Specialista in Ortopedia Pediatrica
Panner disease (elbow)
Home Exercise Program
Not every exercise listed here is suitable for every child: the selection is individual and is defined during the consultation.
1.Relative rest from elbow loading (phase 1)
This is the real treatment: removing repetitive load from the capitellum
Suspend artistic gymnastics, handstands, cartwheels, rolls, climbing, throwing and overhead sports while the elbow is painful. Keep daily life normal: writing, eating and dressing are not harmful. Immobilization is not needed, except for short periods advised by the specialist in case of acute pain: prolonged immobilization promotes stiffness.
Throughout the painful phase, usually 6-12 weeks
2.Gentle flexion-extension mobility
Prevents loss of extension, the most frequent complication of Panner disease
Seated, arm relaxed at the side. Bend and straighten the elbow slowly, within the PAIN-FREE range, without weights and without forcing the last degrees. The other hand may only guide the movement, never push. Compare weekly with the healthy arm to detect any loss of extension early.
10-15 repetitions, 3-4 times daily
3.Forearm pronation-supination
Maintains rotation, often limited by joint effusion
Elbow bent to 90 degrees and held at the side, slowly rotate the palm up and then down, keeping the elbow still against the body. Slow movement, as wide as pain allows. No weights at this stage.
10-15 complete rotations, 3 times daily
4.Gentle wrist flexor and extensor stretching
Reduces tension of the muscles inserting on the elbow
Arm straight forward with the elbow as extended as possible without pain. EXTENSORS: palm down, gently pull the fingers toward the body. FLEXORS: palm up, gently pull the fingers downward. The stretch must be felt in the forearm, never in the elbow: if the elbow hurts, reduce arm extension.
3 x 20-30 seconds each direction, twice daily
5.Progressive isometric strengthening (phase 2)
To start only when the elbow is pain-free and mobility is complete
Phase A: isometric contractions, push the hand against the other hand in elbow flexion and extension without the arm moving, 5 seconds per contraction. Phase B: when isometrics are pain-free, elbow curls with a light weight (0.5 L bottle). Do not progress if pain returns within the following 24 hours.
3 x 10 repetitions, every other day
6.Gradual return to sport (phase 3)
Progressive reintroduction of upper limb loading
Only after the specialist clears it. Weeks 1-2: bodyweight exercises without weight-bearing on the arms. Weeks 3-4: partial weight-bearing on the hands (quadruped, inclined surfaces). Weeks 5-6: progressive resumption of handstands, cartwheels or throwing, starting at 25 percent of usual volume. If pain returns, go back to the previous step for one week.
Progression over 4-6 weeks
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:
- Elbow pain increasing during or within 24 hours after the exercises
- Progressive loss of extension compared with the healthy arm
- Sudden joint locking or painful catching (suspected loose body)
- Swelling, warmth or redness of the elbow
- Tingling or loss of strength in the hand
- 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 • 02/08/2026
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MioDottoreBefore You Start
Who is this guide for?
Children aged 5-10 with Panner disease (osteochondrosis of the humeral capitellum). Conservative programme: the main therapeutic factor is relative rest from sports loading the elbow.
What you need
No equipment. In the advanced phase, a 0.5 L bottle as a light weight.
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:
- Elbow pain increasing during or within 24 hours after the exercises
- Progressive loss of extension compared with the healthy arm
- Sudden joint locking or painful catching (suspected loose body)
- Swelling, warmth or redness of the elbow
- Tingling or loss of strength in the hand
Detailed Exercises
- 1
Relative rest from elbow loading (phase 1)
This is the real treatment: removing repetitive load from the capitellum
Suspend artistic gymnastics, handstands, cartwheels, rolls, climbing, throwing and overhead sports while the elbow is painful. Keep daily life normal: writing, eating and dressing are not harmful. Immobilization is not needed, except for short periods advised by the specialist in case of acute pain: prolonged immobilization promotes stiffness.
Throughout the painful phase, usually 6-12 weeks - 2
Gentle flexion-extension mobility
Prevents loss of extension, the most frequent complication of Panner disease
Seated, arm relaxed at the side. Bend and straighten the elbow slowly, within the PAIN-FREE range, without weights and without forcing the last degrees. The other hand may only guide the movement, never push. Compare weekly with the healthy arm to detect any loss of extension early.
10-15 repetitions, 3-4 times daily - 3
Forearm pronation-supination
Maintains rotation, often limited by joint effusion
Elbow bent to 90 degrees and held at the side, slowly rotate the palm up and then down, keeping the elbow still against the body. Slow movement, as wide as pain allows. No weights at this stage.
10-15 complete rotations, 3 times daily - 4
Gentle wrist flexor and extensor stretching
Reduces tension of the muscles inserting on the elbow
Arm straight forward with the elbow as extended as possible without pain. EXTENSORS: palm down, gently pull the fingers toward the body. FLEXORS: palm up, gently pull the fingers downward. The stretch must be felt in the forearm, never in the elbow: if the elbow hurts, reduce arm extension.
3 x 20-30 seconds each direction, twice daily - 5
Progressive isometric strengthening (phase 2)
To start only when the elbow is pain-free and mobility is complete
Phase A: isometric contractions, push the hand against the other hand in elbow flexion and extension without the arm moving, 5 seconds per contraction. Phase B: when isometrics are pain-free, elbow curls with a light weight (0.5 L bottle). Do not progress if pain returns within the following 24 hours.
3 x 10 repetitions, every other day - 6
Gradual return to sport (phase 3)
Progressive reintroduction of upper limb loading
Only after the specialist clears it. Weeks 1-2: bodyweight exercises without weight-bearing on the arms. Weeks 3-4: partial weight-bearing on the hands (quadruped, inclined surfaces). Weeks 5-6: progressive resumption of handstands, cartwheels or throwing, starting at 25 percent of usual volume. If pain returns, go back to the previous step for one week.
Progression over 4-6 weeks
Frequently Asked Questions
Does my child have to stop sport completely?
Activities that load the elbow (artistic gymnastics, throwing, weight-bearing on the arms) should be suspended until pain resolves, usually 6-12 weeks. Activities that do not load the upper limb, such as running or football, can generally continue unless the specialist advises otherwise.
Do exercises cure the disease?
No. The humeral capitellum revascularizes on its own over time: exercises serve to maintain elbow mobility, which is the real risk in this phase, and to prepare the return to sport. The main therapeutic factor remains relative rest.
When can sport be resumed?
When the elbow is pain-free even on pressure, mobility is complete and symmetrical to the healthy side, and the specialist's clinical or radiographic check allows it. Return must always be gradual, increasing loads over 4-6 weeks.