cols after injury need to address subtle muscle imbalances and joint restrictions, and thus need supervision, isolated rotator-cuff strengthening exercises can be very effective as part of a pre-participation conditioning programme and can be done using the following three simple exercises. The key is to strengthen the internal rotator (subscapularis), external rotators (infraspinatus and teres minor) and abductor (supraspinatus) muscles of the shoulder. This is most easily and safely done using the variable resistance of a cliniband - a length of flat rubber available from large chemists in varying resistances. You will need about two metres; start with the lowest resistance and work up!
To strengthen the right scapularis muscle, start by holding your right arm by the side of your body with your elbow bent/flexed at 90 degrees (the forearm will be at right angles to the upper arm and the line of the forearm points forward). Attach or loop one end of the cliniband over a door handle to the right of your body and hold the other end in your right hand. Internally rotate your humerus against the resistance of the cliniband (seen from above the forearm moves in an anti-clockwise direction towards the left) while keeping your elbow bent at 90 degrees and at the side of your body. Let your forearm return to its starting position by the pull of the cliniband in a controlled fashion.
The external rotators are strengthened by the opposite action. From the same starting position but with the cliniband looped over a door handle to your left, externally rotate your right humerus against the resistance of the cliniband (seen from above the forearm moves in a clockwise direction to the right) while the elbow is again kept to the side of the body at 90 degrees. The forearm is again allowed to return to the starting position in a controlled fashion. Single sets comprise a minute of either external or internal rotation exercises and can be repeated three to five times a day. The cliniband needs to follow you around during the day! To strengthen the internal and external rotators of the left shoulder requires similar but mirror-image manoeuvres.
Supraspinatus conditioning requires abduction work and initially should be performed below shoulder level. The starting position is quite different from the previous two exercises. To strengthen your right supraspinatus, place one end of the cliniband under your left foot and extend (keep straight) your right elbow. Hold the other end of the band in your right hand and then internally rotate your right arm so that your right thumb points towards the floor and the back of your right hand faces forwards. Then, keeping your elbow extended, move your right arm away from your body (keeping the elbow straight) against resistance to just below shoulder level, and then let it return to the starting position in a controlled fashion. An easy refinement is to combine pure abduction with a little flexion so that you bring the arm forward as you move it away from your side.
Pinch your scapulae together
Pain should not be felt during any of the three exercises. Three-to-five minute sets over the course of a day will produce a conditioning effect. By shortening the length of the band you will be able to progressively increase resistance. There are a huge number of variations on the exercises described which achieve similar conditioning gains, and I make no claims for the superiority of the chosen three. However, they have worked well in my clinical practice and rarely cause unanticipated problems. Similar exercises can be carried out using the pulley systems found in most gyms and with further adaptations can be done with free weights. Maintaining scapular retraction (the scapulae are 'pinched together' towards the middle of your back and 'pushed down') while carrying out these exercises enables you to develop your scapular stabilising muscles at the same time.
Strengthening the scapular stabilisers without expert supervision is more difficult, but there is benefit in integrating wall leans (standing push ups ag