Erb's palsy physical
therapy techniques

Erb’s palsy results from a birth injury to the brachial plexus: the nerve network controlling shoulder, arm, and hand. When those nerves are stretched or torn during delivery, weakness follows in a pattern set by which nerve roots were affected. Therapy runs on two tracks at once: preserving the joint while the nerve recovers, and giving a surgical team the measurements it needs if it does not.

This page covers rehabilitation exercises, brachial plexus PT, stretching techniques, and the role of manual and occupational therapy. For the broader picture, see Erb’s palsy overview and our deeper guide on physical therapy for cerebral palsy.

Erb's palsy rehabilitation exercises

Nothing done in a therapy room repairs a nerve. What therapy protects is the joint the nerve will return to, and the child’s habit of using the arm at all.

What home practice is actually protecting

In the first months, therapy is mostly defensive. The nerve recovers on its own timetable or it does not, and nothing done at home changes the nerve. What home work does change is the joint waiting for it: keeping range available, keeping the shoulder from settling into internal rotation, and keeping the arm part of the child’s body map rather than something they learn to ignore.

That last point is easy to miss. An infant who cannot move an arm stops attending to it, and the disuse compounds the weakness. Prompting the child to look at and use the limb, positioning toys to the affected side, and building the arm into everyday handling all count as therapy even though none of it looks like exercise.

Physical therapy for brachial plexus injury

Recovery of elbow flexion against gravity is the marker the whole plan turns on, and the therapist’s repeat measurements are what a surgical team reads.

Inside a PT session

A typical session covers:

• Range of motion assessment
• Targeted stretching of tight muscles
• Strength-building tasks within the child’s ability
• Functional play that doubles as therapy
• Family education on at-home routines

Reading the recovery, and the biceps

Therapy in the first months runs alongside a decision nobody wants to leave late. Recovery of the biceps is the standard marker, because elbow flexion against gravity is the easiest movement to judge reliably. The 2024 review in Plastic and Reconstructive Surgery Global Open describes surgical exploration where there is no biceps elbow flexion at 3 months, or none against gravity at 6 months with scores that have stopped improving.

Outcomes are better when nerve surgery happens before 6 months, so the therapist’s repeat measurements are not just tracking progress. They are the evidence a surgical team uses. If your child is nearing 3 months without elbow flexion against gravity, ask whether a referral to a specialist brachial plexus clinic has been made.

Constraint-induced movement therapy, and what a trial showed

For older children with a persistent difference between the two arms, one approach has been tested directly. A randomized crossover trial published in Developmental Medicine & Child Neurology in 2021 followed 21 children with neonatal brachial plexus palsy, mean age 25 months. Each child received constraint-induced movement therapy for eight weeks and standard care for eight weeks, in a randomized order, with blinded raters scoring bimanual performance.

The therapy meant casting the unaffected arm for three weeks, then five weeks of activities transferring the gains into two-handed use. Bimanual performance improved more after the therapy than after standard care. Notably, the frequency and quality of movement did not differ significantly between the two, so what changed was how well the child used both hands together rather than how much the affected arm moved.

Casting a working arm is a serious ask of a toddler and a family, and this is one trial of 21 children. It is worth raising with a specialist team rather than assuming it applies.

Stretching exercises for Erb's palsy

The target is a specific one: an internal rotation contracture at the shoulder, which develops quietly over months and can eventually deform the joint. Technique matters more than effort, which is why it is taught and rechecked rather than copied.

Why stretching is the therapist’s call, not a home experiment

Stretching in Erb’s palsy is aimed at a specific problem: an internal rotation contracture at the shoulder, which develops when the arm sits turned inward for months. Left alone it can eventually deform the joint itself.

The technique matters more than the effort. A shoulder with a weak or subluxated joint can be harmed by force applied in the wrong direction, which is why a therapist demonstrates the positions, watches you do them, and rechecks as the child grows. Ask to be taught the specific stretches for your child, ask how often and for how long, and ask what should stop you. What that is not is a routine copied from a video.

Manual therapy and occupational therapy for Erb's palsy

Manual and occupational therapy are vital components, focusing on functional abilities and quality of life. Range of motion exercises are central to manual therapy; OT supports motor skills development and daily independence.

What manual therapy is for

Hands-on work by a therapist targets the soft tissue and joint restrictions that build up when an arm moves through a reduced range. It is not a nerve treatment. The purpose is to keep the shoulder mobile and comfortable so that whatever recovery the nerve makes has a joint worth recovering into.

Occupational therapy and the two-handed problem

Occupational therapy takes over where the task, not the muscle, is the unit of work: managing buttons, carrying a lunch tray, riding a bike. Much of it is two-handed, and that is the crux. In a survey of 183 adults with this injury, 80% reported an effect on hand and arm use, and that figure explicitly includes the unaffected limb and bimanual tasks.

Protecting the unaffected side is therefore part of the job, not an afterthought. Ask how the plan addresses overuse, because the shoulder doing double duty at seven is the shoulder with early arthritis at forty. Our page on the long-term effects of Erb’s palsy follows that through to adulthood.