Long Term Goals:
Full Elbow, Wrist, Shoulder Range of Motion Week 6 Pain free ROM UE Performing Shoulder, Arm & Entire Body Strengthening Program Improving Entire Body Strength & Flexibility Return to Unrestricted Throwing
I. Initial Phase: (Week 1)
Goals: Full wrist ROM Decrease swelling Decrease pain Prevent muscle atrophy
Day of Surgery	ROM Brace locked at 70 degrees to Elbow Joint for 7 days PROM wrist & hand
Post op Day 1 and 2	Locked ROM Brace at 70 degrees flexion for 7 days Immediate post-op hand, wrist, and hand exercises Putty/grip strengthening Wrist flexor stretching Wrist extensor stretching Shoulder PROM – all directions Pendulum exercises
Post-op Day 3 through 7	PROM shoulder & wrist/hand ER/IR PROM exercises Shoulder flexion to tolerance Active scapular protraction/retraction & elev/depress seated in brace Continue above exercises Shoulder isometrics ER & IR Abduction, Flexion & extension Scapular strengthening (seated NM control drills with manual resistance) Hand gripping exercises
II. Acute Phase (Week 2-4)
Goals: Gradually restore Elbow Joint ROM Improve muscular strength and endurance Normalize joint arthrokinematics
Week 2, Day 8:	Begin PROM & AAROM Elbow ROM 30-1100 Progress to Elbow ROM brace (30-1100) Elbow AAROM/PROM exercises
	Initiate AROM elbow Initiate AROM shoulder joint Scapular strengthening exercises Progress to light isotonic strengthening at day 10
Beginning Week 3:	Progress Elbow ROM to 10-1250
	Initiate Thrower’s Ten Exercise Program (day 15)
III. Intermediate Phase: (Week 4-8)
Goals: Restore full Elbow ROM Progress UE strength Continue with functional progression
Week 4-6:	Progress Elbow ROM to 0-1450
	Progress to Advanced Thrower’s Ten Program Progress elbow & wrist strengthening exercises Manual resistance wrist flexion & elbow flexion movements against manual resistance Wrist & Forearm strengthening – dumbbell
Beginning Week 7:	Discontinue brace at end of week 6 Initiate 2 hand plyometric throws Prone planks Side plank on uninvolved side &ER on throwing side
Week 8:	Continue with advanced thrower’s ten program Side planks with ER strengthening
IV. Advanced Phase: (Weeks 9-14)
*Criteria to progress to Advanced Phase: Full nonpainful ROM No pain or tenderness Isokinetic test that fulfills criteria to throw Satisfactory clinical exam Completion of rehab phases without difficulty
Goals: Advanced strengthening exercises Initiate Interval Throwing Program Gradual return to throwing
Beginning Week 9:	Continue all strengthening exercises Initiate 1 hand plyometric throws Advanced thrower’s ten program Plyometrics program (1 & 2 hand program)
Beginning Week 10:	Seated machine bench press Initiate Interval Hitting Program (week10) Seated rowing machine Progress Biceps (dumbbell) strengthening Progress Triceps pushdowns
Beginning Week 11-16:	Initiate Interval Throwing program week 12 (Long toss program) Phase I Continue all exercises as in week 9 – 10
Beginning Week 16-20:	Initiate Interval Throwing Program Phase II (Off mound program) Initiate mound throwing when athlete is ready & completed ITP Phase I -Continue Advanced Thrower 10 exercise program -Continue plyometrics -Continue ROM & Stretching programs
V. Return to Play Phase: (weeks 20 >):
Goal: Gradual return to competitive throwing Continue all exercises & stretches
Week 20-24>:	Initiate gradual return to competitive throwing Perform dynamic warm-ups & stretches Continue thrower’s ten program Return to competition when athlete is ready (Physician Decision)