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 cross-overs (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 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.

Strength

As mentioned earlier the RC and SS’s 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 don’t allow your shoulders to round forward. To build strength 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.

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 can’t keep the shoulder blades squeezed you are not performing the 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

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.

Muscular Endurance

Muscular endurance of the RC and SS’s 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

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.

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

Exercise Program for Preventing Shoulder Injuries

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. Infraspinatus and teres minor externally (outwards) rotation of the shoulder.

2. Subscapularis internally rotates the shoulder. (front of shoulder)3. 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.

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.

Sample 2 Day Shoulder Stability Exercise ProgramDay 1 Day 2

Proprioception Ball push ups/cross-overs3x20s

One arm ball stabilization4x15sec

Strength Seated row (elbows at 90)3x4-6 Prone external rotation at 90 degrees3x4-6

Seated row (elbows by side)3x4-6Prone lateral raise3x4-6

Muscular Endurance

Empty can3x30secs

Side lying external rotation3x45secs

ProprioceptionProprioception is the body’s 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