yogabook / functional exercises / Shoulder stabilisation

This page and this programme are not intended to replace consultation with appropriate specialists (orthopaedics, physiotherapy or HP sectoral physiotherapy) or to encourage them to dispense with it. Rather, in view of the rather limited choices and suggestions available, the aim is to provide an overview of the many ways in which meaningful intervention can be provided. This should not tempt you to pick exercises indiscriminately and one-sidedly and create imbalances or risk increasing existing ones. The recommendations of the experts to strengthen this or that muscular competence should be followed, and many possibilities for doing so will be shown here.

Overview

The shoulder joint(glenohumeral joint) has a flat and small joint surface(glenoid) on the side of the shoulder blade, which is opposed by a comparatively large humeral head. This is a very poor prerequisite for stability. The situation is slightly alleviated by the labrum (cartilage lip) surrounding the glenoid, but even with this, the shoulder joint remains heavily dependent on its ligamentous structure and sufficiently toned and balanced muscles. Injuries to the ligamentous apparatus, the muscles or their tendons can easily lead to instability of the shoulder joint, in which the humeral head tends to move out of its physiological position. These instabilities are often the result of trauma. The most important images in which the exercises of the fundus presented below are likely to come into play are:

• Shoulder dislocation (traumatic and habitual: rehabilitative and recurrence prophylactic)
• Shoulder instability
• Impingement

In cases of an unstable shoulder, it must be examined whether the situation can and should be improved surgically. This depends not least on the patient’s constitution, age and expected movement behaviour or the expected load-bearing capacity, i.e. also on the types of sport practised and the physical demands of the job. There are all kinds of variations here: from disorders that cannot be significantly improved by surgery and where the risk of surgery must be weighed against the vague benefits, to disorders that are best treated conservatively. In all cases, however, an exercise therapy programme, if prescribed after a previous phase of immobilisation and rest, provides valuable services or is even obligatory for an acceptable outcome.

Most attention is paid to the so-called rotator cuff, consisting of

• Teres minor: exorotator and adductor
• Supraspinatus: exorotator and initial lateral abductor
• Infraspinatus: strongest exorotator
• Subscapularis: adductor muscle and most important endorotator

which in total is said to have the greatest shoulder-stabilising effect. The subscapularis muscles on the one hand and the supraspinatus, infraspinatus and teres minor muscles on the other form two sets of antagonistic muscles that pull the humeral head into the glenoid by traction from the dorsomedial and ventromedial sides. The supraspinatus presses it into the glenoid by reaching over the humeral head from the cranial side.

However, a biceps brachii should not be forgotten, for example, whose long tendon runs through the sulcus of the humerus and also presses it directly into the glenoid, especially when the bent arm is carrying a load, but also due to the weight of the arm itself at rest when the arm is hanging down.

For the sake of completeness, it should be mentioned with regard to the glenohumeral joint that its range of motion depends to a certain extent on the position of the scapula in the scapulothoracic glenoid cavity. The less flexible a person is in this cavity, the more pronounced this dependency is. In the event of shoulder instability, it should always be checked whether the muscles moving the shoulder blade are in balance or whether there is an imbalance or scapular dyskinesia.

In the event of a dislocation or reluxation, this is very likely (95-97%) to occur anteriorly, i.e. forwards, very rarely and only in the case of special triggers posteriorly, i.e. backwards, and almost never inferiorly, i.e. downwards. Instabilities in an upward direction first lead to impingement and then, in the case of traumatic events with a large force applied in a superior direction, also to a fracture of the acromion with or without acromioclavicular joint disruption.

In all these cases, it is advisable to improve the muscular guidance of the joint. Muscular imbalances must be addressed. The type of instability and the direction of subluxation – usually in one direction – must be taken into account in the selection and sequence of exercises and exercise units.

San Antonio scheme

A not entirely unknown scheme for promoting shoulder stability (more precisely: reducing clinical instability) is the San Antonio scheme from the University of San Antonio in Texas, which is a small set of 6 simple exercises designed to stabilise the shoulder. These can easily be performed with a Theraband (latex band). The aim here is to go well beyond this limited scheme and introduce exercises with your own weight, e.g. asanas, as well as exercises with a theraband and weights.

Adduction(frontal adduction or lateral adduction) of the upper arm does not occur at all in the San Antonio scheme, although the adductors of the upper arm such as teres major, teres minor,
latissimus dorsi can provide additional stability. The teres minor is of particular interest here as an exorotating muscle.

No special mention is made in the San Antonie scheme of the
biceps. Although they are also strengthened during frontal abduction, they are supported by two other muscles, the coracobrachialis and deltoideus pars clavicularis. Simple biceps curls(elbow joint flexion against the force of gravity of a dumbbell, cable pull or Theraband) strengthen the biceps at least as well and contribute to the centring of the humeral head with the pull of its long tendon of origin.
the humeral head. Scott curls (upper arms placed on an incline) are less suitable here than those that start with the upper arm vertical, as the former primarily strengthen the brachialis from the starting position and the latter strengthen the hamstrings.
brachialis from the starting position and place great demands on the insertion of the biceps at the radius.

Movements in the glenohumeral joint

Endorotation should generally be practised less than exorotation and also not with a frontally abducted or laterally abducted arm, as the tendency to dislocate is significantly increased in both cases. The reason for this is that the endorotators of the shoulder joint are much stronger overall than the exorotators and, in addition, habitual factors such as screen work shift the weight and ROM in the direction of endorotation.
During endorotation exercises, the upper arm should be positioned against the torso, at best with the arm laterally abducted by 90° or frontally abducted. In the first phase after the immobilisation prescribed for a shoulder dislocation, exorotation should also only be practised very moderately, as any excessive traction can lead to a dislocation. This decision should be made depending on the direction of the subluxation.

The frontal abduction can be performed while standing with a Theraband anchored to the foot or chair leg or while sitting with a Theraband anchored to the foot or chair leg. Executions with dumbbells are proven classics
upper grip, but also in the lower grip, are proven classics of strength training. If, in addition to shoulder instability, there is also impingement
impingement, the upper angles cannot be used. The posture may only be performed until the impingement-associated pain occurs (at around 70°). In this case, it may be advisable to perform the exercise lying down, where the maximum strengthening is achieved around 0° frontal abduction in accordance with the effect of gravity and 70° is considered the upper limit anyway, as the effect of the exercise decreases too much from this point onwards in accordance with the cosine angle function.

Similar to frontal abduction, lateral abduction can also be performed using various techniques. Again, you can use the pulley, machine, dumbbell and Theraband. The classic technique is to perform it with anoverhand grip, but it can also be practised with an underhand grip from time to time. A combination of frontal abduction and lateral abduction also targets the biceps brachii, whose lateral head with its tendon running through the sulcus contributes to the stability of the shoulder joint. This is of course contraindicated in the case of a dislocated long biceps tendon.

Retroversion is usually performed from a slightly frontally abducted position. The greater the frontal abduction at the beginning, the more relevant the grip technique(upper grip or lower grip) becomes, as it leads to significantly different rotation of the upper arm in the shoulder joint and therefore to different responses of the adductor muscles of the shoulder joint. In principle, retroversions can also be performed with
can also be performed with the arm laterally abducted. If the arm is held in reasonably constant lateral abduction, this also serves to strengthen the lateral abductors such as the supraspinatus and deltoid muscles.
deltoid.

The tools used

Theraband

The Theraband (latex band) is a latex band, usually a few centimetres wide, which is used closed or open as traction resistance. Ideally, the force exerted by the band increases linearly as it stretches. The maximum length and the maximum tensile force (in Newtons) should be taken from the manufacturer’s instructions. Ideally, several strengths (resistance/force ranges) are available. The resistance to be selected depends on the strength of the muscle group to be worked and, due to the force/length function, the working range used with regard to the sarcomere length and, of course, the length of the lever, i.e. the lever arm.

The increase in resistance of the Theraband during stretching accommodates the force-length function on the side of long sarcomere lengths, but the progressive resistance of the Theraband then runs completely counter to the decreasing tendon strength in the direction of short sarcomere lengths. This must be borne in mind when performing Theraband exercises, and this is where cable machines can come up trumps if the exercises can be performed against gravity, as can dumbbells.

If a greater length is required than is available, a closed band can be cut crosswise once, resulting in double the length with half the resistance. In order to cover many possible applications with Therabands, at least the following attachment options are required:

• on the floor: one end can be fixed to the foot or a chair leg. However, this must be done securely without the strap being able to come loose from the fixation, as otherwise injuries such as reflex tensions can occur, not to mention direct impact injuries.
• on the wall, for example at „medium height“ or shoulder height: for closed straps, this can be a wall hook that is open at the top or bottom depending on the direction of pull, or a wall eyelet in which the closed strap is held by means of a fixator such as a snap hook. In the case of an open strap, this can simply be passed through the eyelet and gripped with both ends, with the same hand or one end with each hand, if the length is sufficient for the desired application. Otherwise, it can be knotted with the eyelet or a snap hook, but this requires effort when opening the knot.
  The main applications are transverse abduction and transverse adduction as well as exorotation and endorotation when the upper arm is attached to the upper body. Depending on the height of the wall eyelet and the relative position of the hand, other applications are also possible, such as elbow flexion (strengthening the biceps and brachialis, the former allows better fixation of the humeral head in the glenoid through its long tendon), extension of the elbow joint, frontal abduction, lateral abduction, and, depending on the position, also frontal adduction of the lateral adduction when sitting or lying on the floor. Rotation of the body in space relative to the attachment point results in different working areas for the muscles, i.e. different sections of the ROM are utilised, which increases the overall benefit compared to working with dumbbells of any kind.
• on the ceiling: the fastening of the hinge is analogue to the wall. Here, however, the rotation of the body in the room cannot be used to move the working area. This would require tilting the body in the sagittal plane, which is only practicable to a very limited extent.
  Above all, the ceiling allows lateral and frontal ad duction to be performed easily in a standing position.

Multiplicative effects

Due to the linearly increasing resistance of the Theraband, the maximum load is theoretically always reached at the end of the movement. However, this calculation is relativised by the fact that the movements of the human musculoskeletal system are always rotational movements in a one- or multi-dimensionally moving joint. Therefore, the effect of the variable size of the lever arm running perpendicular to this medium described for the pulley and the dumbbell also applies here. With the latter two, which exert an almost exactly constant physical force in accordance with gravity, the maximum load always occurs where the moving part of the limb, or more precisely: the distance from its centre of rotation to the part of the body holding the medium, is perpendicular to the rope or the direction of gravity. In the case of the Theraband, this variability naturally acts in addition to the linearly increasing resistance, so that these variables must be multiplied. As a result, from the point of the above-described perpendicular to the direction of force (direction of the rope or direction of gravity), the resistance available for the actual movement to be trained no longer increases but actually decreases and is successively replaced by an axial thrust of the distal bone into the joint, so that towards the end of the movement the actual movement is no longer performed against any perceptible resistance, but the limb is pulled all the more strongly in the direction of the rope or the floor.

Installation suggestion for therabands

A very efficient installation that can be realised with inexpensive means can consist, for example, of mounting the following on a stable wall, one above the other
a) a wall eyelet or mounting plate with an eyelet near the floor,
b) one near the ceiling and
c) one approximately in the centre between them, connecting them with a sturdy chain to which the Theraband can then be attached using a snap hook. The height of the Theraband’s attachment point can be finely adjusted using the chain. In addition, for the sake of completeness
d) another eyelet should be attached to the ceiling if it is not too high, otherwise another piece of chain will be required. At current prices, this installation can be realised for material costs of less than 40 euros. The materials used (galvanised steel throughout and an 8 mm wall eye in a 10 mm dowel) offer sufficient stability even with high tensile forces.
The picture above shows the upper attachment to the ceiling.

