I. Initial Phase (Week 1)
Goals: Full wrist and elbow ROM Decrease swelling Decrease pain Prevent muscle atrophy Day of Surgery Posterior Splint to Elbow Joint for 5-7 days PROM wrist & hand
Post-op Day 1 and 2 Posterior Splint to elbow for 5-7 days Immediate post-op hand, wrist, and hand exercises Putty/grip strengthening Wrist flexor stretching Wrist extensor stretching Shoulder PROM – all directions Pendulum exercises
Post-op Day 3 through 7 PROM shoulder & wrist/hand Continue UE exercises Shoulder isometrics ER & IR Abduction, Flexion & extension Scapular strengthening (seated NM control drills with manual resistance) Hand gripping exercises
II. Acute Phase (Week 2-4)
Goals: Gradually restore Elbow Joint ROM Improve muscular strength and endurance Normalize joint arthrokinematics
Week 2: Discontinue posterior splint Progress to Elbow ROM brace (30-1100) … set Brace ROM 30-1100 Elbow AAROM/PROM exercises Initiate AROM elbow Initiate AROM shoulder joint Scapular strengthening exercises Progress to light isotonic strengthening at day 10
Week 3: Progress Elbow ROM to 10-1250 Initiate Thrower’s Ten Exercise Program Initiate Lower Extremity exercises Single leg squats (step downs) Leg press Wall squats Lateral slides Hip & core exercise Caution: no squats with olympic bar, clean & jerks, overhead presses, dead lifts, etc…
III. Intermediate Phase (Week 4-8)
Goals: Restore full Elbow ROM Progress UE strength Continue with functional progression Week 4: Progress Elbow ROM to 0-1450 Progress Thrower’s Ten Program Progress elbow & wrist strengthening exercises Week 6: Initiate 2 hand Plyometrics Discontinue brace at week 6 Week 8 Progress to 1 hand Plyometrics Initiate advanced thrower’s ten program Prone planks
IV. Advanced Phase
(Weeks 9-14)
*Criteria to progress to Advanced Phase: Full nonpainful ROM No pain or tenderness Isokinetic test that fulfills criteria to throw Satisfactory clinical exam Completion of rehab phases without difficulty Goals: Advanced strengthening exercises Initiate Interval Throwing Program Gradual return to throwing
Week 9: Continue all strengthening exercises Advanced thrower’s ten program Plyometrics program (1 & 2 hand program) Side planks for ER strengthening
Week: 10: Seated machine bench press Seated row machine
Week 11-16: Initiate Interval Throwing program week 11-12 (long toss program) Phase I Initiate Interval Hitting Program (week 10) Continue all exercises in week 9
Week 16-20: Initiate Interval Throwing Program Phase II (off mound program) Initiate mound throwing when athlete is ready & has completed ITP Phase I
V. Return to Play Phase weeks 16-24
Goal: Gradual return to competitive throwing Continue all exercises & stretches
Week 16: Initiate gradual return to competitive throwing Perform dynamic warm-ups & stretches Continue thrower’s ten program Return to competition when athlete is ready (Physician Decision)
Note: ** Each athlete may progress thru ITP at different rates/pace. Should complete 0-90 ft within 3 weeks of starting it & complete 150/180 ft within 8 weeks then begin mound program.
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