Physical Therapy for Pitcher’s Elbow
Pitcher’s elbow, an injury to the ulnar collateral ligament (UCL), is caused by repetitive motion and stress on the elbow that results in pain and limits elbow range of motion and strength. Pitcher’s elbow is common among overhead throwing athletes like baseball pitchers, softball and tennis players, and javelin throwers. Physical therapy can effectively treat UCL injury, improving arm and elbow strength and range of motion and enhancing shoulder and core stability for a safe return to sport.
What is Pitcher’s Elbow?
Pitcher’s elbow, an injury to the ulnar collateral ligament (UCL) of the elbow, is often caused by repetitive motion and stress at the elbow, resulting in the pulling and stretching of the UCL and causing pain, swelling, and reduced elbow range of motion.
The UCL complex is a band of tissue located on the inside of the elbow, consisting of three bands: the anterior bundle which plays a key role in elbow stabilization, the posterior bundle which acts as a backup stabilizer when the elbow flexes beyond 90 degrees, and the transverse bundle. The UCL connects the inside of the upper arm (humerus) to the inside of the forearm (ulna). The UCL helps support and stabilize the arm and elbow when throwing.
There are two main causes of UCL injury: 1) repetitive stress that occurs over an extended period of time that causes gradual stretching of the ligament or degradation of the tissue due to repeated force across the elbow joint, often due to excessive overhead throwing; left untreated this can lead to a tear of the UCL; or 2) acute trauma from a collision or sudden force that causes rupture of the UCL.
Common symptoms of Pitcher’s Elbow (UCL Injury):
Soreness or tightness along the inside of the elbow
Minor swelling or bruising along the inside of the arm
Numbness and tingling in the arm
Instability in the elbow joint (feeling that the elbow might give out when performing certain motions)
Pain when using the arm in an overhead position like throwing or pitching a ball or swinging a racquet
Reduced pitching speed
Feeling of a pop after throwing followed by intense pain
Athletes most at risk of developing acute UCL injury are gymnasts, cheerleaders, soccer players, and wrestlers due to a sudden fall. Athletes most at risk of developing a repetitive stress UCL injury are baseball, softball, tennis, and javelin thrower players. Baseball players are at heightened risk of UCL injuries, particularly pitcher’s due to the high stress placed on the elbow during repetitive overhead throwing. UCL injuries have increased significantly over the last 10 to 15 years, likely related to year-round baseball and sports playing by younger athletes.
Risk factors for UCL injury include:
Age: Younger players between ages 9 to 14 are at greater risk of injury due to still growing joints, bones, ligaments, and growth plates. Older athletes also may have a reduced ability to recover after activity, contributing to overuse injury.
Overuse: Pitching too many games without sufficient rest and recovery can lead to pitcher’s elbow.
Throwing curveballs: Throwing curveballs and breaking pitches places additional stress on the arm and elbow and should be limited in young players.
Improper pitching technique: Incorrect pitching technique places too much stress on the elbow and arm, leading to injury.
Certain sports: Sports that place forceful repetitive stress on the elbow such as baseball, softball, golf, tennis, gymnastics, football, wrestling, cheerleading, and javelin throwing.
Physical Therapy for Pitcher’s Elbow and UCL Injury
Physical therapy can effectively treat UCL injury, improving arm and elbow strength and range of motion and enhancing shoulder and core stability for a safe return to sport. Physical therapists work with athletes both before and after surgery, should surgery be necessary.
Surgery is completed for severe injuries such as a full UCL tear and in high demand overhead athletes. Surgery involves UCL reconstruction, or Tommy John surgery (named for the Los Angeles Dodgers pitcher who first underwent this surgery in 1974). UCL reconstruction surgery involves using a tendon from somewhere else in the body or from a donor to serve as the new UCL. Physical therapy after surgery is essential to regain function, strength, and mobility. Rehabilitation can take from 9 months to a year for a full recovery and return to sport.
Physical therapy for UCL injury involves three phases. The first phase involves reducing inflammation and gently restoring the range of motion to the elbow. The second phase shifts to progressive muscle strengthening and endurance of the arm and shoulder as well as of the core, hips, and lower extremity. The final phase involves a gradual return to sport program to rehabilitate the UCL and progressively load the ligament to prepare for a return to competition.
Physical therapy treatment for UCL injury can include:
Pain management using various modalities: ice, ultrasound, or electrical stimulation
Stretching of the shoulder and range of motion exercises to decrease stress on the elbow when performing overhead motions
Targeted strengthening of the muscles of the shoulder, upper back, shoulder blades, and forearm to decrease stress on the elbow joint and stabilize the injured elbow
Strengthening of the core and hips and lower body to address muscle deficits that may have contributed to the injury and to enhance the kinetic chain for improved pitching and throwing
Manual therapy soft tissue mobilizations to restore mobility and range of motion in the elbow
Throwing analysis to assess throwing motion and make adjustments to improve technique
Functional training and a return to sport protocol
As the athlete nears the end of rehabilitation, the physical therapist implements a progressive functional exercise and interval throwing system to simulate sport-specific motions and gradually load the UCL to strengthen it and prepare for a return to competition. One aspect of functional training includes plyometric ball throwing to increase the athlete’s dynamic stability and endurance that is needed with overhead throwing.
The physical therapist then progresses the athlete to a return to sport protocol that involves a thrower’s assessment—a battery of dynamic elbow and shoulder mobility tests that are designed to provide objective measures to monitor the athlete’s strength, mobility, and ability to throw and pitch effectively and ensure a safe return to sport.
Are you a baseball player or pitcher that is experiencing significant elbow pain and loss of function due to repetitive throwing and pitching? Our physical therapists are here to help you regain strength and power in your throw and pitch and successfully return to competition!
