Lewis Physical Therapy & Sports Rehabilitation

Lewis Physical Therapy & Sports Rehabilitation We help active adults and athletes get out of pain, get strong & do what they love

05/09/2026

When rehabbing a UCL and/or flexor-pronator injury, its crucial to find ways to to effectively load the medial elbow in provocative positions.

This is a mid-stage rehab drill we will use with pitchers that typically have symptoms at ball release. I’ve found the TRX to be the best suitable option for this variation because you can better contour the fingers to get the best ability to isolate the flexors (primarily the FDS). A squat rack is also a viable option, but it sometimes takes a little longer to develop the contraction in the right area.

Not shown in this video is the other forearm loading we will do in 90-90/valgus positions, along with eccentrics for the entire flexor-pronator group at different angles.

As a side note, having medial elbow symptoms at ball release is typically more common with a flexor-pronator injury. However, I’ve also seen UCL injuries that have symptoms at ball release ,rather than the traditional pain at layback/early acceleration. This is where a thorough elbow evaluation comes into play, as painful phase of throwing is one of many factors that go into determining whether you are dealing with a UCL sprain, flexor-pronator injury, or a combination of the two.

I’ll be having a YouTube video come out next week that goes over my process of differentiating between the two.

05/05/2026

Build the foundation at specific angles, then improve the ability to decelerate & asborb force. This is the approach we will use for meniscus injuries and other joint-specific knee pathologies (i.e. cartilage injuries, osteoarthritis, etc.).

Isometrics are very helpful early on in controlled ranges as they to work build positional stability via co-contraction of surrounding musculature, local muscular endurance and an overall positive joint response to loading. The possibilities for progressing these isometrics are endless throughout the entire rehab continuum.

Once a patient can handle load isometrically at varied ranges of motion, we will then focus on a heavy dose of eccentrics (preferably single leg) to teach them how to decelerate & absorb forces, along with further driving limb strength gains.

There is definitely value in doing higher-rep single leg work. However, early on I believe patients get more value from a heavy dose of both isometrics & eccentrics to teach them to truly own the positions they need for running or their sport. For many (I’d argue most adults), that alone might be enough to get them ready for a return-to-running since not all joint-specific pathologies respond favorably to plyometrics. More on that to come.

05/04/2026

During the early-mid stages of meniscus rehab, we want to be very mindful of avoiding deep knee flexion, impact and/or twisting based movements. Patients will eventually be progressed to these movements, but its imperative to limit these provocative positions early on to allow them to fully address commonly weak areas (glute/quad/hamstring strength, etc.)

We then want to look at loading the entire lower limb in both closed chain and open-chain movements. Typically, I prefer staying above 60 degrees knee flexion for closed-chain movements (i.e. TKE, step up/down, lunges, weighted wall sits) to minimize the flexion component but still get a good quad & hip stimulus.

To strengthen the quad throughout a greater range of motion without compressive flexion, we will utilize an open-chain progression initially in a 45-90 deg variation (i.e. seated quad isometrics at these angles) before progressing to full range open-chain strengthening (i.e. long arc quads). Once they’re able to tolerate it, I’ve found long arc quads (combined with BFR) to be one of the most effective ways to improve quad strength & tone. We will also heavily utilize BFR for hip-based movements to further promote limb strengthening in a controlled manner.

05/02/2026

Proper isometric & eccentric loading of the flexor-pronator mass is crucial for long-term elbow health and UCL protection in pitchers. There’s nothing wrong with doing dumbbell wrist curls or rice bucket drills early on in rehab to build a foundation, but in my opinion they don’t properly prepare the tissue for a return-to-throwing.

Here is a pronation-specific isometric we will use to further stress the ability of the FPM to protect the UCL and stabilize the medial elbow. The trick here is making sure that force is being primarily generated from the forearm, rather than through the shoulder. To gradually acclimate the elbow to this type of loading, we start with a low intensity, longer duration prescription (typically 4x30-45”) before progressing to more strength and rate of force development variations.

We also can’t forget the importance of consistently loading the FDS & FCU, which are the 2 primary dynamic stabilizers of the elbow that protect the UCL.

For non-baseball athletes dealing with flexor tendon issues, this can also serve as an appropriate way to load the medial elbow.

04/28/2026

One of the primary things we focus on during the early stage of meniscus rehab is restoring full passive AND active knee extension. For many people that have dealt with a chronic meniscus injury, it’s surprising how atrophied/weak that quadriceps is by the time they are evaluated.

