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Then keeping the shoulders pinched and down, slowly raise the arms up overhead into a “Y” position and return them back into a “W” position. Together, this team covers all your major bases for a strong and healthy return. I think there are 3 main reasons you injure your UCL. Otherwise you will be prompted again when opening a new browser window or new a tab. For the youth and even collegiate pitchers, a good timeframe to shoot for is 12 months. But it is also the reason why throwers get injured. The flexor carpi ulnaris and flexor digitorum superficialis muscles of the forearm lay directly over the UCL ligament and have been shown to provide 24% of the dynamic stability of the joint. This site uses cookies. Do you move well? If you refuse cookies we will remove all set cookies in our domain. Do it right the first time. Do you exhibit proper dynamic stabilization? I’ll share this article Mike. You are not ready and you will flare up your elbow (or even shoulder). All rights reserved. Dynamic stability is simply your muscles ability to contract at the right time and intensity to stabilize your arm, and essentially prevent your arm from flying off your body. Throwing a baseball places a lot of stress on your UCL ligament. The key to this is early rehabilitation and finding a skilled physical therapist with experience in Tommy John rehab. Most of the predisposing factors to injuring your UCL involve reduced strength and alterations in shoulder motion. we need better assessments and S&C programs for the youth levels. But are you “ready” to throw? A good exercise to work on the scapular stabilizers is lying on your stomach with an exercise ball or bosu ball under the hips to elevate the body off the ground, and bring your arms up into a W position by pinching the shoulder blades back and down. Pitchers should stand in a pitching position with shoulder and arm in the 90/90 position and a band tied to something solid. Here is an important thing to consider: I usually see these bumps at the transition points such as when you start long toss, or when you start throwing off a mound. I have been throwing for about 30 days and felt great up to 90ft but at 120ft I have pain in elbow and tightness in forearm. Knowledge is power, so in order to recover as best as possible, I want to education you on what I consider the keys to Tommy John rehabilitation. There are many exercise programs designed for pitchers, including the “throwers ten” and “ballistic six”, but we will cover the five necessary exercises that are specific for providing stability against valgus forces at the elbow. Your throwing progression is going to be long. Wrist pronation/supination3. Click to enable/disable essential site cookies. We are dedicated to helping athletes improve their performance while minimizing risk of injury at Competitive Edge Physical Therapy. Now that you know the risk factors and improper pitching mechanics that can lead to excessive valgus stress at the elbow, you are probably wondering what exercises you can do to strengthen the elbow to combat this stress. One of the flaws that I often see in athletes that come to me from a consult, but are rehabilitating elsewhere, is the expectation that the rehabilitation progression is simply a protocol and based on time. Perform 3 sets x 15 sets. Thanks for sharing! Don’t get me wrong, we do plenty of elbow work. Due to security reasons we are not able to show or modify cookies from other domains. But don’t forget that your pitching mechanics have a large impact on your chances of hurting your ligament as well. Similar to emphasis on the shoulder and scapula, to really achieve optimal performance when you come back from Tommy John surgery, you must integrate proper core and lower body training. The key is to avoid a roller-coaster progression of speeding-up, slowing-down, and speeding-up again. The number one factor is overuse. We need to get to a point where we are teaching proper movement mechanics from a youth level. Initially, I like you to just worry about throwing and playing catch, and NOT your mechanics. We perform a series of progressively advanced exercises to enhance your neuromuscular control and maximize your muscles’ ability to dynamically stabilize. Keep the shoulder stable by pulling them back and down and let nothing else move while rotating the arm backwards. Most people, however, take this to mean get these areas strong by performing strengthening exercises. A skilled therapist will know when to push and when to back off, you want them guiding you through this process. Mike is the co-owner of Champion Physical Therapy and Performance, located just outside Boston, MA. We know that injuries are most common in the first month of the baseball season, – Assessment and Treatment of Shoulder Impingement, – Keys to Shoulder Instability Rehabilitation, – Assessing and Treating a Loss of Knee Extension ROM. I have just started the “mound progression” phase and am progressing through it relatively well. But luckily Tommy John surgery is fairly successful. There are a lot of factors in determining this return date. Most importantly I always review their rehab program to date and assure that have went through the proper sequence. We help people feel, move, and perform better. Yes, our research has shown that pitchers return to throwing at 9-12 months following surgery. It