TOMMY JOHN INJURIES

As I write this article, The Toronto Blue Jays just wrapped up their last game in the World Series. What an amazing season. We came so close, several times, to almost clinch that final game! Regardless, it’s been exciting for Canada to be part of this event after more than 30 years, and watching many Canadians come together in
another sporting competition. As internet algorithms go, and being a Physiotherapist, my social media has been blowing up with information about Tommy John injuries. Namely, a tear or sprain of the ulnar collateral ligament (UCL) on the inner elbow. Named after the first baseball player to successfully undergo UCL reconstruction surgery in 1974, this injury has become a defining issue in modern throwing sports.

The UCL is a strong band of tissue on the inner side of the elbow that stabilizes it during the throwing motion. Repetitive stress from overhead throwing places extreme forces on the ligament. Over time, microtears accumulate, which can lead to partial or complete rupture. Other overhead sports such as racquet sports, football and water polo can experience UCL injuries from repetitive motions. In addition, trauma such as a fall on an outstretched arm, a direct blow to the elbow or sports such as gymnastics or wrestling can cause trauma to this ligament.

Diagnosis is based on a combination of physical examination, history, and possibly imaging such as MRI or ultrasound. Mild or partial tears may respond to conservative management, while complete ruptures in competitive athletes often require UCL reconstruction (“Tommy John surgery”). Often people complain of medial elbow pain, decreased throwing velocity, perhaps a popping sensation. There may be numbness or tingling to the ring and little fingers that may occur due to irritation of the ulnar nerve that runs along the inner elbow.

Physiotherapy plays a critical role in both non-surgical and post-surgical management, focusing on restoring strength, stability, and efficient throwing mechanics. Initial rest, protection and modalities can help protect the ligament and reduce inflammation. Progressing to gentle stretching with elbow and shoulder range of motion. Then a graduated dynamic strengthening program including wrist, forearm, elbow, shoulder and scapular control is integral to restore proper throwing mechanics.

Physiotherapy also plays a preventive role. Overuse is the primary risk factor for UCL injuries, particularly in young athletes who throw year-round. Prevention elements include ensuring adequate rest and cross training, maintaining shoulder and core strength, teaching proper throwing mechanics and addressing “kinetic chain deficits” – issues in the hips, trunk, or shoulders that may overload the elbow. Education on recovery, workload management, and early symptom recognition helps athletes stay healthy and avoid re-injury.

The Tommy John injury highlights the complex relationship between biomechanics, overuse, and sport performance. Physiotherapy is vital— not only in rehabilitation after UCL injury or surgery but also in preventing recurrence through strength, stability, and movement retraining.

Whether an elite pitcher or a recreational athlete, early physiotherapy intervention ensures a safer, stronger, and more sustainable return to activity. If you are struggling with any type of elbow injury, we are here to help you diagnose the problem and get you back to your best functional self.

Happy Holidays this season! We wish this great community a happy and healthy end to 2025 and all the best for the
new year ahead.

Jennifer Gordon
(BSc.PT, GunnIMS, AFCI)
Physiotherapist – Bragg Creek Physiotherapy
www.braggcreekphysio.com