How to Treat a UCL Injury and Relieve Elbow Pain, According to Physical Therapists

Your ulnar collateral ligament (UCL) is a thick band of tissue located on the inside of your arm, along the side closest to your body when your palm is facing forward. It helps to stabilize your elbow joint when you bend or extend it, or when you perform overhead movements, like lifting or throwing a ball to your dog. 

UCL injuries aren’t terribly common in everyday activities, says Jennifer Hayes, PT, DPT, a physical therapist at Hinge Health. They more often impact those who routinely perform forceful overhead movements, such as athletes who play baseball, tennis, or pickleball. UCL injury can also occur due to trauma, like falling on an outstretched arm or sustaining a blow to the elbow area. 

No matter what causes a UCL injury, though, gentle movement and targeted exercises can help heal UCL injuries and get you back to doing the activities you enjoy. 

Read on to learn more about what can cause a UCL injury, along with how to treat it — especially with exercises recommended by our Hinge Health physical therapists.

UCL Injury: What It Is and 3 Common Types

Your ulnar collateral ligament is made up of three bands of tissue that connect your ulna and radius, two bones on the outside of your forearm. The UCL can sometimes stretch too much or even tear, causing an elbow sprain. Any type of UCL injury can make it hard to lift and move your arm overhead. 

Like any other type of sprain, there are three grades of UCL sprains:

• Grade 1: The mildest form of UCL sprain, a grade 1 injury involves over-stretching this ligament. You may notice pain during or after activity that involves elbow movement, but you should still be able to perform most activities. This type of sprain generally heals quickly with home care, including gentle movement and activity modifications. 

• Grade 2: A moderate injury, a grade 2 UCL sprain means your UCL is stretched and possibly mildly torn. You may still be able to do your normal activities, but with less speed and force during things that involve your elbow. Pain during and after activity is usually more severe with a grade 2 sprain.

• Grade 3: The most severe UCL injury, a grade 3 sprain indicates a completely torn ligament. You may be unable to do things that involve throwing for a period of time due to pain, and you may notice tingling in your pinky or ring finger, which could indicate a pinched ulnar nerve. A grade 3 tear may need surgery to repair.

Symptoms of UCL Injury

UCL injury symptoms vary depending on severity. With a minor injury to your UCL, you may not notice any symptoms. “It may not become an issue until you do a certain overhead motion repeatedly that aggravates an already-injured ligament,” says Dr. Hayes. 

Some of the most common signs of a UCL injury include: 

• Pain on the inner part of your elbow

• Difficulty performing forceful overhead or throwing movements 

• Weakened hand grip

• Instability around your elbow 

• Numbness or tingling in your pinky or ring finger

Elbow UCL Injury Causes

An injury to your UCL can happen for a number of reasons: 

• Repetitive activity and overuse. The most common cause of UCL injury happens due to repetitive use, such as throwing a baseball or football. Over time, the ligament can develop small micro-tears, which may eventually progress into larger and more painful tears. 

• A blow to the arm. Being hit with something hard, such as a baseball, on the outside of your arm can result in an injury to your UCL. 

• Falling on an outstretched arm. You may also injure your UCL if you fall on it with your arm outstretched in an attempt to break your fall.

You may not feel as comfortable moving your body when you’re in pain, but gentle activity is important to heal injuries like strains, so, over time, you can resume your normal activities. “General elbow health exercises can go a long way to help a UCL injury heal,” says Dr. Hayes. The above exercises recommended by Hinge Health physical therapists are a great place to start. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatment Options for a UCL Injury 

Most UCL injuries heal on their own with conservative interventions. The goal, Dr. Hayes explains, is to encourage gentle movement that brings healthy blood flow to the area without exacerbating the injury. If you have a UCL injury, consider the following treatment options: 

• Do physical therapy. A physical therapist (PT) can help you determine the severity of your UCL injury and develop a gentle-but-effective exercise program, including exercises like the ones above, to help you heal and regain full range of motion in your forearm and elbow. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Modify activities. When you stretch or exercise, avoid repetitive overhead motions until your UCL is stronger and able to withstand more load. Listen to your body. If you start to feel pain that goes beyond an acceptable level for you, it may mean you need to add in more breaks.

• Apply ice. For the first several days after your injury, Dr. Hayes recommends applying ice to the tender or painful area to help reduce pain and inflammation. After that, you may find heat more comfortable, but both ice and heat are perfectly acceptable — it all depends on your preference. 

• Try over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for UCL injury pain. It’s important to make sure that you are safely able to take these medications, based on your medical history and your physician’s recommendation. 

• Warm up before exercising. If you perform overhead activities like throwing, be sure to warm up first. “Any of the general elbow stretches we recommend above can be integrated into a warm-up program,” says Dr. Hayes. 

How to Prevent UCL Injuries

UCL injuries tend to heal on their own with time and conservative treatments. But you can also take steps to prevent an injury to your UCL, such as:

• Strengthen surrounding arm muscles. Dr. Hayes suggests working with a PT on strengthening the areas around your elbow, such as your forearms, biceps, and rotator cuff muscles, to help protect your elbow joint and tissue. The stronger these areas are, the easier it will be to perform overhead movements with less risk of developing a UCL injury.

• Work on your throwing technique. If you play a sport like baseball, football, tennis, or pickleball, talk to a trainer about the best way to minimize your chance of injury. It may require modifying your throwing style as you build strength in and around your elbow and other key areas, such as your core. (Throwing is a full-body motion, so it requires strength in your entire body — not just your arm.)   

• Always warm up. Warmups before exercising can help prepare your muscle tissue for activity, preventing the risk of injuries like sprains. Including arm exercises in your warm-up routine can help send blood flow to the elbow joint and prevent your UCL from overstretching. 

• Listen to your body. Whether you’re an athlete or a weekend warrior, always listen to your body. If you start to feel pain during or after throwing that’s beyond a level that’s acceptable to you, it might be a sign that you need to focus on strengthening exercises more. You can increase your activity as your arm muscles, ligaments, and tendons all get stronger.  

PT Tip: Cool It Down

Warming up before exercise is important, but so is developing a proper cool-down routine after you exercise or play sports. “Cool-down stretches can help make sure all the structures in your arms don’t tighten back up after throwing activities,” says Dr. Hayes. If you feel sore after cooling down, you can also try applying ice to minimize inflammation in the area. 

How Hinge Health Can Help You 

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Dubois, B., & Esculier, J.-F. (2019). Soft-tissue Injuries Simply Need PEACE and LOVE. British Journal of Sports Medicine, 54(2), bjsports-2019-101253. doi:10.1136/bjsports-2019-101253

2. Alaia, M. J., Jost, P. W., Andrews, J. R., Dugas, J. R., & Cain, Jr., E. L. (2012). Elbow Injuries in the Throwing Athlete. OrthoInfo - AAOS. https://orthoinfo.aaos.org/en/diseases--conditions/elbow-injuries-in-the-throwing-athlete/ 

3. Jang S. H. (2019). Management of Ulnar Collateral Ligament Injuries in Overhead Athletes. Clinics in Shoulder and Elbow, 22(4), 235–240. doi:10.5397/cise.2019.22.4.235

4. Liman, M. N. P., Avva, U., Ashurst, J. V., & Butarbutar, J. C. (2021). Elbow Trauma. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542228/