Playground Bumps, Bruises, Sprains, and Suspected Fractures: Safe Care and Supervision

1) Approach and Stabilize the Scene (Keep the Group Safe)

Playground and PE injuries often happen in busy, noisy settings. Your first job is to prevent a second injury—both to the injured student and to others who may trip, crowd, or continue play nearby. Stabilizing the scene also helps you assess the student accurately.

Immediate actions while maintaining supervision

• Stop the activity: Use a clear, firm command (e.g., “Freeze!”) and signal the supervising adult/coach if present.
• Create space: Keep other students back at least several steps. Assign a reliable student to be a “space helper” to hold the boundary.
• Maintain group supervision: If you are the only adult, position yourself so you can see the group while attending the injured student. If another adult is available, delegate: one adult supervises the group; one provides care.
• Control hazards: Move balls/equipment away, stop swings, clear the area of scooters or loose items.
• Calm the injured student: Speak slowly, identify yourself, and ask them to stay still until you check them.

Quick delegation script (example)

“Jordan, stand by the class and keep everyone behind the line. Taylor, go get the nurse/office and tell them we have a possible injury on the blacktop.”

2) Assess for Head/Neck Concerns Before Moving the Student

After a fall or collision, assume there could be a head, neck, or spine concern until you have checked for red flags. Avoid moving the student unnecessarily, especially if they fell from height, collided at speed, or landed awkwardly.

Do not move first—check these concerns

• Mechanism: Fall from playground equipment, head-first impact, collision during sports, or a hard landing.
• Head symptoms: Confusion, unusual behavior, headache, dizziness, nausea/vomiting, vision changes, or “not acting right.”
• Neck/back symptoms: Neck pain, back pain, tingling, numbness, weakness, or difficulty moving limbs.
• Alertness: Drowsiness, trouble answering simple questions, or loss of consciousness (even briefly).

Positioning guidance

• If head/neck concern is suspected: Keep the student still in the position found. Encourage them not to turn their head. Do not reposition “for comfort.”
• If no head/neck concern and the student can move comfortably: You may assist them to a safer location nearby (e.g., sideline) only if it does not increase pain and they can walk without significant difficulty.

Simple check-in questions (age-appropriate)

• “Tell me what happened.”
• “Where does it hurt the most?”
• “Do you feel dizzy or sick to your stomach?”
• “Does your neck hurt?”

3) Manage Bruises and Swelling (Cold Pack Use)

Most bumps and bruises involve soft-tissue injury and swelling. Cold therapy can reduce pain and swelling in the first day or two after injury when used correctly.

Cold pack basics

• Timing: Use cold as soon as practical after the injury.
• Duration: Apply for about 10–20 minutes at a time, then remove. Repeat as needed with breaks between applications.
• Skin protection: Place a thin barrier (cloth, paper towel, sleeve) between the cold pack and skin to prevent cold injury.
• Fit and pressure: Hold gently in place; avoid tight wrapping that increases pain, numbness, or color change.
• Observation: Check the skin every few minutes for excessive redness, blanching, or discomfort.

Practical example: “knee-to-ground” fall

• Student reports soreness and mild swelling, can bend the knee and walk with only slight discomfort.
• Move to sideline, have them sit with the leg supported.
• Apply a cold pack with a cloth barrier for 10–15 minutes.
• Recheck pain and walking ability before deciding on return to activity.

4) Differentiate Minor Sprain/Strain vs. Suspected Fracture/Dislocation

Teachers and staff do not diagnose injuries, but you can use observable signs to decide whether an injury appears minor (likely sprain/strain/bruise) or may be more serious (possible fracture or dislocation) and needs urgent escalation.

Continue in our app.

You can listen to the audiobook with the screen off, receive a free certificate for this course, and also have access to 5,000 other free online courses.

Or continue reading below...

Download the app

What often looks like a minor sprain/strain

• Pain is mild to moderate and improves with rest.
• Swelling is mild and develops gradually.
• Movement is possible (though uncomfortable) and the limb looks normal.
• Weight-bearing is possible with minimal limping (for lower-limb injuries).

Signs that suggest suspected fracture or dislocation (treat as serious)

• Deformity: Limb looks bent, twisted, shortened, or “out of place.”
• Severe pain especially with any movement or touch.
• Inability to bear weight or take steps after an ankle/leg injury.
• Loss of function: Cannot use the arm/hand normally, cannot move a joint.
• Rapid, significant swelling or swelling with visible bruising soon after injury.
• Open wound near the injury or bone visible (emergency).
• Circulation/nerve concerns: Numbness, tingling, pale/blue skin, or unusually cold fingers/toes.

