July 2, 2009 | 
Author I figured I would write a post of milestones of post-surgical activities, as that is a pretty common question people have. I asked other guys all the time when they could do this or that, so here you go. Some of these I can’t remember exactly, so bear with me.
Out of sling: 2 days
Stopped taking painkillers: 1 day
Started forearm rehab: 1 week
Full Range of motion: 3 weeksIncision closed: 3 weeks
Forearm stopped being sore while performing rehab: 2 weeks
Surgical elbow moved like it used to: 8 weeks
No swelling: 3-4 weeks
Start strength training: 6 weeks
Start shoulder prehab: 4 weeks
Start running: 3 weeks
Do full pushup: 8 weeks
Full Chin-up (without soreness): 7 months
Could hold a 50lb dumbbell without any soreness: 16 weeks
Start throwing: 12 weeks
Throw off mound: 6 months
70mph: 7 months
80mph: 7.5 months
90mph: 9.5 month
Full-out long toss: 8.5 months
Start changeups: 7 months
Start curveballs: 8.5 months
100% fastballs: 8.5 months
100% changeups: 8.5 months
100% curveballs: 9.5 months
Curveball actually starts to break: 10 months
Pitched in game: 9.5 months
Cleared by doctor forever: 10 months
Threw back-to-back days: 10 months
Velocity all back: 11.5 months
I enjoy reading your blog. My son had TJ surgery recently (June 10). He is going to be a junior in high school this fall and also plays basketball. I was wondering at what point you could shoot a basketball.
You mention that you have done quite abit of running during your rehab . Could you give more detail on you running program and also your strength training.
Great blog, Dan. My 18 year old son had TJ surgery yesterday. After reading all the online articles about rehab, none seem to have a step by step program for pitchers. My fear is that he’ll be going to some kind of multipurpose rehab clinic and be doing some general stretching and strengthening exercises – not related specifically to baseball pitchers. Do you know of any material we can get that will provide a sound, structured rehab and overall conditioning program for pitchers?
Tom- As far as I know, there is no aftermarket rehab program out there. There are a few pitchers’ conditioning programs, though I have only read through Tom House and Dick Mills’ work, neither of which I recommend for strength training. Steve Ellis has a program called Tuff Cuff, though I have not read it, and can’t say whether or not it’s worthwhile. In general I find the programs out there, even from experts like House and Mills, coddle the pitcher as if he were a fragile newborn. I am currently working with a fellow trainer/ballplayer on our own program, designed to train pitchers into strong, durable athletes, but that is still in development.
What has your son’s doctor given you? He should have a program for him overviewing rehab and detailing throwing. The people who will fill in the gaps (strength, conditioning, pitcher-specificity) are going to be physical therapists, personal trainers, coaches, and people like myself who have been through it and know training. Try to find someone local who knows baseball training, or a therapist who has seen the surgery before. If you can’t don’t worry too much, because the rehab isn’t that complex, and any therapist who knows the human body well should be able to rehab him to 100%.
The problem is that the cutting edge training for pitchers is more or less scattered, and one thing I’m trying to do in my blog, and in my future program, is bring it together. I aim to be the best resource I can. If you have more in-depth questions about all this, or if there is something I can do for you, feel free to email me at dblewett20@gmail.com.
Dan your website is great and very helpful. Found it right after my son was diagnosed. He had his surgery on August 25 and all went well. He started therapy 10 days later. The day of therapy was good, but the next day he had more swelling and pain than before. He was in a splint for the first 9 days after surgery. Did you have alot of swelling/achiness after your first therapy session? Did you wear a mechanical brace during therapy? I would call the therapist, but its a holiday weekend.
Shari,
Your son and I share the same surgery date! My elbow had it’s first birthday almost two weeks ago.