The chain is tensioned in two directions from the upper fastening on the wall shown here, to the fastening point on the ceiling shown above and to the fastening near the floor:

We recommend an additional fixing point approximately in the centre between the upper and the lower one:

The entire installation looks as follows (with two carabiners with therabanders)

This means that every important pulling direction can be realised and all movements in the shoulder joint can be trained. The cost advantage over a pulley machine with constant resistance, which has an upper and lower deflection point for great flexibility, is immense: even hobbyist devices are rarely available for a three-figure sum. And this means that transverse adduction and transverse abduction are not even as successful as with the above design proposal.

Dumbbells

Dumbbells, generally used as dumbbells or kettlebells, are somewhat less universally applicable than therabands because their effect always follows the direction of gravity, i.e. the normal to the earth’s surface. Certain effects are difficult to achieve with dumbbells, such as frontal adduction or lateral adduction, as they are essentially performed against the direction of gravity when the upper body is in an upright position. In the case of frontal abduction, the upper body can still be brought into the supine position, which results in the „pull-over“ exercise that allows at least the upper part of the ROM (large sarcomere length). An analogue to this for lateral abduction, for example in the lateral position on the contralateral side, is contraindicated for unstable shoulders, especially in the lower grip, as it is very difficult to maintain the necessary exorotation of the upper arm in the shoulder joint and thus minimise the risk of dislocation: due to the long lever, which is essentially horizontal at the start of the movement while the lateral adductors are still working at a very long sarcomere length, the starting weight should be selected accordingly defensively. This analogy has a serious design flaw in that the verticality of the arm and thus the end of the effectiveness is reached at the maximum force (according to the force-length function) of the lateral adductors of the shoulder joint to be trained. After passing the vertical, the lateral abductors are strengthened instead of the lateral adductors.

There are two fundamentally different types of dumbbells: those with a fixed weight and those that consist of a dumbbell bar and attachable weights. The latter appear attractive due to their flexibility and cost advantage over a small number of different dumbbells, but practice shows that fitting a different weight, be it the next higher or smaller one, quickly becomes a nuisance. In practice, the immediate availability of different weights (a kind of „random access“) usually proves to be the decisive argument in favour of several fixed-weight dumbbells. This is particularly true when training in supersets where different weights are required for both exercises, such as side raises or front raises, which can be performed with much lighter weights for the upper limb and with a large lever arm than dumbbell deadlifts, which involve the lower limb and can be performed with rather heavy weights that can sometimes be five times the weight used for side raises or even front raises. The weights that can be used for bicep training(curls), for example, are even further in between, so that re-mountable dumbbells represent a very significant loss of comfort, which usually has a very detrimental effect on training practice.

Cable pull

Pulley machines are well known from gyms. The most suitable machines for our purposes are those that can guide the rope either over a pulley near the floor or overhead. Basically, the exercises performed on these pulleys are biomechanically very similar to those performed with the Theraband, but there are usually a maximum of these two deflection points available, and because of the weights generally used as resistance, the inertia factor plays a much greater role than with Therabands, which means that the movement should be started somewhat more gently, especially at higher resistances, so as not to put excessive strain on the tendons and their insertions. This applies all the more if insertional tendinopathy is present in strained muscles. After all, depending on the relative position of the shoulder and gripping hand, the cable machine already offers significantly more pulling directions than the barbell.

Another difference is that the resistance offered by the cable machine remains the same over the entire working range, in contrast to the progressive resistance of the Theraband. However, both do not correspond to the force-length function of the trained muscle, but eccentric-based cable machines are practically not available on the market and are hardly practical. In principle, the Theraband, with its ideally linear increase in resistance during stretching, accommodates the force-length function on the side of long sarcomere lengths, but the progressive resistance of the Theraband then runs completely counter to the decreasing tendon strength in the direction of short sarcomere lengths. It is important to bear this in mind when performing Theraband exercises, and this is where cable machines can come up trumps.

