Simplifying Performance Rehab Part 5: UCL Reconstruction

Presented by Phil Plisky and Nate Denning

Video Runtime: 38 Minutes; Learning Assessment Time: 38 Minutes

This course is part of a series designed to be taken sequentially. It is recommended that learners view the series in the following course order:

After a UCL repair or reconstruction, an overhead athlete faces months of healing before returning to competition, yet clinicians often pause performance training entirely during that window, leaving the athlete detrained and underprepared when clearance finally comes. Building on the framework from earlier courses in this series, this course applies performance programming to a real postsurgical case: a 17-year-old baseball pitcher recovering from a UCL repair with an internal brace. It works through the five physiological phases of healing; defines the clinical goals and progression criteria for each; and shows how upper body push and pull strength, power, speed, agility, and metabolic conditioning are modified phase by phase to respect tissue constraints. Throughout, the course reinforces that structured strength and conditioning runs alongside—never in place of—the ongoing local elbow rehabilitation the repair still requires. Physical therapists, athletic trainers, and other clinicians managing postsurgical throwers will be able to plan phase-specific goals and safely progress a complete performance program from the early postoperative period through return to sport.

Learning Outcomes
  • Plan phase-specific clinical goals and progression criteria based on the physiological stages of healing following a UCL reconstruction
  • Implement foundational rehabilitation essentials necessary to protect and support optimal tissue healing of the UCL
  • Apply upper body strength training and coaching progressions safely across all phases of postsurgical UCL healing
  • Modify power training and rate-of-force-development variables to accommodate tissue constraints throughout the healing timeline
  • Prioritize speed, agility, and metabolic conditioning progressions to safely prepare the postsurgical athlete for return to sport

Meet your instructors

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Phil Plisky

Dr. Phil Plisky is a professor in the University of Evansville’s Doctor of Physical Therapy and PhD in Health Professions Education programs. He is the host of the Medbridge Rehab and Performance Lab podcast and founder of the Coaches Club at

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Nate Denning

Dr. Nathan Denning is the founder of Integrated Performance and a partner at Athlete Development Solutions. His mission is to revolutionize human performance and rehabilitation through the integration of physical, mental, and educational support. Nate believes that peak performance—whether for an athlete or a clinician—is the…

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Chapters & learning objectives

UCL Reconditioning: The Essentials

1. UCL Reconditioning: The Essentials

This chapter introduces the recurring case—a 17-year-old baseball pitcher recovering from a UCL repair with internal brace—and establishes the rehabilitation essentials that must continue throughout the process: restoring elbow, wrist, and shoulder range of motion; rebuilding local strength; and managing swelling and pain. It defines the clinical goals and progression criteria for each of the five physiological phases of healing, from the time-based initial phase through to the return-to-play phase. Anchoring performance work to a phase-based roadmap ensures clinicians layer strength and conditioning onto the athlete without compromising the healing and repair.

Upper Body Push Progressions

2. Upper Body Push Progressions

This chapter details how upper body push strength is advanced from phase 2 through return to sport, using concrete progressions such as the bilateral horizontal push, progressing from high plank to push-up on a box, alternating single-arm bench, dumbbell bench, and finally barbell bench. It also addresses the prioritization of movement deficiencies through corrective programming and coaching the athlete through each stage. Sequencing pushing exercises with biological healing allows clinicians to rebuild pressing capacity without exceeding what the repair can tolerate at any given phase.

Upper Body Pull Progressions

3. Upper Body Pull Progressions

This chapter details staged upper body pull strength across the phases of healing, including the bilateral vertical pull progressing from supine banded superman through hangs and eccentric pull-ups to weighted pull-ups, and the unilateral horizontal pull progressing from supine shoulder packing to loaded single-arm rows. Each stage includes coaching cues for safe execution. Because pulling strength is essential to the throwing athlete’s shoulder and elbow health, progressing it gradually rebuilds capacity while protecting the repair.

Power, Speed, Agility, and Metabolic Training

4. Power, Speed, Agility, and Metabolic Training

This chapter shows how power, speed, agility, and metabolic conditioning are modified for each phase of UCL recovery, with phase-specific exercise examples for every quality. It emphasizes that these qualities can begin as early as phase 2, when progressing in relation to biological healing. It explains how metabolic training must be added to replace the load an athlete would normally get from practice and games. Progressing these domains alongside healing ensures the athlete returns not only recovered but fully sport-ready.

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