Minor lower extremity injuries are relatively common in soccer. If your child has pain in their lower leg (foot, ankle, knee) after playing, there are a few questions you will want to ask. Did the pain start all of a sudden after a trauma, fall or sudden movement? Or did the pain begin gradually without any obvious incident? Next, and importantly, can your child bear weight on their leg?
If your child cannot or has trouble bearing weight on the limb, see a doctor. If the pain started after a trauma and if the joint is giving way or locking up where your child can’t easily bend or extend the joint, see a doctor. If the pain is severe and your child can’t get comfortable despite the steps recommended below, see a doctor. If the pain is mild or moderate but is not getting better after about a week, see a doctor.
If your child’s pain does not fit the above criteria, then starting some basic home care makes a lot of sense. The acronym PRICE is helpful.
P stands for protection and refers to protecting the limb from further injury. For practical purposes, this means stopping the activity that was making the limb hurt and possibly using a brace or splint to help protect the body part from further injury.
R stands for rest. This is an important one for our purposes in part because it’s always a question of how much to rest and how much to work through a little pain. This is going to depend on the age of your child, extent of the injury, nature of the injury and the degree of pain, to name a few important variables. A good rule of thumb, though, is that injuries need a little rest to heal properly and quickly. On the other side of the ledger is that joints need movement or they get stiff and cause other problems. The balance lies in some common sense and prudence. If your child has pain in the leg and there is no serious injury, you want to maintain a good range of motion but you also want to listen to your body. If you are doing an activity that makes it hurt more, back off that activity. If walking is okay but running exacerbates the pain, you may need a few days of relative rest before starting to run again.
I stands for ice. This is an important one. For the first 48 hours after an injury, icing the injury, particularly if there is swelling, is a good idea. Be careful not to hurt your skin so use a barrier between the ice and your skin. The barrier could be a towel, pillow case, or old t-shirt. A bag of crushed ice or frozen peas are excellent to use under the barrier. Of note, people often ask why a bag of frozen peas as opposed to some other vegetable should be used and it’s because peas are packed with protein and fiber and so that diffuses into the injury…… totally kidding. Sorry, that last part is just a joke. But the question does come up a fair amount. A bag of frozen peas or corn or any other similarly sized small vegetable, or a bag of crushed ice is good because it conforms nicely to the shape of your body where you need to use it. That’s the reason.
C stands for compression. Compressing a swollen body part is a good way to help reduce swelling and speed up recovery. An elastic bandage is often used and is applied directly to the skin. Typically, you should start by wrapping a few inches above the injury to a couple of inches below the injury. The bandage should have a medium amount of tension in it so that the compression is firm but not too constrictive. It is important to make sure that your child does not experience any numbness, tingling or color change of the soft tissue where you put the bandage or below it. If these things do occur, loosen the bandage so that the symptoms go away. It is usually best to take the bandage off before going to sleep and re-apply in the morning.
E stands for elevation. In a perfect world, you could elevate the injured leg above your child’s heart while you put ice (or frozen peas) on it. Elevating the limb higher than the heart allows the fluid to not accumulate and drain from the limb. During sleep, if you can use a couple of pillows to raise the limb above the heart, that helps to drain the fluid overnight.
PRICE is good, basic homecare. One additional approach I would add to the standard PRICE, is that if your child has a bruise or a mild sprain or strain, then using a topical diclofenac product can speed their recovery a little bit. The most common over the counter topical diclofenac is called Voltaren gel. Voltaren gel is basically like a topical Advil or Aleve and the anti-inflammatory medication diffuses through into the injured body part. Using this in conjunction with the PRICE protocols works best. Of course, if your child is allergic to non-steroidal anti-inflammatory medication or has any other contraindication for it, then don’t use it.