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How forearm strengthening can decrease risk for UCL tears

Updated: Aug 24, 2022

As we’ve discussed in previous blog articles; Ulnar Collateral Ligament injuries are becoming more and more common in baseball players – of all ages. To the point that 25% of MLB pitchers have undergone Tommy John Surgery to repair the torn ligament.

As a physical therapist I find myself treating younger and younger athletes with these tears as well. We know the main way to prevent these injuries is to keep pitch counts within the recommended ranges and provide adequate rest time between pitching appearances. But there are other aspects of injury prevention including proper strengthening of specific muscles that should be a focus of the athlete’s training routine.

In this article we discuss the importance of the forearm musculature and its role in support the UCL during throwing.

Even though baseball players are only throwing a five-ounce ball when they pitch, there is upwards of 60 pounds of force going through the UCL! This is equal to five bowling ball hanging from your wrist in the cocked position of the throwing motion…

A ligament’s job is to essentially hold two bones together. But we can’t ‘strengthen’ a ligament like you can a muscle or tendon. So how do you fortify this specific area of the inside of the elbow that undergoes an extreme amount of stress when you throw if we can’t make the UCL any stronger?

There is a group of muscles in the forearm that are theorized to provide the stability necessary to allow the UCL to perform its job of stabilizing the inside of the elbow joint especially when throwing. These are commonly known as wrist flexors and pronators.

Electromyographic studies, where we test how well a muscle is firing, show that these muscles do not fire as well when there is a known injury to the UCL. So, theoretically the stronger these muscles are, the healthier you can keep your UCL. We cannot confirm there is a causal relationship between strength of these muscles and tears of the UCL, but new ways to perform Tommy John surgery involve surgeons specially trying to avoid damage to these muscles during the surgery. This has shown to lead to an improve d rehab process for the patient and gives them the greatest potential on returning to pitching at a high level.

Because of this, I believe forearm strengthening is essential to all good rehab programs and I use these same exercises when training baseball players to avoid developing UCL tears in the future.

Watch the following videos to learn how you can add a few simple exercises into your weekly routine to not only prevent injury, but possible increase spin rate and velocity as well!

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