Rehabilitation Following a Tommy John Surgery

Rehabilitation Following a Tommy John Surgery

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.

The 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.

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