I am a competitive gymnast in floor exercise and the balance beam. Last summer in a competition, I blew out the ligament on the inside of my elbow. Rehab didn't work to give me the stability I need, so I'm having reconstructive surgery. The surgeon mentioned a long rehab process but didn't say much about it. Just how long will it take for me to get back into competition?
The current standard of care in the rehabilitation of ulnar collateral ligament (UCL) reconstruction starts right after surgery and progresses through four stages or phases over time. Those phases include: immediate post-op, intermediate (weeks one through three), and advanced (weeks nine through 12). The fourth phase is the return-to activity stage, which takes place from week 13 through the first nine months post-op.
Programs vary slightly depending on the type of surgery done. The two most commonly used reconstruction procedures include the figure of eight (also known as the modified Jobe procedure) and the docking procedure. The basic method of either approach is to take a piece of tendon from another muscle (usually the palmaris longus or gracilis) and use it to replace the damaged ulnar collateral ligament.
The main difference between the two procedures is the way in which the tendon graft is anchored to the elbow. In either operation, the surgeon assesses the damage and performs a few extra steps when needed, like shaving off any bone spurs or moving the ulnar nerve if it's rubbing against the bone.
After either procedure, a posterior splint is used at first to hold the elbow in 90-degrees of flexion. A posterior splint is placed along the back of the arm/elbow, specifically preventing extension. The patient is allowed to move the wrist and fingers but not the elbow. Acute injuries heal faster and progress more rapidly through the rehab protocol than chronic injuries. In all cases, the goals are to promote healing, reduce pain, limit inflammation, and return to normal motion, strength, and function.
Even though a small area of the body was operated on (the elbow), a gymnast will need a complete head-to-toe conditioning, strengthening, and endurance training program. Restoring joint proprioception(sense of position) and kinesthesia (sense of movement through space) involves the entire upper quadrant (neck, shoulder, arm), not just the elbow. Stabilization of the shoulder through strengthening of the rotator cuff and scapular (shoulder blade) muscles surrounding the shoulder joint reduces stress across the elbow.
Eventually, you will need to progress through training to restore control through various activities using the elbow. Advanced training incorporates plyometrics, a type of exercise training designed to produce fast, powerful movements. With plyometric training, muscles are loaded and then contracted in rapid sequence. Plyometrics is used to increase the speed or force of muscular contractions, a very necessary component of gymnastics in all events.
Todd S. Ellenbecker, DPT, et al. Current Concepts in Rehabilitation Following Ulnar Collateral Ligament Reconstruction. In Sports Physical Therapy. July/August 2009. Vol. 1. No. 4. Pp. 301-313.
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