Recovery from an elbow ligament procedure takes months, and the first several weeks are slow. Athletes who understand what each phase is asking of them handle the long stretches better and return in better shape. This page describes our approach whether you had a repair or a reconstruction.
- Splint
- 1 week
- Hinged brace
- From week 1
- Full motion
- 8–12 weeks
- Weight room
- ~4 months
- Throwing program
- 4–6 months
- Gate to throw
- Objective testing
01 Before the operating room
Recovery starts with the right expectations
A good deal of your recovery is determined before you ever go to sleep on the operative day. Athletes who understand the plan in advance do better with it. They know which weeks are supposed to feel slow, they know what their therapist is working toward, and they know what we intend to measure before they pick up a baseball again.
There are two things you should understand going in. The first is the difference between a UCL repair and a UCL reconstruction, and how that decision gets made. Some of it is determined ahead of time by your imaging, your tear pattern, your tissue quality, and your age and level of play. Some of it is determined in the operating room, once I can see and test the ligament directly. I will discuss the likely plan with you beforehand, along with the findings that would lead me to change it.
The second is that the two procedures do not follow the same timeline. They share the same early phases and the same philosophy, but a reconstruction requires a graft to biologically incorporate before it can tolerate throwing loads, and that takes time a repair does not need. This affects when we begin loading the medial elbow and when the throwing program starts. It has very little effect on the first several weeks, which look nearly identical either way.
For the full explanation of how that decision is made, read UCL repair versus reconstruction. This page stays intentionally broad so that it applies to you either way.
02 Preparation beyond the elbow
Nutrition and the mental side of recovery
Two things get underestimated at the start of this process, and both influence how well you come out the other end.
Fuel the healing and the training
Surgery raises your protein and caloric requirements at exactly the time when most athletes are training less and eating less. Those two things pull in opposite directions. Through the early weeks you are healing tissue, and through the later months you are rebuilding strength across your entire body, and both processes depend on what you are eating.
Aim for a widely nutritious diet with adequate protein spread throughout the day rather than concentrated in one meal. If you work with a dietitian or performance staff, involve them from the beginning. If you do not, we can set targets appropriate for your body weight and your sport.
Train the mental side early
A UCL recovery is long enough that motivation alone will not carry it. There will be weeks with no visible progress, and most athletes hit at least one point where the elbow feels worse before it feels better. Athletes who have built some resilience in advance move through those stretches without losing the thread of the program.
Visualization is worth starting early as well. Rehearsing your delivery mentally maintains the motor pattern during the months you are not throwing, and it makes the return to the mound feel familiar rather than foreign. Mental performance work belongs in the program from the first week, the same way shoulder and core work does.
03 The operative day
What surgery day looks like
You will see me in the preoperative area before anything else happens. I will mark your arm, confirm the plan, and answer any final questions. This is a good time to ask whatever has been on your mind. Then we head back to the operating room.
You will wake up in a long-arm splint that holds your elbow still. That splint protects the repair or the graft through the earliest and most vulnerable window. You go home the same day.
04 The timeline
Phase by phase
These ranges describe the typical course. Your pace depends on your procedure, your tissue, and how you respond, and we adjust accordingly.
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Week 0–1
The quiet week
Splinted, elbow still, moving your fingers. There is very little to do in this stretch, which is expected, and it only lasts about a week.
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Week 1
Out of the splint, into a hinged brace
You come back to the office one week after surgery. We check the incision, remove the splint, and place you in a hinged elbow brace. This begins the motion restoration phase and the start of formal physical therapy.
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Weeks 1–12
Motion restoration
We allow progressive restoration of motion in close coordination with your physical therapist. Motion returns gradually rather than all at once.
It often returns more slowly after procedures that use suture augmentation, such as a repair with internal brace or a hybrid reconstruction. In those cases full motion can take somewhere between 8 and 12 weeks. We plan for that, and a slower start does not mean anything is wrong.
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Early
Flexor-pronator strengthening
The flexor-pronator mass is the dynamic protector of the medial elbow, so we begin strengthening it early in the program rather than saving it for the later phases.
If you had a concomitant flexor repair, these timelines shift. We may delay when this work starts or reduce its intensity to protect the repair, and your program will reflect that.
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From day one
The rest of the body keeps training
Shoulder and core work start right away. We also allow low-intensity cardio, lower body lifting, and lifting with your opposite arm.
Training the opposite arm produces measurable crossover strength on the surgical side, which is why we ask you to keep working it rather than sitting the whole upper body down.
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First 3 weeks
Keep the incision dry
We ask that you avoid heavy sweating for the first three weeks, until the incision is well healed. Wound problems are uncommon and straightforward to avoid, and a wound complication is one of the few early issues that can cost you real time.