Quick comparison table

5) Immobilization Basics (Without Attempting Realignment)

If you suspect a fracture or dislocation, your goal is to prevent further injury by limiting motion. Do not attempt to straighten, push, or “pop” anything back into place.

Step-by-step immobilization approach

• Keep the student still: Encourage slow breathing and minimal movement.
• Support the injured area in the position found: Use what you have (rolled towel, folded sweatshirt, small pillow).
• Immobilize the joint above and below the painful area when possible (e.g., for forearm injury, limit wrist and elbow movement).
• Use simple, safe supports:
  • Arm injuries: Sling made from a triangular bandage or a sweatshirt; secure the arm against the body if tolerated.
  • Lower-limb injuries: Keep the student seated or lying down; avoid walking. Support the leg with padding on both sides if you must wait for help.
• Check comfort and circulation: Ask about tingling/numbness; look for color changes in fingers/toes. Loosen any wrap that increases pain or causes numbness.
• Cold pack can be used over the area (with a barrier) if it does not require moving the limb and does not increase pain.

What not to do

• Do not attempt to realign a limb or joint.
• Do not force range-of-motion “tests.”
• Do not allow a student with suspected fracture/dislocation to “walk it off.”

6) Criteria for Immediate Escalation and Parent/Guardian Notification

Some injuries require urgent medical evaluation. Others may be managed with basic care and monitoring, but still require timely communication with the school nurse/office and families according to school procedure.

Escalate immediately (urgent/emergency response) if any of the following are present

• Head/neck/spine concern: neck pain, neurological symptoms, altered alertness, repeated vomiting, worsening headache, seizure, or any loss of consciousness.
• Suspected fracture/dislocation: deformity, inability to bear weight, severe pain, or loss of function.
• Open injury or uncontrolled bleeding near the suspected fracture.
• Circulation/nerve warning signs: numbness/tingling, pale/blue extremity, cold fingers/toes, increasing tight swelling.
• Severe mechanism: fall from height, high-speed collision, or multiple injuries.

Parent/guardian notification: practical guidance

• Notify promptly when there is suspected fracture/dislocation, significant swelling, inability to use the limb normally, or any head/neck concern.
• Share objective observations: what happened, where it hurts, visible swelling/deformity, ability to walk/use the limb, and what care was provided (e.g., cold pack, immobilization).
• Avoid diagnosing: say “suspected” or “possible” and recommend medical evaluation when indicated.

Example message (objective and clear)

“During recess, your child fell while running and has significant ankle pain and cannot bear weight. There is swelling. We kept them seated, supported the ankle, and applied a cold pack with a barrier. We recommend medical evaluation today.”

7) Return-to-Activity Considerations and Monitoring (Next Class Periods)

Returning a student to play too soon can worsen an injury or lead to a second incident. Decisions should be cautious, based on function and symptoms, and aligned with school health guidance.

Same-day return to activity (only for clearly minor issues)

• Return only if all are true:
  • Pain is mild and improving after brief rest.
  • Full or near-full movement is comfortable.
  • No limping; can jog lightly without pain (for lower-limb injuries).
  • No head/neck symptoms and no concerning mechanism.
• Modify participation: If uncertain, choose a lower-risk role (walking, non-contact drills, seated activity) rather than full play.
• Set a re-check time: “I’m going to check you again in 10 minutes.”

Do not return to activity that day if any of the following are present

• Persistent limp or inability to bear weight normally.
• Increasing swelling, worsening pain, or reduced range of motion.
• Any suspected fracture/dislocation signs.
• Any head/neck symptoms after a fall or collision.

Monitoring over the next class periods

• Watch for delayed swelling and bruising: Soft-tissue injuries can look worse later the same day or the next day.
• Check function: Can the student use the limb for writing, carrying, stairs, or PE movements without worsening pain?
• Observe gait and participation: Limping, guarding, or avoiding use suggests the injury needs reassessment.
• Reinforce safe choices: Encourage the student to report increasing pain, tingling, numbness, dizziness, or headache.
• Document and communicate changes to the nurse/office per school procedure, especially if symptoms worsen or new red flags appear.

Practical scenario: “seems fine” at recess, worse in PE next day

• Student fell and had mild wrist pain; used cold pack and returned to class.
• Next day, they avoid using the hand and report sharper pain with gripping.
• Action: stop PE participation for that student, support the wrist in a comfortable position, notify the nurse/office and family for evaluation, and monitor for swelling or numbness.