should work.

Damage to these ligaments

causes this system to fail therefore
causing the shoulder to be unstable.
Exercises which are proprioceptive in
nature are categorized as dynamic or
static. A 1-arm stabilizing exercise on a
ball (figure 1) is considered static (place
the ball in different points on the floor).
Push-ups on a ball (figure 2) and crossovers (figure 3) are considered dynamic.
Both types should be trained. You are
trying to train the muscles to be able to
keep the shoulder stable in an unstable
environment. Expect to wobble when
starting these exercises. Your body is
trying to train the rotator cuff to stabilize
the shoulder. Proprioception exercises are

repetitions should be between 4 and 6

repetitions. This will develop strength but
not muscle size. You should rest 1 to 2
minutes between sets.

exercise correctly or you have reached maximum

repetitions.
Prone external rotations at 90 degrees (figure 5) To strengthen infraspinatus and teres minor, lay face
down on the bench bring the arms out to the side (90
degrees to the body) with elbows bent to 90 degrees.
With weight in hand, externally rotate arms lifting
the weight up. Make sure you keep your shoulder
blades squeezed together.
Side lying external rotation (figure 6) This
exercise strengthens the teres minor muscle. Lay on
your side, with the upside elbow bent to 90 degrees,
externally rotate your shoulder, lifting the weight up
to the point that the arm is horizontal to the ground.
Keep your elbow close to your side.
Empty can (figure 7) This exercise strengthens
usually performed for a set length of time,
usually between 20 to 30 seconds. It is
imperative that you are completely rested
before you perform a subsequent set.

supraspinatus. Stand with arms by your sides arms

turned in so the backs of your hands are against your
thighs. With your arms straight, lift the weight up.
The weight is raised at a 30 degree angle to the body.

Strength

Muscular Endurance

As mentioned earlier the RC and SSs need

strength to slow down the arm after the racquet
hits the ball. To develop the strength of the
scapular stabilizers we can perform some
familiar exercises, seated rows (with the
elbows at your side and with elbows out) and
shrugs. Note: make sure to keep your shoulder
blades squeezed back dont allow your
shoulders to round forward. To build strength

Muscular endurance of the RC and SSs is important

because shoulder instability often occurs when the
muscle becomes fatigued. To train the endurance
multiple repetitions must be performed, at weights
significantly lower than for strength. To train
endurance we can either train to a set number of
repetitions (ie. 20 repetitions) or for a set length of
time (30 to 45 seconds). I recommend training for a
set length of time. Attempt to perform as many
repetitions as possible. Perform 3 to 5 sets. Rest for
60 to 90 seconds between sets. Use the same
exercises discussed in the strengthening section.
Conclusion

Bentover/prone lateral raises (figure 4) Lay down on a bench or bending over at the
waist, squeeze your shoulder blades
together and raise your arms out to the side
(90 degrees to the body). This isolates the
rhomboids and trapezius. Point your
thumbs down and you will strengthen
supraspinatus. If you are unable to raise the
arms up fully or you cant keep the shoulder
blades squeezed you are not performing the

Preventing muscular imbalance in the shoulder will

minimize shoulder instability. By minimizing
shoulder instability you will lessen the chance of
instability injuries such as impingements, bursitis,
and tendonitis. There are three components to
developing stability of the shoulder. Proprioception is
the ability of the joint to know where it is in space.
Strength is important to slow down the high speed of
the arm after each stroke and be able to hold the joint
together.

Muscular
endurance
ensures that
the muscles
do not
fatigue
quickly and
thus prevent
instability.
The program
given is only
a sample.
Varying the
exercises in
the strength
and
endurance
section will
add variety to
your
program. If
you have any difficulty or pain with any of these exercises or you are
already suffering with an injury please contact me.
Sample 2 Day Shoulder Stability Exercise Program
Day 1
Day 2
Proprioception
Ball push
One arm ball stabilization
ups/cross-overs
4x15sec
3x20s
Strength
Seated row
Seated row (elbows by
(elbows at 90)
side)
3x4-6
3x4-6
Prone external
Prone lateral raise
rotation at 90
3x4-6
degrees
3x4-6
Muscular
Endurance

Empty can
3x30secs

Exercise Program for Preventing Shoulder Injuries

What is Athletic Therapy?

Athletic Therapists are the
specialists in muscle and joint
injury rehabilitation. Our three
years of study have educated us
in the recognition, prevention,
management and rehabilitation
of muscle and joint injuries
resulting from physical activity,
work related accidents and
motor vehicle accidents.
Certified Athletic Therapists
use contemporary rehabilitative
techniques, therapeutic
modalities, massage, physical
reconditioning, and supportive
strapping procedures in
preparing the individual for safe
reintegration to work/sport.

Side lying external

rotation
3x45secs

Note: If you are a beginner, perform

one set when performing the
strengthening aspect of the program. Each week add another set until you are performing 3
sets. Perform 8 to 12 repetitions for 6 weeks instead of 4 to 6. After 6 weeks, perform 4 to 6
repetitions.
Christopher Notley is a Certified Athletic Therapist (CAT(C)) and also a Certified Strength
and Conditioning Specialist (CSCS). If you have any questions regarding this article or
regarding an injury please contact him at 831-8326 or cnotley@mts.net

The shoulder joint is known as a ball and socket joint. The socket that makes up this joint is very shallow. Only a
quarter of the ball (humerus) comes in contact with the socket (shoulder blade). This makes the joint inherently
unstable. The ligaments that hold the shoulder joint together are not very strong therefore the muscles that surround
the joint are responsible for maintaining shoulder stability. This puts a lot of stress on the muscles, especially the
muscles known as the rotator cuff.
The rotator cuff (RC) is made up of four muscles; supraspinatus, infraspinatus, teres minor and subscapularis. Their
primary job is to stabilize the shoulder. Their secondary jobs are:
1.
2.
3.

Infraspinatus and teres minor externally (outwards) rotation of the

shoulder.
Subscapularis internally rotates the shoulder. (front of shoulder)
Supraspinatus abducts (arm away from the body) the shoulder.

Other muscles, important in the stabilization of the shoulder joint, are the
scapular (shoulder blade) stabilizers. These muscles indirectly stabilize the
shoulder by stabilizing the scapula.
Shoulder injuries may occur due to improper training, overtraining, poor
mechanics, poor equipment, or there may be a muscular imbalance which we will discuss here. With any sport such as
tennis, squash or racquetball the muscles that get used the most are the muscles found on the front side of the shoulder.
These muscles are used frequently during the forehand and the service. After the ball hits the racquet the RC muscles
(not subscapularis), and scapular stabilizers (SS), are responsible for slowing down the arm, which is moving at a very
high speed. If the RC is not strong enough to withstand the forces produced by the muscles of the forehand or service
an instability injury may occur. Such injuries are: shoulder bursitis, shoulder tendonitis, RC tears, or shoulder
impingements).
The goal with the following exercise program is to prevent these injuries from happening. This program is not
intended for someone who already has an injury.
There are three components that must be addressed: proprioception, strength and muscular endurance.
Proprioception
Proprioception is the bodys sense of position. The ligaments that surround the shoulder joint are responsible for
providing information about the stability of the shoulder. They tell the RC muscles when and how they