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Phase I- Protective Phase (Weeks 0 – 3)
Goals:
- Protect healing tissues and minimize deleterious stresses
- Decrease pain, inflammation and swelling
- Gradual return of protected AROM
Week 1
- Brace: Functional Hinge Brace at 90° of elbow flexion
- Elbow Compression dressing for 2-3 days (post-cast removal)
- Exercises:
Week 2
- Brace: ROM set at 20° – 100°
- Exercises:
- Continue exercises listed above
- Initiate active elbow flexion and extension within brace limits
- Elbow PROM in brace
- Elbow extension isometrics
Week 3
- Brace: ROM set at 10° – 110°
- Exercises:
- Continue exercises listed above
- Elbow PROM in brace
- Initiate AROM wrist and elbow (no resistance)
Phase II – Intermediate Phase (4 – 8 Weeks)
Goals:
- Gradually increase ROM to attain FROM by week 4 - 6
- Promote healing of tissue
- Regain and improve muscular strength
Week 4
- Brace: Elbow ROM 0° -125°
- Exercises:
- Begin light bicep curls – 1 lbs
- Being wrist pronation/supination/flexion
- Cont elbow AROM flex/ext
- Shoulder Isotonics/T-band (NO ER until week 6)
Week 5
- Discontinue brace
- ROM: Elbow ROM 0° -135°
- Continue all exercises
Weeks 6 – 8
- ROM: Full ROM (0° -145°)
- Begin shoulder ER exercises to compliment existing shoulder/scapular exercises
- If needed – can being low-load stretching for elbow extension
Phase III – Advanced Strengthening Phase (Weeks 9 - 13)
Goals:
- Increase strength, power and endurance
- Gradually initiate sports activities
Weeks 9 - 16
- Progress isotonic program
- Begin isokinetic program for shoulder and elbow
- Begin plyometric program at week 11
- If baseball player - begin hitting at week 11
Phase IV – Return to Activity Phase (Weeks 16 – 26)
Goals:
- Gradual return to sport activities
- Continue stretching/strengthening program
Week 16
- Initiate throwing/interval sports program
Phase V – Return to sport (6 months)
- Return to mound program/positional play
Criteria for return to play:
- Physician approval
- Full, non-painful ROM
- Satisfactory strength test
- Satisfactory clinical exam
- Satisfactory completion of interval sport program
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