Return to Play After UCL Surgery
Rebuilding arm strength after UCL reconstruction (Tommy John surgery) requires a meticulously phased approach. Balancing tissue healing with progressive loading ensures optimal recovery and safe return to high-velocity throwing. This rehab plan integrates ROM work, resistance training, and structured throwing progressions to re-establish arm health and performance.
Rehab Phase Overview
| Phase | Goals | Timeframe |
|---|---|---|
| I. Protection & Healing | Protect graft; restore passive ROM | 0–4 weeks |
| II. Early Active ROM & Strength | Regain active flexion/extension; start rotator cuff activation | 5–8 weeks |
| III. Intermediate Strength | Build scapular stability; resisted rotations | 9–16 weeks |
| IV. Throwers’ Tenization (Late Strength) | Advance to dynamic and functional strength exercises | 17–24 weeks |
| V. Return to Throwing | Graduated throwing program; velocity build | 25–40 weeks |
Phase I: Protection & Healing (0–4 Weeks)
- Immobilization & Sling: Wear at all times except for exercises.
- Passive Range-of-Motion:
• Supine elbow flexion/extension with assistance: 3×10 reps.
• Wrist flexion/extension and pronation/supination w/ dowel: 3×15 reps. - Isometric Activation:
• Rhythmic stabilization for rotator cuff: 3×10 seconds holds (arm in neutral).
Phase II: Early Active ROM & Strength (5–8 Weeks)
| Exercise | Sets Ă— Reps | Focus |
|---|---|---|
| Active-assisted Flex/Ext | 3Ă—12 | Shoulder/elbow mobility |
| Scapular Retractions | 3Ă—15 | Rhomboids, middle traps |
| Isometric Rotations (ER/IR) | 3Ă—10 sec holds | Gentle rotator cuff activation |
| Light Resistance Bands | 3Ă—12 each | Internal/external rotation |
Begin unloaded or light band work to encourage controlled muscle activation without stressing graft.
Phase III: Intermediate Strength (9–16 Weeks)
- Progressive Resistance: Increase band tension or light dumbbells (1–3 lb).
- Scapular Stability Circuit:
• Prone “Y–T–I”s – 3×8 each.
• Standing Row with band – 3×12. - Rotational Core Integration:
• Half-Kneeling Woodchops – 3×8 each side.
• Pallof Press – 3×10 sec anti-rotation holds.
Focus on symmetry, ensuring no compensations or pain.
Phase IV: Throwers’ Tenization (17–24 Weeks)
Incorporate med-ball and plyo work to develop late-phase throwing strength:
| Drill | Sets Ă— Reps | Emphasis |
|---|---|---|
| Med-Ball Overhead Slam | 3Ă—6 | Eccentric control |
| Seated Rotational Toss | 4×8 each side | Hip–shoulder transfer |
| Plyometric Band Push-Pull | 3Ă—10 each | Dynamic cuff response |
| Elevated Plyo Push-Up | 3Ă—8 | Upper body explosive strength |
These drills prime the musculature for higher-load throwing.
Phase V: Return to Throwing (25–40 Weeks)
Follow a structured throwing progression, incrementing distance and intensity:
| Week Range | Distance | Intensity | Throws/Session | Frequency |
|---|---|---|---|---|
| 25–28 | 45 ft | 50% effort | 30 throws | 3× week |
| 29–32 | 60–90 ft | 60–75% effort | 40 throws | 3× week |
| 33–36 | 120 ft | 75–85% effort | 50 throws | 2× week |
| 37–40 | Mound | Full effort | 60–80 throws | 2× week |
Monitor pain and fatigue; if symptoms reappear, drop back one stage.
Objective Return Criteria
- ROM: Elbow and shoulder within 10% of contralateral side.
- Strength Tests: ER/IR strength ≥ 85% of contralateral.
- Velocity: Fastball velocity within 90% of pre-injury benchmark.
- Functional Test: Long toss ≥ 90% distance pain-free.
Meet all criteria before unrestricted mound work.
Key Takeaways
- Follow a five-phase protocol: Protection, Active ROM, Strength, Tenization, Throwing.
- Progress loading gradually, prioritizing form and symptom-free movement.
- Integrate rotator cuff, scapular, and core exercises before throwing.
- Use objective ROM, strength, and velocity benchmarks to guide transitions.
- Always regress if pain or compensatory movement patterns emerge.
Ready for a science-backed, phased return to the mound after UCL surgery?
Learn more → https://nextswingbaseball.com/return-to-play