In these cases, we will use a variety of manual therapy techniques (in my experience with these cases, dry needling typically provides the most relief) to help calm the joint down and THEN follow it up with some loading of the quadriceps to achieve terminal knee extension. We will typically use BFR for our quad work as well to further accelerate quad strengthening without adding excessive load to the knee. Loading in this manner becomes even more imperative if there is effusion (joint swelling) present.

In general, I don’t push flexion too much (or really at all unless truly needed) in the early stages of these rehabs. I’ve found that focusing on the above approach helps get pain under control and restores passive + active extension via quad strengthening. In doing so, this helps create a “quiet” knee that then allows flexion to come a bit more naturally throughout the rehab process.

04/27/2026

Meniscus tears can be a frustrating injury for athletes, recreational runners and lifters to navigate. These can occur either due to acute (twisting or traumatic injury, etc) or chronic mechanisms (impact-based tasks such as running/jumping, repetitive deep knee flexion tasks, etc.)

These are some of the typical complaints we hear patient’s have and present with on clinical exam that are in line with some type of meniscal injury:

*Joint line tenderness (possible swelling)
*Pain with knee hyper extension and/or maximal knee flexion (passively or actively via bottom position of a squat or lunge)
*Pain with twisting motions (either in weight bearing or done passively through varying degrees of knee flexion)
*Pain during initial steps after sitting/staying in a flexed position for a prolonged period of time
*Pain with knee-dominant hamstring tasks (i.e. machine hamstring curls)
*Painful clicking or locking of the joint

In these cases, activity modification during the EARLY stages (not forever) are crucial to help the joint calm down. Specifically, I have patients eliminate or heavily reduce their overall training volume for running, lunging, squatting or other similar tasks. During that time, we primarily focus on restoring quad strength, knee extension ROM and other deficits we identified.

As a side note, don’t push flexion early on (regardless whether surgical or non-surgical). Forcing flexion tends to further irritate the joint and prevent progress, so we let it come naturally as we focus on the above.

04/22/2026

Hip hinge mechanics are a crucial component to look at in pitchers who have a hard time getting into their back hip. Inability to do so can have a multitude of negative downstream effects in the throwing motion, including but not limited to, “pinching” in the rear hip due to inability to “hold” proper limb positioning as they stride, insufficient stride length and ultimately limited hip shoulder-separation. Each of these will negatively impact throwing velocity and, in some individuals, can be the cause or byproduct anterior hip/groin pain.

In general, it comes down to helping teach these pitchers how to “feel” proper posterior chain (specifically glute and deep rotator) engagement that they can then utilize during the stride phase.

This is a drill we will use early on to teach both proper hinge mechanics from both a hip and pelvic positioning. The beauty of this drill is it can be used in many different applications: warm-ups, rehab/prehab or even as a loaded hinge pattern during training. The possibilities are endless, but dependent on each athlete’s goal.

The key here is to make sure you are feeling it in the posterior hip/glute area without any pinching in the anterior hip or groin.

04/20/2026

Hamstring Strain Injuries are one of the more common soft tissue injuries in field-sport athletes.

Early stage hamstring rehab is all about implementing effective loading strategies. Specifically, the hamstring needs to be loaded as both a knee flexor, hip extensor and then in combined hip extension + knee flexion (as this is typically the position these injuries occur during high-speed running).

This drill is an isometric we work to introduce early in the rehab process at lower-intensity, longer duration holds to help both pain control and muscle recruitment. The key here is to ensure the athlete is create tension through the hamstring as both a knee flexor and hip extensors, while maintaining good trunk & pelvic positioning. As the rehab process goes on, we will work to increase the intensity of this drill and use it as a warm-up for running.

04/10/2026

When looking to improve hip-shoulder separation in pitchers, we have to look at the ability to achieve rear leg hip extension, pelvic rotation (toward front side), shoulder/scap loading and thoracic rotation towards arm side. These can be limited individually or in their ability to occur simultaneously, thus limiting separation and requiring greater stress to occur on the arm.

When performing these drills, it’s important to minimize compensating from the shoulder/lat or hip, which can create the illusion of getting more separation.

Give this drill a try in your warm-up and make sure you feel this in your spine while keeping a closed hip position.

04/08/2026

Shoulder pain with lifting overhead? This could be due to a variety of factors, but for many people it is typically a result of poor scapular mechanics in that overhead position.

These Banded Multidirectional Overhead Taps will not only challenge the scapular muscles, but the rotator cuff as well.

For adults that are dealing with rotator cuff pain, I’ve nearly moved exclusively away from doing isolated External Rotation exercises (I.e. “rotator cuff exercises”) as I’ve found it typically provokes symptoms. Challenging the cuff in different positions, like this drill, while encouraging proper scapular work is typically much more effective tolerable and effective for loading.

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