Why Elbows Stiffen and the Sheffield Early Motion Rehab Program

The elbow has three joints in one capsule, poor capsular proprioception and a strong tendency to stiffen. Fear of movement in patients, surgeons and physiotherapists adds to the risk, and fear avoidance at two weeks predicts outcome at six months after distal humeral fracture. Immobilization causes muscle wasting, shrinks the elbow's cortical representation and reduces balance. Capsular contraction starts within days, so Val aims to start movement in the first week. Rehab is milestone-driven. Active movement is done overhead in supine, using thumb landmarks from forehead to shoulder tip, with balloons and no long-lever shoulder flexion or abduction for six weeks. Sensory retraining such as stereognosis, graphesthesia, mirror therapy and left-right discrimination is done for 10 minutes a day, alongside a compression sleeve. Strengthening and weight bearing start at 4 to 6 weeks, with lifting limited to 10 kg for three months after biceps repair. Advanced strength, drop and catch, falling practice and return to sport tests such as the ball abduction external rotation test follow from about 8 to 12 weeks.