My elbow was swollen for a good 2-3 weeks, and some days I would get aching and bruising in different places, but it was never a concern. It just slowly went down. I started moving mine around from day 3, and I was never in a mechanical brace at all. My doc said the new ligament was so strong that there was nothing I could do, aside from throwing, that would hurt it. So i went home without a brace and slept on it and did whatever. Maybe that will inspire in you some confidence.
Moving it around, especially after being immobilized for it’s short life, is going to stir things up a bit, break away scar tissue, and may hurt and cause swelling, but all that stuff is just a part of the process. Therapy hurt sometimes, but I got through it, and its just how the progression often is. The ligament has to get used to stretching out and moving around and assimilating into the bone. I still get random pains in my forearm, a year later, but none of it is a big deal. It goes by quickly and the swelling, soreness, etc. all fade pretty fast, even if they sometimes fluctuate. He will start to learn as time progresses which pains are OK to push through and which mean slow down. Hope that helps.
Well I thought I would update my progress. Last Tuesday I threw my first flat ground at 6.5 months threw 71mph I could have thrown a little harder but that was the most effort I was comfortable giving. Throwing back to back days without any soreness now and am long tossing twice a week to 180ft. I will start throwing from a mound (50 ft) in a few weeks at 90%ish. Pretty much stopped working out upper body a month ago just too much soreness in my elbow with working out and throwing. I still do plenty off lower body stuff, core, and all my prehab/ rehab work. Push ups don’t cause any soreness but other things do sometimes and right now throwing is most important to me. I hoping I can meet your mark Dan of throwing in a game at 9.5 months that will be the start of our season. Hope everybody’s recoveries are going great.
That’s awesome, bro. It definitely becomes tough balancing lifting and throwing as the bullpen intensity rises. That was one of the trickiest things about that phase. Fortunately, the soreness was never debilitating for me so I was able to keep lifting, but im glad you’re listening to your body and not pushing the issue. Definitely keep doing what you’re doing and if you are ready on opening day, go for it, but if not, remember that you need to be healthy longterm. Your day in the sun will come.
I stoped working out because of the same reasons. Upper body lifting is just to much with the throwing program.
My son is 7 months post TJ surgery. He’s throwing off a mound at about 50-70% effort (50-60 MPH). He’s throwing with no pain but there is what he calls tightness in the elbow when starting to throw towards 70%. A) is this normal – part of the surgery process installing the new tendon B) should he be pushing it slowly to teach/stretch out the new tendon and C) are there any pre-throwing stretching routine that he can follow – for both the shoulder and elbow?
Just curious, did you ever get back to 100% velocity? Your last entry in your rehab says that you weren’t 100% yet at 10 months post-op.
I am at 100%+, and have been for quite a while. In my most recent bullpens I have been averaging a tick over 90 for about 50-60 pitches, which is harder, on average, then I threw back a few years ago. I also peak as high as I used to, and will likely pick up one or two more in the coming months.
Your answers:
A) Yes. When myself and all the other TJ guys I knew jumped effort levels, from 50-75, 75-90, 90-100%, there was often a cramping period. Tightness, soreness, cramping, etc., were all common symptoms of the additional velocity. I know exactly what he is going through.
B) He should listen to his body, and do what he thinks is right. I can’t say exactly what he should do, but sometimes I moved on in accordance with the schedule, and sometimes I took extra time off or slowed down. The soreness will abate as he continues to move through the program, but yes, his new elbow will have to learn to tolerate the increased stresses.
C) Check out my posts on the sleeper stretch, “more shoulder stretches for pitchers,” and the hip flexibility article, all of which contain stretches he should do regularly. He should also stretch out his forearm flexors and extensors and lats and triceps, which I don’t have pictured on my site, but can be easily found on the web. My “pitchers homework” section is the bulk of what pitchers should do routinely, if not everyday. That’s actually a good question, on the routine, and I will have to make a little write up on my pre-pitching stretch routine. I hit pretty much my whole body in 20 minutes before I throw. I’ll put that together soon.
