Baseball player with an elbow injury (UCL strain): A Case Study

I had a conversation with a patient's family recently and I thought it might be helpful to other athletes, parents, coaches and physical therapists (PTs).

The patient: A high school, high-level baseball player with an elbow injury (read: dominant arm Grade II UCL strain). He plays all phases of the game at an elite level (running, hitting, fielding, pitching/throwing).
The question: Will he be able to pitch or play the field within the next several weeks?
Parent's and athlete's thoughts: "Well, he should definitely be ok to play the field before he is back to pitch 100%, right?"

The answer: It's actually the reverse and it’s based on a lot of factors that might not be common knowledge.
The rationale: When a pitcher throws the ball, while it is a violent action in itself, it’s among the most “sterile” movements in sports. It’s a closed environment in that there is little in the way of distraction, barring a few situations, to interrupt the mechanics of throwing. The thrower’s lower body positioning, arm loading and acceleration, as well as the follow through are consistent and should be variation free.

When playing the field as a defender, the entire the upper extremity operates in a much more varied way. There is often lateral movement involved, momentum, obstacles, runners and not to mention situational strategy which all put the kinetic chain at risk.

This is the type situation that will ‘find’ the weak link in the chain. This is of greatest concern when coming back from a significant injury but it holds true in all athletes performing all kinds of movements.

Injury prevention is a main reason that athletes should be seeking PT evaluation on a regular basis. During such an eval we actively look for any less-than-optimal range of motion, strength and joint mechanics. We treat any issues we find and provide our athletes with the information they need to monitor any pain and take an active role in their prehab.

I'm happy to say that we have effectively lengthened seasons and increased performance in our practice. Using this approach we can have great confidence that our clients are prepared for the highest levels of competition. I'd recommend that all parents, coaches and PTs become more involved in preventing problems before they begin. There is no situation in which I'd rather see someone as a patient with an injury versus as a client for a prehab visit!

In the above patient case, the patient was advised to return to play along the originally established timeline after all manual techniques to rehab the elbow. The advanced timeline included hitting drills, THEN hitting practice, THEN pitching drills, THEN pitching and then finally back to playing defense. The athlete and family understood the rationale and the athlete is back on the field at this time.