Most cases of ulnar collateral ligament replacement (UCLr, or “Tommy John” surgery) follow a fairly standard throwing program and rehabilitation program. A sample throwing program once cleared to throw looks something like this:
However, not all athletes respond to such a conservative program. It is also our opinion that touching a baseball should show up significantly later in the “throwing program” than what most PT and MDs recommend. For example, in weeks 1-3, many of our athletes will never touch a baseball and instead will do primarily negative/reverse throwing with Driveline PlyoCare Balls. Furthermore, they will generally NOT throw balls at the regulation weight – 5 oz. Their first throws will often be with an overload ball (8 oz) at very low intensities to “feel” the motor patterns they should be building. Touching a baseball and throwing it brings back hundreds of thousands of reps and feelings from throwing a baseball, which is hard to change. This psychological connection is meaningful and is often overlooked!
Here’s an example of the intent with an 8 oz. ball for the first week of throwing:
Specific Case – Ex-Pro Tennis Player
Jeff is a converted ex-pro tennis player (now pitcher) who had an unsuccessful rehabilitation from UCLr. While the surgery left his elbow stable, he lost gross amounts of shoulder external rotation, has nagging biceps irritation, and lost massive ball velocity, going from 88-90 to 78-81 despite completing a full throwing program similar to the one above in this post.
He felt rehab was not specific enough to traits that were not common in baseball pitchers, like increased hypertrophy of the upper arm that is seen in tennis players.
In cases where pitchers who can still throw with significant ball velocity (80+ MPH) and have serious loss of static external rotation (ER), we will do manual therapy to stretch them into that position. While this is usually NOT RECOMMENDED (I cannot stress this enough), research does support the idea that a large deficit of dynamic ER vs. static ER could be linked with medial elbow pain/injury:
ER and MER in throwing, and the ratio of the MER to the ER were compared between high school baseball players with and without a history of throwing elbow injuries. The elbow-injured group demonstrated significantly greater ratio of MER to ER than that in the control group. This finding suggests that the throwing mechanics that is characterized by great MER in relation to ER could be associated with medial elbow pain in high school baseball players. (The Role of Shoulder Maximum External Rotation During Throwing for Elbow Injury Prevention in Baseball Players, Miyashita et. al. JSSM 2008)
Here’s a day in the life of Jeff rehabbing at Driveline Baseball in his new program. Not shown is the movement prep and PlyoCare throwing circuit he uses to “warm up” prior to flat ground throwing: