An ulnar collateral ligament (UCL) reconstruction, colloquially termed
a Tommy John surgery (TJS), is a surgical graft procedure during which
the UCL in the medial elbow is replaced with a tendon from another part
of the patient’s body or the use of a tendon from the donated tissue
of a cadaver. The procedure was named after Tommy John, the first baseball
player to undergo the surgery. Many baseball players, particularly pitchers,
must receive treatment because they have partially or fully torn the UCL.
After MRIs are taken, and orthopedic surgeons are consulted, many players
opt for the Tommy John surgery to reconstruct their tendons. The next
12 to 18 months are dedicated to many hours of rehabilitation to build
strength and fully recover.
The recovery process is usually separated into 5 phases, though each athletic
trainer or physical therapist might have their own differences based on
individual experience and training. The first step is the
acute phase, which occurs immediately after surgery. This period will last from 1
to 2 weeks, during which the elbow is placed in a brace with no movement.
The arm will usually be at a 90-degree angle. An athlete can move his
or her wrist or shoulder, but the primary goal of this stage is to manage
pain, encourage healing, and maintain motion in the shoulder and wrist.
Next is the
early phase. This usually ranges from 2 weeks to 6 weeks after surgery. The goal here
is to gradually increase elbow movement, so the patient has full motion
by the end of the 6 weeks. Your physical therapist or athletic trainer
will use manual therapy or gradual stretching, range of motion exercises,
and increase the amount of the movement the brace allows. Pain control
is also important during this stage, as pain indicates a necessity for
less movement. The patient will do gentle shoulder, scapula, and wrist
exercises with an emphasis on regaining normal motion and protecting the
elbow. You may be required to wear a brace to protect your healing ligament
during this phase.
After the early phase is the
middle phase. This period will last from 6 to 18 weeks and will involve small increases
in the intensity of exercises, including cardiovascular, core stabilization,
and lower extremity. While protecting your elbow and avoiding stressing
the UCL, your therapist will have you exercise the shoulder and scapula.
They will also help you incorporate safe elbow motions. This stage and
future stages have very few elbow exercises and stretches, as the majority
of the work consists of strengthening the scapula, lower extremity, shoulder,
and core and increasing flexibility. Your therapist will also evaluate
movement and posture dysfunction and potential issues to determine what
factors led to the initial injury. Once the dysfunction has been identified,
they will help you address the issues, so it doesn’t become a problem
in the future.
The 4th phase is called the
throwing (long toss) phase. This usually begins at 18 to 24 weeks and lasts for 4 to 5 months. Depending
on your age and the advice of your surgeon, this period can often vary.
The stage involves throwing a ball 45 feet 30 times every other day. After
some progress, you can move to 45 feet for 50 times a day; this development
usually takes about 2 weeks. Every 2 to 3 weeks, it advances to 60 feet
and increases by 30-foot increments. The patient will improve long toss
to 100 throws with 25 of those throws at distances as much as 210 feet
for many professional, college, and some high school players. Even younger
pitchers should be able to long toss to 150 feet. Once sufficient throwing
strength is managed, and the pitcher is long tossing 5 days per week with
proper mechanics, he or she can move on to throwing from a mound. Be aware
this is not all smooth progress all the time. If you feel sore, you should
reduce your workload to only a couple of days. Keep in contact with your
therapist to ensure you are not damaging your healing tendon.
final phase happens at about 8 to 10 months. During this time, you will return to
pitching and throw from the mound. After enough long tosses to loosen
up, you will throw 20 to 25 pitch bullpens. You will add 5 pitches every
other practice time and throw 2 bullpens a week. You will also continue
to long toss 3 times per week in addition to the bullpens. Once you can
throw 40 to 45 pitch bullpens with no soreness, good mechanics, and near
normal velocity (usually around 5 to 6 weeks), you can throw a few sessions
facing hitters in batting practice (around 15 pitches in 1 inning and
adding 10 pitches in an outing). The goal is ultimately pitching in a
live game. However, you should not expect to throw at full strength in
a live game before 11 months to 1 year has passed. Younger pitchers may
take even longer to pitch at full strength. Each case is different and
should be evaluated according to different standards.
For more information about rehabilitation, or to get started with one of our
experienced Aberdeen physical therapists, call us at (732) 333-6360. Our dedicated team can help you improve your
range of motion, strength, and mobility following your surgery. ProFysio
Physical Therapy uses only the most advanced, state-of-the-art equipment
to help patients with their recovery. Each patient also receives individualized
attention and treatment, so we won’t provide a treatment that isn’t
tailored specifically to your case. Let us see what we can do for you.
Contact us today to request a free consultation with one of our team.