Elbow Pain in Baseball: From Tommy John Surgery to Non-Operative Rehab, How Physical Therapy Gets You Back Stronger

Tommy John surgery used to be rare. Now it feels like every MLB season sidelines multiple pitchers, and more and more youth players are joining that list.

Elbow pain in baseball has become an epidemic. But not every UCL injury requires surgery. With the right physical therapy, many athletes can rehab non-operatively, restore strength, and get back to throwing without ever stepping into an OR. For those who do need surgery, PT is the difference between just returning and coming back stronger.

Why UCL Injuries Are Everywhere

• MLB teams lose pitchers every season to UCL reconstructions

• The fastest-growing group getting Tommy John are 15–19 year-olds

• Why it’s happening:

  • Year-round throwing with no off-season

  • High pitch counts in tournaments

  • Early specialization (kids only pitching, no cross-training)

  • Poor workload monitoring

Bottom line: overuse and poor recovery are breaking down elbows earlier than ever.

Tommy John Isn’t One Surgery Anymore

There are now multiple ways surgeons repair the UCL:

• Traditional Reconstruction (tendon graft), 12–18 months recovery

• Hybrid (Reconstruction + Internal Brace), about 10–12 months

• Internal Brace Repair (no graft), partial tears only, about 6–9 months

Regardless of the type, one fact remains: no one skips PT. Rehab drives recovery.

Non-Operative Rehab: What Parents Need to Know

Not every UCL injury means surgery. Many sprains respond to therapy, but the timeline still matters:

• Three to six months of rehab for a sprain equals the same time as a throwing buildup

• Skipping PT or rushing back can turn a partial tear into a full rupture

• Rehab focuses on:

  • Restoring shoulder and total ROM

  • Strengthening forearm, grip, and cuff

  • Plyometric drills to safely reintroduce elbow torque.

  • Correcting mechanics and workload management

The takeaway: PT can often prevent surgery if caught early.

Clearance: Why Pain-Free Isn’t Enough

Being pain-free doesn’t mean you are ready to throw. Successful return requires objective, measurable criteria:

• Completed 2-hand to 1-hand plyometric progression pain free.

• Balanced ER/IR shoulder strength >0.75

• Full shoulder flexion ROM (Wilk et al. showed deficits = 2.8× injury risk)

• Grip strength greater than 15 percent of body weight in the throwing arm

• Chronic workload monitored, not guessed

Without these, clearance often equals re-injury.

Warning Signs Parents Should Watch For

Parents are often the first to notice the early red flags. Don’t ignore these:

• Sudden drop in velocity

• Sharp inside-elbow pain

• Feeling of instability or a pop

• Rubbing or grabbing the inner elbow

• Soreness or swelling that lingers after rest

If you see these, don’t wait. Early PT can prevent a minor sprain from turning into Tommy John.

The Role of PT: More Than Just Rehab

Physical therapy for throwers isn’t about ice and rest. It is about durability.

At PJA, we focus on:

• Advanced screening (mobility, ArmCare, grip testing)

• Restoring shoulder, scapular, and trunk mobility

• Strengthening forearm, cuff, scapular stabilizers, and core

• Velocity-safe plyometric and performance drills

• Long-term workload management

The PJA Difference

• One-on-one with a Doctor of Physical Therapy (no hand-offs, no rushed visits)

• Baseball-specific expertise (former collegiate pitcher, baseball rehab specialist)

• Cash-pay model with no restrictions so we can use the tools athletes actually need

• Continuum of care: rehab into performance into durability

Conclusion

Elbow injuries in baseball are not going away, but they don’t have to define your career. Whether it is a UCL sprain that can be managed without surgery, or recovery after Tommy John, the right physical therapy program is the key to returning stronger, safer, and more durable.

Parents and players, don’t wait for pain to sideline you. Book your evaluation today and protect your future on the field.