Protecting the UCL (Tommy John Ligament)

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

Elbow Image

A recent study in The Physician and Sports Medicine showed that 29% of youth baseball players up to the age of 12 reported episodes of shoulder or elbow pain.  Another report in the Journal of Arthroscopy noted 31% of pitchers up to the age of 22 have experienced an arm injury as well.  Over a third of Tommy John procedures performed are done on youth pitchers.  Here is a graph showing the rise in Tommy John surgeries performed on youth each year by Dr. Andrews:

UCL surgery chart

Today, I want to touch on three things we do here to help stabilize and protect the UCL (Tommy John Ligament):

  1. Strengthen the “Flexor / Pronator” Groups
  2. Improve Shoulder Mobility
  3. Controlling Excessive ROM During the Season

1. Strengthen the “Flexor / Pronator” Groups – These are some of the muscles that help stabilize and protect the elbow, especially in the “layback” position:

  • Flexor Digitorum Superficialis
  • Flexor Carpi Radialis
  • Flexor Carpi Ulnaris
  • Pronator Teres

The flexor digitorum superficialis is an extrinsic muscle that allows the four medial fingers of the hand to flex. These fingers include the index, middle, ring, and pinkie fingers.

flexor digitorum superficialis

The flexor carpi radialis muscle is a relatively thin muscle located on the anterior part of the forearm. It performs the function of providing flexion of the wrist and assists in abduction of the hand and wrist.

flexor carpi radialis

The flexor carpi ulnaris arises along with the other superficial muscles, from the medial epicondyle of the humerus. These muscles flex the wrist and adduct it (move it laterally in the direction of ulnar).

flexor carpi ulnaris

The pronator teres muscle is located on the palmar side of the forearm, below the elbow. its function is to rotate the forearm palm-down. This is also known as pronation.

pronator teres

Here are a few of the exercises we do to strengthen the flexor/pronator group.

  • Stretch – Wrist flexion/extension Stretch (x 20-30 sec/side)
  • Strengthening Exercises (1-2 sets ea / 2x per week)

(Isolated DB Wrist Curls – x10/side)

(Grip Strength – x3/ea way)

(Pronators – x8 reps)

2. Improve Shoulder Mobility – A lack of shoulder flexion has been shown to place stress on the medial elbow. Improving shoulder mobility will go a long way in helping to take extra torque /stress off the UCL.

(Band Res. Shoulder Flexion)

(Side Lying Windmill)

3. Controlling Excessive ROM During the Season – Gains in external rotation (ER) happen naturally from throwing during the season, but excessive gains in ER can create an unstable shoulder, forcing the elbow to have to take up the slack and placing added stress on the UCL. Monitoring throwing volume as well as participating in a good strength training program complete with shoulder stabilizations during the season can be a career saver.

See ya in the gym…
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