Hi guys, I’m Mai-Linh Dovan, Certified Athletic Therapist and Founder of Rehab-U Movement and Performance Therapy.
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In this week’s video, we’re going to talk about rehabbing the throwing elbow.
So I’m with Matt again (a pitcher who has undergone UCL reconstruction).
And I want to go through some of the stuff that we do typically, structurally for the elbow.
The first four or five, four to six weeks, post-surgery are really about recovering from the surgery and recovering range of motion and all that kind of stuff. And we went through other elements throughout the kinetic chain that we need to assess during that period to make sure that when Matt returns to throwing, he’s not getting excessive valgus stress at that. elbow.
That being said, there’s always a way to optimize what we typically do within the rehab process for the elbow. For example, we’re going to do a lot of mobility work, making sure that Matt gets his extension back, that kind of stuff. He’s done a really great job of that, he’s got good extension. What I find is always important, is to get athletes to do some homework at home and obviously, they’re going to be like soft tissue stuff in the forearms because he’s a little bit limited in his wrist range of motion initially, and all that kind of stuff. And in the clinic you can do, you know, manual therapy on that kind of stuff but I like to give athletes homework.
So, one of the things that we would do in the mobilization sequence for Matt, is give him tendon glides exercises. Now these exercises are interesting because they will mobilize the soft tissue, and they are also going to increase circulation, all kinds of things that the elbow needs right now. That gliding movement is also analgesic, and it’s very interesting to get all those tissues moving and reintegrate that function through the forearm.
So Matt’s going to show what those tendon glide exercises look like. We want to have the elbow supported and he’s gonna keep the wrist neutral the whole time, flexing the fingers, and then fingers into the hand. So that’s the first one. Just do a couple Matt.
Now, he would do essentially about eight of those and then the second one that he’ll do is with straight fingers and same thing, always keeping the wrist neutral and then fingers into the hand.
MAKE SURE TO WATCH THE FULL VIDEO TO SEE THESE EXERCISES IN DETAIL
So, those are exercises that he can do on his own that will help mobilize those tissues.
The other thing that we typically find in elbow rehab is all of the wrist flexion, extension, extension elbow flexion and extension exercises. Usually, starting with some pain free, submaximal isometrics, and then progressively moving to isotonics. So things like doing bicep curls.
Elbow flexion and extension exercises are going to be super important because those muscles cross the elbow joint and are important for strengthening the joints. The one thing that we should keep in mind as well though, is we’re trying to establish a solid structure, and what we need to go back to is our hypertrophy elements. We’re trying to strengthen the structure essentially. So let’s make sure that we do things under control.
A lot of the times these exercises are prescribed as the classic 3 sets of 10, with very little attention to tempo, for example. But what we want is time under tension so we can stimulate hypertrophy. We also want slow eccentrics, so we can work on deceleration, which is going to be an important aspect as we get more and more specific in his rehab to recreating the stresses of throwing.
So, just as an example, if you were just doing a bicep curl, I would make sure that I have him do a very slowly eccentric, so down in 5, 4, 3, 2, 1 and then up, right? So that will increase the time under tension for the number of repetitions that I’m doing. So he might have, like a two second concentric with a five second eccentric with one second pause between the eccentric and the concentric for his ten reps, which increases that time under tension. So at least we’re using hypertrophy parameters and we’re addressing strengthening the structure.
So that’s the kind of stuff that we would have in his activation phase.
Now, if we move to integration, again we want to start slowly preparing, not just the elbow, but also the shoulder for what is going to be like to accelerate and decelerate; what that throwing motion is going to require.
PNF patterns are really great for this. With PNF patterns, the most important cue to give the athlete is to lead with the thumb because there’s always a rotational component and he needs to start with that rotational component. So, he drives with the thumb first to bring the thumb towards the opposite hip. So there is proprioception involved, it’s multiplanar movement and it starts to prepare, like I said, not just the elbow for that kind of stress, but the shoulder complex for those deceleration, acceleration mechanics.
The second pattern is from the ground, so opposite movement, he’s starting thumb at the hip and then he comes up and out, always leading with the thumb as he comes up and as he releases back. And I call this one, taking the sword out. That’s the easiest way to remember that one. So leading with the thumb is the cue.
And so all this stuff is stuff that the athlete can do on his own. So there’s stuff you’re going to do in the clinic and then the more you can give the athlete to do on their own that provides the care that they need to have for the structure, is going to provide better outcomes because even if they’re coming into the clinic to see you twice a week, if they’re doing this kind of stuff on a daily basis, that’s going to contribute to having a much better quicker outcome for their rehab.
So there you have it guys, how we optimize what we typically do post-op for the structure, how we make that just a little bit better and how we give homework to our athletes, so they’re doing more.