Thanks Dan. The good news is that he doesn’t have any soreness – only a little tightness (at higher velocity). I want him to get into a very regimented routine before throwing – stretching (should he be using bands), slow warm up and long toss(?) before starting to heat up. He used to be a kid that spent little time on prep and basically, warmed up in about 10 minutes and was ready to go. This surgery gives him the opportunity to re-evaluate getting ready and taking care of him arm. Also, if you have any post throwing routines (stretching, ice, etc.), I would appreciate some feedback on that too. He has a preferred walk on opportunity in college this fall and I’m hoping he’ll be ready to go. The coach was very impressed pre-arm trouble and will be giving him a good look this fall.
Well I thought I would update everyone on how I have been doing. I pitched last saturday for the 1st time in a game 2 innings 55 pitches, 4 unearned runs, 4 singles for my first outing post TJ at 10 months and 1 week. I was 80-83, wasn’t trying to throw hard just happy to be back out there. Elbow has now been hurting ever since then. More of a sharper pain doing various things most notably throwing. Physical therapist things its my nerve. Swelling in the elbow is pinching the nerve when I do certain movements is the thought. I had this pain one other time in my recovery and I just took about 10 days off and it went away, but I’m pretty frustrated right now because I want to get back on the mound and I can throw through it but I want to be safe at the same time. Coming back from tj is a b****. Sometimes you gotta know when to quit being a sissy and other times you really do need to be a sissy. The hard part is figuring out which is which.
Yeah man it’s hard, but you’ll be alright. I had serious tendinitis after throwing at a guy’s head in a summer game. My elbow swelled and hurt like when I tore it. I was a wreck for a while thinking I was gonna have to do it all over again, because it really felt like it. 2 months later, all was well and here I am, down the road doing fine. It’ll work out. 10 months is still very early.
Is the pinching feeling that Steven is feeling “normal”? My son has some tolerable pinching in the inside portion of the elbow (on the wrist side of the elbow but no swelling) as he increases the velocity. We’re not sure if he should be fighting through this or resting longer between throwing sessions.
The easiest format for this discussion about rehab is the “Did you feel _____” format. I know what was normal for me and a lot of other guys, but it is really difficult to tell you what your son should or should not push through; that’s more of the role of his therapist. As you know, some you push through and some you don’t, but I feel like it would be irresponsible for me to give you a strong recommendation one way or the other. If you’re really worried, then rest. Rest is always safe and won’t hurt him, and he will be able to figure out where he needs to be by listening to his arm and therapist.
As far as warming up, the stretch routine I posted is very thorough and, coupled with some form running and sprints to actually generate warmth, should be a great start. As a general rule of thumb, anything he does to maintain the health of his arm (forearm and shoulder prehab) can be done in a light set as an aid to warming up, and it is HIGHLY recommended that he do that. For each exercises think 1 set of 12-20 reps of a weight lighter than he would do in his normal prehab sessions. If he doesn’t want to bring dumbbells to the field, than a flat thera-band and clip-on band for the fence would be a good substitute. Stretching afterward, and even another 1-2 sets of prehab is great for after an outing. Bringing fresh blood into the arm could only benefit him after an outing.
For healthy athletes, icing afterward is a topic of great debate, yet for injured ones it is not – he should most likely be icing after every session, unless his orthopedist advises him otherwise. It will keep the inflammation caused by microtrauma down.
It’s pretty normal to have some general tightness, soreness, etc from everyone I have talked to. My new pain is a sharp pain which is from the ulnar nerve being pinched.
