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:
  • Gripping
  • Scap Squeeze

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