Elbow UCL Reconstruction Rehabilitation Program

0-7 DAYS

  • 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.

1-4 WEEKS

  • 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.

1-2 MONTHS

  • 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).

2-3 Months

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

3-4 MONTHS

  • 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)

4-5 MONTHS

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)

5-6 MONTHS

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)

6-7 MONTHS

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)

7-8 MONTHS

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)

9-10 MONTHS

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)

Day 1

# of THROWS DISTANCE (ft)
10 warm up 120-150 (lobbing)
10 warm up 60 (off the mound)
40 pitches 60 (off the mound)
REST 10 MINUTES
20 pitches 60 (off the mound)

Day 2

Off

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