Im at 120ft two sets of 25 on the throwing program. Did anyone who experienced the surgery have swelling or stiffness behind the elbow after throwing.
my son had tommy john surgery this year 1/13/2010 anyway hes 6ft 4inc 240 lbs a big boy he went threw his rehab pretty good but he always felt a pinching pain that was tolorable and tightness in the elbow the rehab guy and doctor both said that he would have to break threw this that it might be scarring —-he pitched at 9 to 10 months this past october about 9 innings in the fall for his college 50 to 60 throws each time –his velocity was at 90 already but a steady high 87 to 89 mph any way fall ball was done and the doctor suggested with his rehab guy to keep thrwoing once a week building it up anyway last week he threw leting a few go at 80 to 100% for 50 pitches his velocity is there everything is in the ninties but he said his elebow had that tightness and pinching pain a little more so we laid off it for a week and he threw 50 pitches a week later but he said it still there and it felt like crap and that pinching is still there to —— what i want to know is this the normal or not —-i mean do a lot of guys that can throw hard go threw this —-we are going to see the doctor again i made an appointment and then the doctor can take a xray incase of any bone spurs —-but he took a lot of xrays along the way and said there were no bone spurs but one more wont hurt also i want a MRI which i told them to do but said we didnt need it well now i want it ——i mean hes ready to come back but its not going to do him any good if he keeps feeling that pinching unless its normal —-i think at this point it might be more mental than physical —-hes also been in the gym with a private trainer for the last 3 months —-i just want to see him pitch in college whats your advice on this
I didn’t have lingering sharp pain like the pinching you describe, and it would have concerned me if I had. I think the best course of action is the consult with the doctor like you have planned to do – they will be able to get to the bottom of it. A lot of guys I’ve talked with had scar tissue break loose, had lingering pain and soreness that persisted for sometime. I also know that Danys Baez of the Orioles (his name is spelled weird) had elbow pain like what you’re describing for a long time, and was really nagged by it, even 18 months later. He got over it, though, and throws gas. I’ve also heard that PRP injections work well for such injuries, so that may be something to discuss with your doctor as well. And yes, mental blocks with pain can make the symptoms worse; if he focuses on pain, the pain will increase. Hope that helps
i emailed you about my son having that pinching pain back in december but hear we are a few months later and its barley there if at all he said —it must have been scare tissue breaking thru——we went to the doctors and he said work thru it keep throwing—– unless it gets that sore then just take time to let it rest which was your advise to and dont worry —– his arm is very strong but gets sore kind of fast as he rebuilds his number of pitches that he can do—- is there any advice you can give him that will help him recover quicker from the sore arm—-i mean he is doing his streches and arm excercise but is that all he can do or is there more and what is PRP injections what are they and are they safe for tommy john patients—-i mean the doctor said for any tommy john patient the recovery takes a while because of the inflammation is that what the PRP injections do take away inflammation —–thanks you have been helpfull—–he is working very hard its been 13 months now—-thank you
my son had tommy john june, 2010, he progressed nicely through all the initial phases, he just began throwing off the mound and started bull pen sessions , first few times, he felt great, and just recently experienced tightness, he seems to think this is normal he is a division 1 college player, 6ft 4 in, 215 and threw about 90-92 before surgery, he was throwing hard last few sessions, and things look good, even breaking ball. Is this to be expected, they slowed him down, extra day rest with no throwing. Is this typical?
Very typical. Every time he adds new things to the mix, whether it’s the mound itself, more velocity, breaking pitches, game situations, he can expect a new reaction out of his elbow. When you do something new, the elbow isn’t to it and it will sometimes be fine, sometimes get tight, sore, painful, or whatever, but it all seems to be part of the process. Most of them won’t be cause for alarm, but always pay attention to it and back off if need be. He will continue to have this stuff possibly up to 14 months, and sometimes even longer.
