The Rehabilitation of Elbow Ulnar Collateral Ligament Injuries In Baseball Pitchers

Elbow ulnar collateral ligament (UCL) injuries are common in baseball. Despite the identification of several modifiable risk factors, elbow UCL reconstruction surgeries have become increasingly more common.

Recent research has shown that up to 25% of all current Major League and 15% of Minor League pitchers have already undergone at least one UCL reconstruction procedure. Even more alarming, elbow UCL reconstruction surgeries have increased by 343% in adolescent baseball players between the ages of 15-19 years old, with this population now representing about 60% of all UCL reconstruction surgeries performed in the United States. UCL reconstruction surgeries also represent a significant amount of time lost from sport, with the average return to play between 15-18 months post-surgery.

While overall return to play statistics have demonstrated that UCL reconstruction surgeries have good to excellent results, studies have shown that only 67% of pitchers that undergo the procedure return to play at the same level of competition or above, with over 25% of these pitchers returning to the injured list at some point in their career secondary to recurrent elbow pain.

Although elbow UCL reconstruction and repair surgeries have become more common, variation in post- operative protocols and return to play interval throwing programs still exist. This presentation will focus on some of the current rehabilitation strategies that physical therapists utilize during post-operative elbow UCL reconstruction rehab, including total body kinetic chain exercises, neuromuscular re-education interventions, and sport specific plyometric exercises to improve return to play outcomes and decrease the risk of re-injury. In addition, workload considerations, and key performance indicators for interval throwing programs to help physical therapists progress pitchers from flat ground throwing to pitching off the mound will also be discussed.

In recent years, several programs designed to help mitigate the risk of elbow UCL injury in adolescent baseball pitchers, including the PitchSmart Guidelines and arm care programs have been introduced. The presentation will conclude with a discussion on the role that physical therapists can play on community health education to help decrease the prevalence of elbow UCL injuries in the future.

Upon completion of this session, the attendee will be able to - 

• Identify three risk factors associated with elbow UCL injuries in baseball pitchers.
• Demonstrate three interventions that can be utilized in the rehabilitation of post-operative elbow UCL injuries prior to beginning a return to play throwing program.
• Identify the throwing distance a baseball pitcher should achieve during flat ground long toss before progressing to throwing off the mound.