The Rehab Process Following Tommy John Surgery
One of the most common injuries we see in baseball is a fully or partially
torn ulnar collateral ligament (UCL). This occurs when a pitcher throws
a pitch, then grabs his elbow.
In most cases, these players choose to have Tommy John surgery to reconstruct
the UCL. The process of rehabilitation to return to a level of playing
equal to before the injury often takes approximately a year for pitchers
and about six months for position players.
The following is a general timeline of the rehabilitation process:
Following UCL reconstruction and lasting for 7 to 14 days – The elbow is placed in a brace with no movement in a 90-degree
position. The player is able to move his wrist and shoulder.
Two weeks until six weeks after reconstruction – While the goal in the previous step is to control pain and maintain
motion in the shoulder and wrist, the goal changes to gradually increasing
movement in the elbow in order for the player to regain full motion by
the end of the sixth week. This is typically accomplished by increasing
the amount of motion the brace allows. Since less movement results in
an increase in pain, pain control remains important.
Six weeks to 18 weeks after reconstruction – There is a minimal increase in intensity of exercises, such as
cardiovascular, core stabilization, and lower extremity exercises. While
the goal remains to protect the elbow and not stress the UCL, exercises
for the shoulder and scapula will also start to incorporate safe elbow
motions and become increasingly harder to strengthen and prepare the pitcher
to start throwing again.
18 weeks to 40 weeks after reconstruction – The pitcher may start throwing the baseball 30 times at 45 feet
every other day and progress to 50 throws at 45 feet within about two
weeks. Then it progresses to 60 feet and increases by 30-foot increments
every two to three weeks, then progress long tosses to 100 total throws
with 24 of those throws at distances as high as 210 feet. As soon as sufficient
throwing strength is obtained and the pitcher is long tossing five days
per week with solid mechanics, he progresses to throwing from the mound.
8 to 10 months after reconstruction – This is considered the “return to pitching” phase and
involves throwing from the mound. After sufficiently tossing the ball
from a long distance to loosen up, pitchers will throw 20 to 25 pitch
bullpens, adding five pitches every other time and throw two bullpens
per week. Additionally, they continue the long toss three times per week.
As soon as they can throw 40-45 pitch bullpens (about five to six weeks)
without any soreness and with good mechanics and near normal velocity,
they throw several session facing hitters in batting practice and ultimately
pitch in a live game.