still amazes me that in this day and age, there are still surgeons who do not emphasize early rehabilitation. Over time they do often get flexion contractures. Resist this urge. With the right care and attention, UCL reconstruction surgery can have a really good outcome. This means that muscles and other soft tissue structures around the elbow need to make up the difference in force generation to prevent ligament injury. They often times actually improve from surgery as they clean out the joint. To break this down, the first 4-6 weeks are focused on recovering from the surgery, reducing your pain and swelling, restoring your motion, and starting basic exercises. Your are probably going to feel great about 1-2 months into your throwing program and think you can throw 100 mph. I took 10 days off from throwing and again at 120 ft same issue it’s painful. Realize there are a large variety of people in a study like this. Quickly take turns flexing each wrist so that the string rolls around the dowel until the weight is brought up to arm height, slowly lower the weight rolling the dowel in the opposite direction, and repeat for 3 sets x 15 reps. For wrist pronation/supination exercise, the pitcher should be standing or sitting with forearm supported and holding onto a short dowel with 3-5 lbs tied to the end. We’ve talked a lot about working the elbow, shoulder scapula, trunk, core, and lower body. Please, please, please do not rush back to returning to pitching, especially for the youth and parents reading this. Did you restore your strength? The scapular muscles help provide a strong and stable base from which the other arm muscles can use during a throw. You should probably go back and read my past article on the 5 Myths of Tommy John Surgery as well. By continuing to browse the site, you are agreeing to our use of cookies. https://mikereinold.com/wp-content/uploads/elbow-extension-tommy-john.jpg, https://mikereinold.com/wp-content/uploads/MikeReinold-Small-Signature-Logo-2017-red.png, 5 Common Stretches We Probably Shouldn’t Be Using. To throw a ball effectively, you must be strong and stable. These are common and expected. The Official Physical Therapy Provider of the San Jose Earthquakes, How to Avoid Tommy John Surgery Part III: 5 Necessary Exercises to Avoid Injury. Continue to check out our website at compedgept.com for more great blogs and come visit our state-of-the-art clinic here in San Jose, CA if you need help returning to your sport after injury or just want to improve performance! I tell my athletes undergoing UCL reconstruction that there are three phases of Tommy John rehabilitation – The Boring Phase, The Monotonous Phase, and the Fun Phase when you get back to advanced exercises and eventually throwing. This concludes our three part serious on avoiding Tommy John surgery, and I hope it was informative to learn the risk factors for medial ulnar collateral ligament injury, proper and improper pitching mechanics, and exercises pitchers can perform to strengthening the … For those unfortunate to have injured their elbow, sorry to hear that. The more you throw, the more stress you put on your ligament. All of these muscles are strengthened using the following five exercises: Wrist flexor roll-ups require a weight (3-8 lbs) be tied onto the center of a dowel. Hello, I had the Tommy John Procedure in July and am now 8 months through my recovery program. The next two months consist of building back your strength, mobility, and stability. The key is to move slowly and keep the shoulder and arm stable while only the forearm rotates for 3 sets x 15 reps. Bicep curls are a very familiar exercise for most athletes and gym goers, but to make this exercise more specific for baseball pitchers, it should be modified and performed in a pitching position. Hi Brendan, yes many throwers have a loss of extension, though some is transient from the forces observed with throwing. This is trainable, but it is difficult to do on your own. OK, sounds good, on the inside your UCL ligament is healed enough to throw in the doctor’s mind. Repeat for 3 sets x 15 reps, and then turn around so you can pull the band forwards. Knowledge is power, so in order to recover as best as possible, I want to education you on what I consider the keys to Tommy John rehabilitation. If you put in the proper effort and progression to date, you have put yourself in position to successfully deal with these events. This concludes our three part serious on avoiding Tommy John surgery, and I hope it was informative to learn the risk factors for medial ulnar collateral ligament injury, proper and improper pitching mechanics, and exercises pitchers can perform to strengthening the shoulder and elbow to help reduce the risk of injury. We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. Manual therapy here is key. Any restrictions or deficiencies in mobility, strength, or stability will cause an inefficient transfer of energy and often times your elbow takes that extra load. I have a question though, B-complex; what are the effects of this to our joints? You can check these in your browser security settings. External/internal rotation at 90/905. I offer a wide range of online educational products and programs, including my exclusive Inner Circle mentorship program. Pre Order Dr. Kevin Vandi's NEW Book: The Running Blueprint.

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