my son john now is 15 months out and has just concluded playing for his college—-he pitched a total of 8 times did extremly well at first it was tough because of the cold and then as it warmed up it went easier —-he even hit 94 mph in florida when it was 85 to 90 degrees —but sat mostly between 89 and 92 on the scouts radar guns and the best is yet to come as his arm gets stronger and stronger –the soreness now only lasts a couple days which for a pitcher is normal after he is done pitching 7 to 9 innings 80 to 100 pitches and no pain —thank god as he continues his arm is getting stronger —the doctor said next year he will notice it even stronger but he said it feels pretty darn good now—-o well i guess all that fuse for nothing but as you said before its better to be safe than sorry and get it checked out by the doctor great advice—thanks again—-paul
My son went through TJ last April down in Cincy. Great surgery result. He ws at 87 – 89 capping at 91 prior for a D2 Juco. Rehab has been hard. He just began throwing at the 8 month point as he switched colleges and did not want to rush it though it has been rough. He has been doing PT all along progressing well and began working out – lifting, core, legs and upper body.
Need your take on what’s the most important aspect to focus on as time is a scarce due to school : throwing, PT, lifting, core or aerobic…… Are there things he should over emphasize to bring back or increase velocity and develop stamina once he starts throwing more regularly ? His goal is to : 1) pitch in summer ball which would be at the
14 month point 2) make a D1 team in late August as a walk on down south. He would have multiple years if eligibility despite being a senior, A guess is that he would need to be maintaining 90ish velocity. He has always had a good curve and change.
Thanks.
Any comments and/or advice would be great………….thanks.
Hmmm. His decision to wait until 8 months to throw is a bit unorthodox, so I’m not sure what timetable he would be on…most start throwing at 3-4 months and doctors don’t seem to think there’s any additional benefit from waiting longer. I would assume more scar tissue would have formed in the absence of throwing, but I don’t know.
Really, his focus needs to be on progressive rehab. Though that’s a vague statement on my part, he really just needs to start at the bottom of all those activities – throwing, strength training, conditioning, and slowly progress at each as tolerated; that’s rehab. I mixed in everything I could when I was allowed by my doctors; for me, I had a very liberal rehab program so I was able to start lots of strengthening things extra early, and I did well. I did as much as I could with all of it without overtraining on any; it’s a balancing act.
To have him throw competitively 6 months after starting throwing is going to be tough. Most guys at 9 months on a normal rehab plan (3 months not throwing + 6 months progressive throwing) have 90-100% of their velocity back but little stamina, control, feel for location or breaking pitches. It varies person to person, but the throwing progression doesn’t have much room to work on the feel that throwing accurately with ALL pitches requires. I really didn’t have my true “stuff” back until about 14 months post-op, which was 11 months of throwing. I could throw my offspeed pitches at 9 months, but they, along with my location, were just flat out not good.
I realize I haven’t answered your questions except for vague generalities, but unfortunately the question isn’t that precise; a lot of it depends and a lot of it is just starting slow with all of it and progressing. Good luck.
Hmm, I don’t know the answer to that one. It’s a question best left for his doctor, but I would imagine it would probably be a couple of months. I actually haven’t shot a basketball since surgery, as strange as that might seem. The big concern would probably be getting hacked or blocked while playing, rather than just shooting itself.
My running program consisted of 3-5 days per week, typically one or two moderate runs (2-4 miles) and two or three sprinting or interval runs. A day of intervals or sprints would last 15-25 minutes, depending on the intensity. For example, a sprint day might look like 10 sprints at 60yds, 20 x 40yds, and 10 x 20yd. Rest would be a walk back between sprints. An interval day might entail 4x400yd, w/2min rest, 4×200 w/1-2 min rest, and 4×100, with 30-60 sec rest, or simply a distance run in which you sprint for an interval of time or distance, and then slow to a jog or walk as rest.
Strength training consisted of 3-4x per week total body workouts. The focus was on a 2 or 3:1 ratio of upper body pulling exercises to pushing exercises, core work and leg work, with an emphasis on the posterior chain (hamstrings, hips, glutes and lower back). All weights started very light and increased as tolerated. Thats the general picture, but I’ll provide a more complete picture in one of my upcoming posts which will be specifically on the strength and rehab work.