Specialista in Ortopedia Pediatrica
After elbow cast
Home Exercise Program
Not every exercise listed here is suitable for every child: the selection is individual and is defined during the consultation.
1.Active assisted flexion and extension
Fundamental exercise to recover elbow range of motion
Seated or standing, arm at side. With other hand, GENTLY assist flexion movement (bend elbow bringing hand toward shoulder) and extension (straighten arm). Movement should be slow and controlled. STOP if pain appears - never force! The other hand's help is only to guide, not push. Gradually increase range of motion each day.
10-15 repetitions, 4-5 times daily
2.Forearm pronation-supination
Recovers forearm rotation (turning palm up and down)
Seated, elbow bent 90° and held at side (elbow "glued" to body). SLOWLY rotate forearm: palm up (SUPINATION, as if holding soup bowl), then palm down (PRONATION, as if pouring water). Keep elbow still - only forearm rotates! If one movement is more limited, gently focus on that one.
10-15 complete rotations, 4-5 times daily
3.Stick exercise (pronation-supination)
Increases pronation-supination mobility using a stick or wooden spoon
Grip a stick or wooden spoon (30-40 cm) with affected arm, elbow at 90° and against side. Rotate stick bringing end up and down like a turning rod. Other hand CAN gently assist at end of movement to gain a few more degrees. Move slowly, feeling stretch but without pain.
10 reps each direction, 3 times daily
4.Flexion and extension stretching
Passive stretching to improve last degrees of movement
FLEXION: seated, place palm on same-side shoulder. With other hand, GENTLY push wrist toward shoulder to increase flexion. EXTENSION: arm resting on table, palm up. Gently press down with other hand to increase extension. In both cases: gentle stretch, never painful, hold 20-30 seconds.
3 × 30 seconds each direction, 2-3 times daily
5.Progressive strengthening - flexors
Strengthening muscles that bend the elbow
START ONLY when mobility is almost complete and pain-free. Phase 1: flex elbow without weight, hold 5 seconds. Phase 2: use light weight (can, 0.5L bottle) and perform slow curls. Phase 3: gradually increase weight. DON'T start strengthening if elbow is still stiff or painful - first recover mobility!
3 × 10-15 repetitions, once daily
6.Daily functional activities
Use the arm in daily activities to recover function
Encourage child to USE arm in daily activities: eating, dressing, washing, playing. Helpful activities: throwing and catching soft ball, drawing, coloring, stacking objects, building blocks. Avoid contact sports and high fall-risk activities for first 4-6 weeks after cast removal.
Encourage active use throughout the day
RED FLAGS - When to stop and contact the doctor immediately
Stop the exercises immediately and contact the specialist (or go to the emergency department if severe) if any of the following occur:
- Acute pain during mobilization exercises
- Persistent or increasing swelling
- Complete joint block
- Feeling of instability
- Fever, redness or warmth of the joint, or inability to bear weight
In case of doubt, always prefer a check-up over continuing the exercises.
Dott. Daniele Priano
Ortopedia Pediatrica - ASST Gaetano Pini-CTO
ortopediaevolutiva.com • 26/08/2026
Versione Web
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MioDottoreBefore You Start
Who is this guide for?
Children who had elbow cast removed. Extension recovery may take time.
What you need
Clear floor space, mat or soft surface, comfortable clothing. Some exercises may require resistance bands or supports.
Suggested frequency
Usually 1-2 times daily, as directed during the visit. Consistency is more important than intensity.
Common mistakes to avoid
- •Performing exercises too quickly without control
- •Pushing beyond the pain threshold
- •Skipping days or doing occasional very long sessions
- •Not warming up before strengthening exercises
⚠️ Red flags — when to stop and contact the doctor immediately
Stop exercises immediately and contact the specialist if any of the following occur:
- Acute pain during mobilization exercises
- Persistent or increasing swelling
- Complete joint block
- Feeling of instability
Detailed Exercises
- 1
Active assisted flexion and extension
Fundamental exercise to recover elbow range of motion
Seated or standing, arm at side. With other hand, GENTLY assist flexion movement (bend elbow bringing hand toward shoulder) and extension (straighten arm). Movement should be slow and controlled. STOP if pain appears - never force! The other hand's help is only to guide, not push. Gradually increase range of motion each day.
10-15 repetitions, 4-5 times daily - 2
Forearm pronation-supination
Recovers forearm rotation (turning palm up and down)
Seated, elbow bent 90° and held at side (elbow "glued" to body). SLOWLY rotate forearm: palm up (SUPINATION, as if holding soup bowl), then palm down (PRONATION, as if pouring water). Keep elbow still - only forearm rotates! If one movement is more limited, gently focus on that one.
10-15 complete rotations, 4-5 times daily - 3
Stick exercise (pronation-supination)
Increases pronation-supination mobility using a stick or wooden spoon
Grip a stick or wooden spoon (30-40 cm) with affected arm, elbow at 90° and against side. Rotate stick bringing end up and down like a turning rod. Other hand CAN gently assist at end of movement to gain a few more degrees. Move slowly, feeling stretch but without pain.
10 reps each direction, 3 times daily - 4
Flexion and extension stretching
Passive stretching to improve last degrees of movement
FLEXION: seated, place palm on same-side shoulder. With other hand, GENTLY push wrist toward shoulder to increase flexion. EXTENSION: arm resting on table, palm up. Gently press down with other hand to increase extension. In both cases: gentle stretch, never painful, hold 20-30 seconds.
3 × 30 seconds each direction, 2-3 times daily - 5
Progressive strengthening - flexors
Strengthening muscles that bend the elbow
START ONLY when mobility is almost complete and pain-free. Phase 1: flex elbow without weight, hold 5 seconds. Phase 2: use light weight (can, 0.5L bottle) and perform slow curls. Phase 3: gradually increase weight. DON'T start strengthening if elbow is still stiff or painful - first recover mobility!
3 × 10-15 repetitions, once daily - 6
Daily functional activities
Use the arm in daily activities to recover function
Encourage child to USE arm in daily activities: eating, dressing, washing, playing. Helpful activities: throwing and catching soft ball, drawing, coloring, stacking objects, building blocks. Avoid contact sports and high fall-risk activities for first 4-6 weeks after cast removal.
Encourage active use throughout the day
Frequently Asked Questions
How long does it take to recover elbow mobility after a cast?
Recovery time varies from child to child. Generally, most mobility returns within 4-8 weeks with consistent exercises. Some children recover faster due to the plasticity of their joints.
Is it normal for the elbow to still be stiff after cast removal?
Yes, this is completely normal. Immobilization always causes some degree of joint stiffness. With gentle daily exercises, mobility improves progressively. Never force movement beyond pain.
Should I worry if my child cannot fully extend their elbow?
Temporary loss of full extension is common. In most cases it improves with time and exercises. If there is no significant improvement after 2-3 months, a specialist re-evaluation is advisable.