Rehabilitation after UCLR: 12 Week Post-Op to Return to Play

During this phase of rehabilitation after Tommy John surgery, isokinetic exercise can be initiated if available and interval throwing program (ITP) can be initiated. In most protocols, isokinetic shoulder internal and external rotation, wrist flexion and extension, and forearm pronation and supination exercises can be initiated after 12 weeks after surgery. Shoulder internal and external rotation exercise may be initiated even earlier. However, these exercises should be done pain free or any ulnar nerve symptoms. Shoulder and wrist plyometric exercises after 12 weeks. Strengthening exercises should be advanced including shoulder exercises with shoulder in 90 degrees of abduction (closer to throwing motion). The athlete will start swinging a bat and start a batting program. Fielding the ball can also the initiated without throwing.  

 ITP is usually initiated after 16 weeks post-operatively. There are several ITP's available, each of which starts with short distance and gradually increases in distance and the number of throws (an example of ITP is listed below). Again, ITP must be done symptom free throughout. If any symptoms exist, it should be stopped until it resolves. After completion of ITP, the athlete will gradually return to play. For baseball pitchers, it usually takes about 10-12 months before they will start pitching in a game.

The goals of this phase are 1) to maintain full ROM, 2) to advance in strengthening program, 3) to initiate plyometric exercise for shoulder and wrist, 4) to start sport specific training such as ITP, swinging a bat, and fielding, and 5) to gradually return to play. 

Interval Throwing Program (ITP) (Phase 1: Soft Toss) 

Distance (ft)                   Warm-Up                  # of Throws

30                                                                      20 - 20
45                                    30                              20 - 20
60                                  30 - 45                         20 - 20
75                                  30-45-60                      20 - 20
90                                  45-60-75                      20 - 20
120                                45-60-90                      20 - 20
150                                45-60-90-120               20 - 20
180                                45-60-90-120-150        20 - 20

This is an example of ITP. The athlete will soft-toss 2-3 times at each distance before advancing to next and may throw 10-15 times at each distance for warm-ups. And ITP should be done every other day. The distance can go farther than 180 feet if athletes want to. 

Interval Throwing Program (ITP) Phase 2

In this phase of ITP, the athlete will start throwing with intensity gradually increasing. They will start at a shorter distance (around 60 feet) and less intensity (50%) and gradually increase in intensity and distance as needed.

Rehabilitation after UCLR: 6-12 Week Post-Op

After 6 weeks post-operatively, strengthening exercises of forearm, wrist, and shoulder should be advanced while maintaining/regaining full ROM of the elbow. Isometric and isotonic exercises can be used for forearm, wrist, and shoulder muscles. The goals of this phase is 1) to maintain or regain full ROM, 2) to control pain/inflammation, and 3) to progress in strengthening program. Some examples of shoulder (posterior cuff and scapular) exercises can be seen in our website (Please note that NOT ALL of these exercises are appropriate for this phase of rehabilitation after UCLR). Wrist curls using free weights and tubing, radial and ulnar deviations, pronation and supination, grip exercises are some of examples.

If full ROM is not achieved by this phase, it is critical to regain full ROM, especially in extension. ROM (active and passive) exercise to regain full ROM should be emphasized. Exericises that cause any pain on the surgical site or any ulnar nerve symptoms should be avoided. Note that ulnar nerve may or may not be transpositioned.

Use of elbow brace is usually discontinued at week 6 (may vary depending on the surgeon's protocol).