UCL Tears
Maturation and Remodeling Phase
The maturation and remodeling phase focuses on realignment of the collagen fibers that make up scar tissue around the injured site. With increased stress to the area the collagen fibers realign in a position of maximal efficiency, parallel to the lines of tension. Wolff's law states that bone and soft tissue will respond to the demands placed upon them. Tissue will gradually assume normal appearance and function through demands placed upon the area, although scar tissue is not as strong as original tissue. This phase can last for years after the injury occurs.
At weeks 12-16 the patient should begin plyometric exercises and throwing motions. Valgus stresses can now be placed on the medial aspect of the elbow in respect to exercise. Appropriate progression is critical when dealing with plyometric exercises and potential valgus stressors of the elbow. Plyometric exercises should being with basic plyometric exercises being demostrated and explained appropriately. Begin plyometrics at week 12 and progress into throwing motions. Throwing motions should first begin with two hands at 14 weeks and progress to one hand at 16 weeks. This can now include a seperate interval throwin program. Pitchers or other throwing athletes can being high velocity throwing typically around 20-22 weeks post-surgery, and progress until return to play criteria is met.
Goals for this phase of rehabilitation include: agility and functional/coordinated movements, along with maintaining cardiovascular fitness.
Rehabiliaton exercises for this phase include:
Push ups
Patient performs isotonic push-ups against gravity. Patient starts in a prone position with elbows at 90 degree horizonal abduction, feet are placed firmly on the ground. Patient then exerts force from the chest and arms to propell oneself upward off of the ground. This exercise can be progressed into uneven surfaces, added resistance, hands leaving the ground with a quick eccentric load followed by an explosive concentric contraction.
Medicine ball plyometrics
Patient performs a plyometric exercise by throwing and catching a medicine ball. The patient is supine with a medicine ball on their chest. Patient performs a quick concentric contraction with both arms to propell the medicine ball upward and catch the medicine ball allowing for a eccentric contraction, again followed by a quick concentric. This can also be done standing and passing the ball forward or sideways. This is repeated for desired number of repititions.
Throwing drills
This exercise is dependant upon patient's sport or life-style. Patients involved in baseball will go through throwing and catching motions of a single arm. Begin with basic throwing motion with a light weigh and similar sized ball (compared to a baseball) and begin playing catch with the health care provider. Exercise can be progressed with throwing of an actual baseball or object appropriate to ones sport, the volume of throws, and intensity of each throw.
Rope exercises
Using weight ropes, move them in a variety of waves. You can move both arms together, one at a time, alternating, move up and down, move side to side, or in circles.
Elbow Joint Mobilizations
If your athlete is still suffering from a lack of range of motion, he or she may benefit from joint mobilizations.
Joint mobilization grades:
Grade 1: A small-amplitude movement at the begining of the range of motion. Used for when pain and spasm limit early range of motion.
Grade 2: A large-amplitude movement within the middle of range of motion, a quick oscillation followed by a slow oscillation. Used when spasm limits movement.
Grade 3: A large-amplitude movement towards the end range of motion or pathological point of limitation. Used when pain, spasm, inert tissue tension or compression of surrounding tissues limit end range of motion.
Grade 4: A small-amplitude movement at the end range of motion. Used in the absence of pain when resistance limits range of motion.
Grade 5: A small-amplitude, quick thrust movement at the end of the range of motion, usually associated with a popping sensation. This is known as manipulation and requires additional training and certification to perform on a patient.
Short term goals: Gain back full agility and coordination for sports activities and daily living.
Long term goals: Return to play 100%