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After 3 weeks
Back to training as an athlete
Once the incision is healed, we open up higher-intensity cardio and strengthening. This is the point where we ask you to start treating yourself as an athlete again, physically and mentally.
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~4 months
Full weight room reintegration
We progress upper extremity strengthening throughout, and by roughly the four-month mark we want you completely reintegrated into weight room activities with your team or your performance staff.
Our goal in this phase is an athlete who is stronger, more explosive, and more durable than you were in the period before things broke down. We want that in place before the throwing program begins rather than something you chase afterward.
Depending on whether you had a repair or a reconstruction, this is also when we introduce low-intensity valgus loading, which applies the kind of stress throwing creates at a fraction of the magnitude so that the medial elbow is prepared for what comes next.
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4–6 months
Objective testing
Between four and six months, again depending on your procedure, we perform objective testing to determine your readiness to throw. The decision comes from measured thresholds rather than from the date on the calendar or how the elbow happens to feel that week.
If you clear them, you start throwing. If you do not, we know precisely what needs work.
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Throwing program
An intentional interval program
Our interval throwing program uses velocity and wearable technology to incrementally increase stress on the medial elbow. Measuring intensity directly, instead of inferring it from throwing distance, changes what the program is able to do.
It also allows us to return athletes to the mound considerably earlier than traditional programs do. That helps you hold onto your feel for the mound and avoids the long transition into bullpens that many programs leave until the very end.
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Late phase
Return to performance
We track your progression against granular pitch metrics including velocity, spin rate, and spin axis. Our standard is return to performance rather than return to play, and those are separate milestones with separate finish lines.
Once you are back to your prior level, the emphasis shifts to building workload and capacity so that your arm is prepared for the demands of high-level competition.
We would rather measure your readiness than estimate it. That principle runs through the entire program, from the first week to the last bullpen.Matthew Fury, MD
05 How we work
You are not doing this alone
A UCL recovery is measured in months, and no one person is with the athlete for all of it. Throughout the process we stay closely connected with our patients and consult with our colleagues in physical therapy and sport performance, so that your therapist, your performance staff, and I are working from the same plan.
When something changes, whether that is a slow stretch of motion, a new ache, or a season timeline that moves, we would rather hear about it early and adjust than find out at the next scheduled visit.
06 Common questions
Questions we get every week
How long am I in a splint?
About one week. You wake up in a long-arm splint that holds the elbow still, and at your first office visit we transition you into a hinged elbow brace to begin restoring motion.
How long until I have full motion?
Most athletes get there between 8 and 12 weeks. Motion returns more slowly after procedures using suture augmentation, such as a repair with internal brace or a hybrid reconstruction, and a slower start in those cases is expected.
What should I be eating?
Eat a widely nutritious diet and pay attention to protein. Your requirements go up while you are healing tissue and rebuilding strength, and this is the period when many athletes eat less because they are training less. We can set targets for your body weight and sport, and we are glad to work alongside a dietitian or performance staff if you have one.
Can I keep working out?
Yes, and we want you to. Shoulder and core work begins immediately, along with low-intensity cardio, lower body lifting, and lifting with the opposite arm, which produces measurable crossover strength on the surgical side. The one early restriction is avoiding heavy sweating for three weeks while the incision heals.
When do I start throwing?
Between four and six months, depending on whether you had a repair or a reconstruction. Objective testing determines the start date rather than the calendar, and you begin once you clear those thresholds.
When can I get back on the mound?
Earlier than most traditional programs allow. Because we monitor intensity with velocity and wearable data rather than estimating it from distance, we can reintroduce mound work sooner, which preserves your feel for the mound and avoids compressing all of your bullpens into the final weeks.
Does a repair recover faster than a reconstruction?
Generally, yes. The two procedures share the same early phases, but a reconstruction requires the graft to biologically incorporate before it can tolerate throwing loads. The difference shows up in when valgus loading and the throwing program begin rather than in the first several weeks.
References
- Fury MS, et al. Return to Performance After Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers. Orthop J Sports Med. 2021.
- Mastroianni MA, Ahmad CS, et al. Return to Performance After Ulnar Collateral Ligament Surgery in Major League Baseball Pitchers. Am J Sports Med. 2025.
Matthew S. Fury, MD is a board-certified orthopaedic surgeon at the Baton Rouge Orthopaedic Clinic and team physician for LSU Athletics, specializing in sports-related injuries of the shoulder, elbow, and knee. He completed his orthopaedic residency in the Harvard Combined Orthopaedic Residency Program and his sports medicine fellowship at the Hospital for Special Surgery in New York City. His research focuses on UCL surgery, return-to-performance analytics, and surgical innovation in baseball players.
Dr. Fury sees throwing athletes in Baton Rouge and Gonzales, including second opinions on UCL injuries and return-to-throw planning.
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