Early management of elbow sprains and strains

Minor injuries to the elbow such as a mild sprain or strain should settle with time. They can often be managed very well at home.

A soft tissue injury to the elbow may result in the following:

• Pain
• Swelling
• Bruising
• Stiffness and loss of function

The pain can be particularly strong in the first three weeks as this is the inflammatory phase of your body healing itself. Typically, these injuries last 4 to 6 weeks depending on the severity.

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Up to date guidelines can be found on the NHS website:

Paracetamol

Go to an urgent treatment centre or emergency department if your arm:

• has been injured and you heard a snapping noise or your arm has changed shape
• is swollen and you have a very high temperature or feel hot and shivery
• is extremely painful and difficult to move
• tingles or feels numb

These could be signs of something more serious.

You can also call 111 for advice or go 111.nhs.uk.

Speak to a GP or physiotherapist if:

• the pain is severe or stopping you doing normal activities
• the pain is getting worse and/or keeps coming back
• the pain has not improved in any capacity after following the simple advice below
• Click here to self-refer to a physiotherapist.

How to manage a sprain or a strain

Day 1 – Early Management

Protect: Rest or restrict movement for 1 to 3 days after injury to minimise bleeding and prevent further injury.

Elevate: Elevate the injured limb above heart level to reduce swelling.

Avoid anti-inflammatories: Avoid non-steroidal anti-inflammatory drugs (NSAIDs), like Ibuprofen and Naproxen, as the inflammatory process is necessary for tissue repair. Icing a new injury can hinder the natural healing process so avoid this if you can. You can use pain medication like paracetamol. Take this regularly to control the pain and always follow the instructions on the packet.

Compression: Use an elastic bandage or wrap to help reduce swelling.

Education: Best practice advice now focuses on an active recovery, encouraging movement, and there is a recommendation to avoid passive treatments where you remain still and treatment is done to you. An active approach has been shown to improve recovery in the short and long term.

 After the first few days, follow the L.O.V.E guide below

Load: Gradually reintroduce movement and normal activities. Optimal loading without increasing pain promotes tissue repair, builds tissue tolerance, and improves strength.

Optimism: Maintain a positive outlook. Psychological factors like depression,  fear and worry regarding damage to tissues or getting moving again can hinder recovery.

Vascularisation: Engage in pain-free cardiovascular activity to increase blood flow to the injured area and promote healing.

Exercise: Restore strength, mobility, balance and coordination by incorporating specific exercises into the rehabilitation plan as soon as you feel able.

WEEK 1 – Early Mobilisation

After 72 hours is important to start using your elbow normally again. Start to do normally everyday activities. You should also try doing these exercises 3 – 4 times a day. Repeat each one 10 times..

4.

Support your elbow on a table make a fist bend your fingers into your palm as tightly as you can and feel them stretching. Now stretch your fingers as wide as you can and feel them stretching.

WEEK 2 – Strengthening Exercises

2. Sit or Stand with one elbow bent and palm turned up. Hold on to a small weight such as a can of beans or bottle of water. Turn your palm down by rotating your forearm.

As you start to do these exercises you may feel there is some discomfort, however, this is normal and you should continue. If you have discomfort and pain for more than 2 hours after these exercises, then you should reduce the number and gradually build up again. 

Recovery time and returning to activity 

It usually takes 6 weeks to heal from simple soft tissue injuries to the elbow.  However, everyone recovers from injuries at different rates. Some may be back in 2 weeks however for some it can take up to 3 months.    

Returning to work – Gradually build up your strength and function, practice doing similar tasks that you would do at work before returning. Start doing this little and often ensuring there is minimal pain or swelling. 

Returning to hobbies/sport – it is advised not to return to these activities until you have full strength and range of movement without pain or swelling. Try to practice the specific movements of your hobby / sport in a controlled manner and build up the time and intensity that you do the movements before returning to your activity fully.