The Elk River is rated as a Class I to II stream with no significant rapids or waterfall drops. Its watershed headwaters originate in Big Sugar Creek and Little Sugar Creek. The two streams merge near Pineville, Missouri to form the Elk River. 
The Elk River flows out of Missouri and forms the Elk River Arm of the Grand Lake O’ the Cherokees. in Oklahoma. Most reviews of Big Sugar Creek tend to suggest a waterway of about 24.5 miles in length, starting near Powell and ending at the Little Sugar confluence, where the Elk River is born of the meeting of the two creeks.

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