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By Mike Dodd, USA TODAY
BIRMINGHAM, Ala. — The operation takes about an hour, and the ensuing rehabilitation about a year.
When patients of James Andrews check in for Tommy John elbow surgery, they visit the adjacent HealthSouth Sports Medicine & Rehabilitation Center for an overview of their work ahead. The rehab regimen varies from team to team, doctor to doctor and with the patient's progress. But this is the basic schedule as outlined by Kevin E. Wilk, national director of research and clinical education for the center: • First five to seven days— Elbow immobilized at 90 degrees in a hard brace. Patients can move the hand and start light gripping exercises immediately. • Second week— Arm is in an adjustable brace that allows limited movement. Patients can begin everyday movements, such as using the arm to eat. Elbow extension is gradually increased, and the brace can be eliminated at four to six weeks. • Weeks three to eight— Emphasis on range of motion exercises for the elbow, plus isometric and light weights (dumbbells) for the shoulder. Heavier resistance to elbow work added at about eight weeks. • 10 weeks— Simulating a throwing-type motion with a medicine ball, making two-hand overhead lobs and chest passes. • 12 weeks— Can start to swing a golf club. • 12 to 14 weeks— One-hand throwing motion with a 1-pound medicine ball "to get the tissue used to these applied forces," Wilk says. • 16 weeks— Begin throwing program. Start on flat ground, with soft tosses from about 45 feet. About 25 tosses, rest, then 25 more. End workout. Throw every other day; distance and repetitions are repeated two or three workouts before being increased. Build to 150 to 180 feet. • Four to five months— Bowling permitted, slowly. • Six months— Begin to throw off mound. Start at about 50% speed/effort — no curveballs or specialty pitches — and gradually increase the number of pitches and intensity. • Seven months— Start throwing breaking balls, first from short distances on flat ground and with little torque. Build up intensity and distance gradually. • Eight to 10 months— Introduction to game conditions: batting practice, then a simulated game, then game at a lower level. • Eleven to 12 months— Return to competition. It often takes a full season of action before the pitcher returns to presurgery effectiveness. |
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