Rehabilitation after medial ligament reconstruction – throwers
Author: Tanya Anne Mackenzie, Manchester Shoulder Clinic
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All advice is general and you are advised to consult with your own physiotherapist and coach before undertaking any exercises.
Phase 1 | Maximum Protection (0 to 14 Days) |
Aims | Protect healing tissue
Decrease pain and inflammation Prevent muscle atrophy Initiate elbow ROM |
Precautions | Avoid valgus force or position during exercises
ROM exercises are gentle active or active assisted. No shoulder external rotation |
Treatment | Week one
Week two
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Phase 2 | Active Range of Motion and Early strengthening (2 – 6 weeks). |
Aims | Gradually increase elbow ROM
Protect repair Introduce shoulder girdle function Regain and improve muscular strength as a secondary goal Scar tissue management and scar mobility |
Precautions | Avoid valgus force or position during exercises
ROM exercises are gentle active or active assisted. Avoid passive and resisted shoulder ER until 6 weeks. |
Treatment | Week 3
Weeks 4 to 5
Weeks 5 to 6
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Other |
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Phase 3 | Strengthening Phase (6 – 10 weeks) |
Aims | Increase strength power and endurance
Maintain full elbow ROM Gradually initiate sport activity |
Precautions | There should be no pain on doing the strength exercises. Post exercise soreness should be mild and relived within a few hours of stopping exercises |
Treatment | Weeks 6 to 8
Week 8-10 Concentric and eccentric biceps and triceps Stabilisation of wrist flex/pronators Isotonic forearm and wrist program Shoulder program introduce resisted shoulder external rotation Evaluate upper limb ANT and restore normal neurodynamics Scapular muscle function Initiate plyometrics starting with 2 hand drills close to the body-chest and side throw Week 9: Diagonal PNF patterns, shoulder rotations in neutral and in abduction and scaption, Scapular retractors, posterior tilt, and upward rotation with resistance. Introduce upper limb weight bearing into isometric holds in the press up and push up positions. |
Other | Week 11 onwards: Can start to swim, and walking, stationary bike with brace off. Continue to avoid running or jumping |
Phase 4 | Advanced Strengthening (12 16 weeks) |
Precautions | There should be no pain on doing the strength exercises. Post exercise soreness should be mild and relived within a few hours of stopping exercises.
Control the speed of the movements carefully |
Treatment |
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Other – throwers | Initiate plyometrics starting with 2 hand drills first further from the body
Start slow motion air throws Running and sprinting can be introduced gradually.(50%-75% speed) Start hand wall dribbles |
Phase 5 | Interval throwing Program (16- 20 weeks) |
Aims | Increase strength and power and endurance of upper limb musculature |
precaution | There should be no pain on throwing. If there is soreness after throwing it should be mild and subside within a few hours. |
Treatment | Gradual return to sport program
Week 16: running allowed but monitor environment to minimise falls. |
Guide | Return to full work capacity and competitive throwing from 28 weeks |