After Tommy John Rehab, Take These Steps
Article printed in Jan. 4, 2013 edition of Collegiate Baseball

Special To Collegiate Baseball

LOS ANGELES ó Elbow and shoulder injuries are taking place at an epidemic rate in baseball.

After surgery is performed, the pitcher is put on a rehab program which takes months to complete depending on the surgery. This is typically the point in which a pitcher has built up his throwing distance to 120-180 feet and is now ready to return to normal baseball activity under the guidance of a coach.

While great care is used in the rehab program to get the pitcher to this point, what does the pitcher do now? Physicians and trainers usually sign off on the pitcher at this stage as coaches take over.

All too often the pitcher believes that he is ready to throw off a mound at this point, and another injury takes place. It is common for pitchers who undergo Tommy John elbow surgery to suffer from shoulder pain at this juncture. The fact of the matter is that a pitcher should not get near a mound until he has finished a "post rehab" throwing program.

Throwing off a mound after rehab has become the new "normal" because it is consistent with the format that has been established by the medical community for the past 30 years or so.

And this makes sense on some level because 120-180 feet became the new normal for healthy arms. So it would follow that once the rehab was completed, it essentially doubled for the training too, and it would make sense for a pitcher to begin his mound work. The problem is that a very important stage was skipped ó the "post-rehab" training.

When players have been referred to us, post-rehab, we donít let them get near a mound until they get into what we call post-rehab shape. In short, rehab does a great job of building the pitchers base, but there needs to be a lot more stacking of the base until the arm is ready for the more demanding effects of throwing off a mound.

This training phase may take an additional 3-4 weeks of arm conditioning/long toss before we would want a pitcher near a mound. This window of training between rehab and mound work is critical and often misunderstood for pitchers who have completed the rehab program and think they are ready to get on a mound.

Pitchers simply must go through another phase of training and conditioning/long toss prior to getting on a mound if they truly want their arm to have the best chance possible to be healthy, strong, durable and have ideal recovery period.

And this is a critical component of maintaining health once they return to the mound. This can be especially important for pitchers who have gone through Tommy John surgery to keep in mind.

The emphasis during rehab may focus so much on the elbow that the shoulder needs extra attention once the post-rehab, conditioning phase begins.

Naturally, this phase will be different for everyone. But it is critical that a pitcher first goes through this next phase of training before getting on a mound. Unfortunately, many of the rehab programs that cap out at 120-180 feet will also begin to integrate bull-pens along the way (usually toward the end of the rehab program.

For a pitcher that never threw beyond 180 feet, it would then make sense to continue with the protocol laid out by the rehab program. However, if you were a long toss pitcher prior to surgery, then itís important to first stretch your arm out to distances that are probably similar to pre-surgery distances. However, only stretch your arm out to distances that are comfortable. You may find that you donít initially get out as far as you did pre-surgery.

That may not be unusual, but perhaps youíll get back to that distance a year or two down the road. A couple of respected doctors/trainers I spoke with suggest that it may not be ideal to long toss out to pre-surgery distances, especially following shoulder surgery rehab.

Regardless, the arm should feel good as you gradually build up to your furthest distance over time. If you do this right, it should actually feel like a massage to the arm and shoulder.

Thatís a sign that you are adding distance and workload (reps) at the right pace. You should also notice that your recovery period is getting significantly better. Otherwise, back off and return back to your distance/workload from the previous day when there wasnĎt a problem with how your arm felt or recovery period. Eventually, once you find that you are reaching your maximum distance (this occurs when you have a number of throwing sessions in a row and your maximum distance is basically the same) you are ready to come back into your partner in a more explosive way, "downhill."

The first two weeks or so is to simply stretch the arm out to post-rehab distances by throwing with arc as you move away from your throwing partner. This second phase, or what we call the "pull down" phase, is a sign that your arm is not only completely stretched out and well conditioned, but itís ready for aggressive throwing on flat ground.

Once you can repeat this process of getting out to your furthest distance and pulling down at least three days a week with a great recovery period, you are now ready to get on a mound.

Again, itís a process of listening to the arm each day, allowing distance and quantity of throws to come naturally. It should feel good to the arm, or else, simply back off. The message is clear. Stay away from a mound until your arm has been best positioned to open up (extended) to further distances then your rehab protocol, and your quantity of throws (workload) has increased a great deal as well.

Thus, donít just focus on extending your distance each day. Focus as much, or even more, on building up your workload (quantity of throws).

For more information about how we build up an arm, visit:

More Information: In-depth articles on arm care have been printed in the Sept 6 and Oct. 4, 2012 issues of Collegiate Baseball. To obtain a copy of these superb articles written by Alan Jaeger, call us at (520) 623-4530 M-F from 8 a.m.-5 p.m. Mountain Time.

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