THE ANKLE turned in ballet class or the knee jammed on the soccer field may be "oh, nothing." Then again, it may be something.
Parents need to know the difference.
With physical education classes gearing up and fall sports in full swing, youngsters are apt to be straining and spraining, pulling and pinching. Even one of America's favorite passive pastimes -- Nintendo -- can bring injury and pain to its players.
"Any type of activity that is repetitive . . . stresses a single joint and can result in injury," says Diane Runkles, a physical therapist and mother of two boys.
Some children respond to stress and injury by moaning and groaning; others try to ignore the whole thing.
Parents need to know what to pay attention to.
"No injury is too small to discuss, but not every injury needs to be treated," says Runkles, who actually treats few children because most of their injuries are not chronic.
There are three signs of injury: pain, swelling and elevated temperature around the injured joint. If any of these conditions persist, it's time for treatment, says Runkles, the clinical coordinator at the Maryland Center for Physical Therapy in Owings Mills.
Treatment for common sports injuries is usually rest and ice for the first 24 to 48 hours, she says. If the swelling does not go down, consult a doctor. The ultimate treatment is exercise -- to get the joint or muscle working again.
The most common injuries from soccer, lacrosse and basketball are to knees and ankles, says Runkles. Football players are also subject to back and neck problems.
Ballet, "a very strenuous sport," demands flexibility, posture control and training, says Runkles. And very young children usually do not have the strength to "come totally up on their toes repeatedly;" this is why toe dancing should be avoided until a child is 11 or 12.
Some pain results not from a specific injury, but from overdoing: swimming too many laps without conditioning, running too many miles without a proper warm-up.
"The key with children is prevention," Runkles says. That starts with coaches and teachers who know that "a child needs to warm up before any form of exercise" and that the warm-up needs to be appropriate to the activity.
"Children need to have a certain amount of strength and a certain amount of flexibility" for sports and physical education. "If a parent or a coach or teacher can recognize weakness or lack of flexibility," many injuries can be prevented, she says.
Because some teachers and intramural coaches -- often volunteering parents -- have "limited medical experience," Runkles adds, this weakness or lack of development may go unnoticed, causing a child harm.
There may be one child out of every 100 who is not strong enough or developed enough to do a certain activity, such as calisthenics, Runkles suggests. The parents of that child need to let the teacher know, and the teacher needs to find an alternative program for the child, she says.
Prevention also includes having the proper equipment and shoes.
The danger in Nintendo, as Runkles sees it, is in hunching over the screen for long periods and in repetitive arm movements, resulting in stress to the back, neck and shoulders. Parents need "to monitor [Nintendo] so children are not doing it all the time."
The caution to gauge a child's strength and flexibility before encouraging him to take up a sport applies to soccer, lacrosse, basketball, weight-lifting, gymnastics, skiing and even skating. Even with conditioning, however, "it is difficult to prevent injuries in football," she says. "Football puts a tremendous amount of stress on the body." Also, there is no guarantee that a player will be as big or as strong as the person he comes up against.
"I encourage children to be active," says Runkles. "They are ready . . . to be involved in some sort of sport by age 5. But they should be supervised."
And they should also be told "to listen to their body." It will tell them when they have done too much. And youngsters should also be instructed "to let parents and coaches know when they hurt.
" 'No pain, no gain' is totally wrong" when it comes to children and sports, Runkles says.