Rehabilitation of the Overhead Athlete's Elbow

Kevin E Wilk, Leonard C Macrina, E Lyle Cain, Jeffrey R Dugas, James R Andrews, Kevin E Wilk, Leonard C Macrina, E Lyle Cain, Jeffrey R Dugas, James R Andrews

Abstract

The activities required during overhead sports, particularly during baseball pitching, produce large forces at the elbow joint. Injuries to the elbow joint frequently occur in the overhead athlete because of the large amount of forces observed during the act of throwing, playing tennis, or playing golf. Injuries may result because of repetitive overuse, leading to tissue failure. Rehabilitation following injury or surgery to the throwing elbow is vital to fully restore normal function and return the athlete to competition as quickly and safely as possible. Rehabilitation of the elbow, whether following injury or postsurgical, must follow a progressive and sequential order, building on the previous phase, to ensure that healing tissues are not compromised. Emphasis is placed on restoring full motion, muscular strength, and neuromuscular control while gradually applying loads to healing tissue. In addition, when one is creating a rehabilitation plan for athletes, it is imperative to treat the entire upper extremity, core, and legs to create and dissipate the forces generated at each joint.

Figures

Figure 1.
Figure 1.
A low-load, long-duration stretch into elbow extension is performed using light resistance. The shoulder is internally rotated while the forearm is pronated to best isolate and maximize the stretch on the elbow joint.
Figure 2.
Figure 2.
(a) Joint Active System (JAS, Effingham, Illinois) and (b) Dynasplint (Severna Park, Maryland) are 2 commercial devices commonly used by patients at home to work on elbow extension range of motion.
Figure 3.
Figure 3.
Manual concentric and eccentric resistance exercises for the elbow flexors and wrist flexor-pronators.
Figure 4.
Figure 4.
Advanced Thrower’s Ten: Full can raises with sustained holds while seated on a stability ball.
Figure 5.
Figure 5.
Advanced Thrower’s Ten: Prone horizontal abduction on a stability ball while performing sustained holds.
Figure 6.
Figure 6.
External rotation at 0° abduction with exercise tubing, manual resistance, and rhythmic stabilizations while the athlete is seated on a stability ball.
Figure 7.
Figure 7.
Plyometric wall throws with a 2-lb (0.91 kg) ball while the rehabilitation specialist performs a rhythmic stabilization at end range.
Figure 8.
Figure 8.
Plyometric wrist flips using a 2-lb (0.91 kg) medicine ball to strengthen the wrist flexors.
Figure 9.
Figure 9.
Hinged elbow brace utilized postoperatively to protect the graft from deleterious valgus stresses

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