Tommy John Rehabilitation

August 13, 2018

Introduction

The ulnar collateral ligament reconstruction is a tendon transfer procedure. No muscles are transected during this process which allows for a faster recovery time since there is less surgical trauma. Postoperatively, the body requires time to accept the transfer and establish adequate blood supply in the new tissue. The focus of this rehabilitation program is to provide gradually increasing stresses on the transferred material to allow the tendon to adapt to the forces the ulnar collateral ligament would typically withstand. According to Wolff’s Law, the strength of the tissues matrix is directly proportional to the stresses place upon them during their development.

Approximately one year is needed for the transferred tissues to assume their new functions completely. The patient tends to protect and compensate for their limited ability which promotes dysfunction of the upper extremity as a whole; therefore, it is important to address the function of the should girdle (i.e., scapulothoracic, glenohumeral, and acromioclavicaluar joints), along with the return of full elbow function (i.e., range of motion, strength and endurance).

In general, avoid any valgus stress during the rehabilitation period until actual pitching starts. Many athletes wish to resume playing golf during their rehabilitation period but valgus forces are not permitted. Putting is allowed, as is chipping, as advised by your physician. No drives are allowed for six months. Before this time, hitting a divot may pull out the repair altogether.

0 to 7 days:

• Splint is work for one week.
• No valgus stress to the elbow.
• Full active forearm pronation and supination range of motion.
• Full active wrist radial and ulnar deviation range of motion. Gentle stretching of write and fingers is okay.
• Active and active assistive wrist flexion and extension range of motion exercises.
• Full active should range of motion – flexion, abduction, internal & external rotation.

1 to 4 weeks:

• Discontinue splint in one week.
• A 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, you run the risk of getting perspiration in or on the wound, increasing the risk of infection).
• Gradually achieve full elbow range of motion.

1 to 2 months:

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

2 to 3 months:

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

3 to 4 months:

• If there is no swelling and the athlete has full, pain free elbow range of motion, the athlete may begin easy tossing (no wind-up), start with 25 to 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.

4 to 5 months:

• Continue the Throwing Program by tossing the ball with an easy wind-up on alternate days.

5 to 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.

6 to 7 months:

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

7 to 8 months:

• Progress to throwing off the mound at 1/2 to 3/4 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.

9 to 10 months:

• At this time, if the if the pitcher has successfully completed the above phase without pain or discomfort and is throwing approximately 3/4 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.

9 to12months:

• At this point, the pitcher is ready to begin a normal routine, from throwing batting practice to pitching in the bullpen. This program should be adjusted as needed by your physician, athletic trainer or physical therapist.