Splint is worn for one week.
No valgus stress to the elbow.
Full active forearm pronation and supination ROM.
Full active wrist radial and ulnar deviation ROM. Gentle stretching of wrist and fingers is okay.
Active and active assistive wrist flexion and extension ROM exercises.
Full active shoulder ROM – flexion, abduction, internal and external rotation.

Discontinue splint at one week.
Sling may be worn for one more week, if necessary.
Two weeks post-operation, begin a Total Body Conditioning Program after incision is closed (starting earlier runs the risk of getting perspiration in or on the wound, increasing risk of infection).
Gradually achieve full elbow ROM.

Athlete should have full ROM at the elbow, wrist, forearm, and shoulder.
One month post-operation, add light weights for resistive elbow and forearm exercises (i.e. elbow flexion and extension, forearm pronation and supination).

Continue active, resistive exercises for the entire extremity, including the rotator cuff.
Continue lower body and trunk conditioning program.

If there is no swelling and the athlete has full, pain free elbow ROM at fourteen weeks post-operation, the athlete may begin easy tossing (no wind-up), start with 25-30 throws, building up to 70 throws and gradually increase the throwing distance.
Note: The Throwing Program is performed 3-4 times per week. Apply ice after each throwing session to help decrease the inflammatory response to microtrauma.

# of THROWS	DISTANCE (ft)
20	20 (warm-up phase)
25-40	30-40
10	20 (cool down phase)

Continue the Throwing Program by tossing the ball with an easy windup on alternate days.

# of THROWS	DISTANCE (ft)
10	20 (warm-up phase)
10	30-40
30-40	50
10	20-30 (cool down phase)

Continue increasing the throwing distance to a maximum of 60 feet.

Continue tossing the ball with an occasional throw at no more than half speed.

# of THROWS	DISTANCE (ft)
10	30 (warm-up phase)
10	40-45
30-40	60-70
10	30 (cool down phase)

During this step, gradually increase the distance to 150 feet maximum.

Phase 1

# of THROWS	DISTANCE (ft)
10	40 (warm-up phase)
10	50-60
15-20	70-80
10	50-60
10	40 (cool down phase)

Phase 2

# of THROWS	DISTANCE (ft)
10	40 (warm-up phase)
10	50-60
20-30	80-90
20	50-60
10	40 (cool down phase)

Phase 3

# of THROWS	DISTANCE (ft)
10	40 (warm-up phase)
10	60
15-20	100-110
20	60
10	40 (cool down phase)

Phase 4

# of THROWS	DISTANCE (ft)
10	40 (warm-up phase)
10	60
15-20	120-150
20	60
10	40 (cool down phase)

Progress to throwing off the mound and ½ to ¾ speed. Try to use proper body mechanics, especially when throwing off the mound.

Stay on top of the ball.
Keep the elbow up.
Throw over the top.
Follow through with the arm and trunk

Phase I

# of THROWS	DISTANCE (ft)
10	60 (warm-up phase))
10	120-150 (lobbing)
30	45 (off the mound)
10	60 (off the mound)
10	40 (cool down phase)

Phase II:

# of THROWS	DISTANCE (ft)
10	50 (warm-up phase)
10	120-150 (lobbing)
20	45 (off the mound)
20	60 (off the mound)
10	40 (cool down phase)

Phase III:

# of THROWS	DISTANCE (ft)
10	50 (warm-up phase)
10	60
10	120-150 (lobbing)
10	45 (off the mound)
30	60 (off the mound)
10	40 (cool down phase)

Phase IV:

# of THROWS	DISTANCE (ft)
10	50 (warm-up phase)
10	120-150 (lobbing)
10	45 (off the mound)
40-50	60 (off the mound)
10	40 (cool down phase)

At this time, if the pitcher has successfully completed the above phase without pain or discomfort and is throwing approximately ¾ speed, the pitching coach and trainer may allow the pitcher to proceed to the next step of “Up/Down Bullpens”. Up/Down Bullpens is used to simulate a game situation. The pitcher rests in between a series of pitches to reproduce the rest period in between innings.

Up/Down Bullpens: (1/2 – 3/4 speed)