Depending on the exercise, the maximum load of the cable pulling machine is at different points:

• if you move in the elbow joint, where the forearm is at a 90° angle to the rope
• if moved with the elbow joint held still in the shoulder joint, where the distance between the shoulder joint and the wrist is at a 90° angle to the rope.

In contrast, with the Theraband the effect of progressive resistance generally outweighs all physical effects, so that the maximum load almost always occurs at the end of the movement when the band is at maximum tension. However, the load there no longer acts quite regularly in the sense of the exercise, because the direction in which the band pulls deviates more and more from the normal to the rope as the sarcomere length becomes shorter and shorter, so that the lever perpendicular to the rope approaches zero more and more. This is a natural and unavoidable result (in the case of classic cable pulling machines) of the musculoskeletal system ’s ability to perform movement as a rotation in a joint. It was this anatomical fact that led to the development of eccentric machines, the discussion of which is beyond the scope of this article.

The exercises according to their main effect

Exorotation

Theraband

1. Standing exorotation with Theraband with the upper arm applied to the flank between an exactly or largely frontal position and the 90° exorotated(lateral) position of the forearm, sitting or standing, Theraband attached contralaterally.
   Working range: submaximal end rotation to maximal exorotation. Maximum load: due to the progressive resistance at the end of the movement(*)
2. the same as before, with a different rotation in relation to the anchor point of the Theraband, shifts the
   Working range: shifted according to the rotation
   Maximum load: due to the progressive resistance at the end of the movement(*)
3. Exorotation of the upper arm in supine position with the Theraband anchored inferiorly (e.g. at the foot) and the upper arm placed on the floor at 90° to the spine.
   Working range: just under180°,
   Maximum load: due to the progressive resistance at the end of the movement(*)
4. Exorotation of the upper arm in a sitting or standing position with the upper arm placed at shoulder height and the Theraband fixed to the foot or the same side as the chair leg.
   Working range: only about 90°.
   Maximum load: due to the progressive resistance at the end of the movement(*)
5. Variation of the last exercise by placing the upper body on a normal or inverted incline bench. There is no need for an incline bench if the Theraband can be attached flexibly in terms of height.
   Working range: 180° at best.
   Maximum load: due to the progressive resistance at the end of the movement(*)

Dumbbell

1. Exorotation of the upper arm with dumbbells in a sitting or standing position with the upper arm or elbow positioned at 90° laterally.
   Working range: approx. 90°
   Maximum load: with the arm horizontal, i.e. average sarcomere length of the exorotators
2. Variation of the above exercise by placing the upper body on an incline bench.
   Working range: up to 90° if the inclination of the incline bench is selected so that the forearm is horizontal at maximum end rotation of the upper arm
   Maximum load: shifted in the direction of greater sarcomere length
3. Exorotation of the upper arm with dumbbell in supine position with the elbow placed at 90° laterally, whereby the hand lifts from the maximally endowed position of the arm to just under 90°. Great attention must be paid to the retraction and depression of the shoulder blade.
   Working range: depending on endorotation ability, but considerably less than 90°
   Maximum load: at the start of the movement with the arm at maximum endorotation
4. Exorotation of the upper arm with dumbbell in lateral position with the upper arm supported on the flank
   Working range: depending on exorotation ability in the shoulder joint up to a maximum of 90°
   Maximum load: with horizontal forearm

Cable pull

1. Exorotation of the upper arm on a cable pulling machine with the cable running over the pulley on the floor or at a moderate height and the upper arm supported on the body; preferably on an adjustable incline bench
   Working range: up to approx. 90°
   Maximum load: with forearm at 90° to the rope

Endorotation

Theraband

1. Standing end rotation with Theraband with the arm positioned between an exactly or largely frontal position and the 90° exorotated(lateral) position of the forearm, sitting or standing … also with altered rotation in relation to the anchor point of the Theraband
   Working range: up to approx. 90°
   Maximum load: due to the progressive resistance at the end of the movement(*)
2. Endorotation of the upper arm in a lying position with the Theraband anchored superiorly overhead and the upper arm resting on the floor at 90° to the spine
   Working range:
   Maximum load: due to the progressive resistance at the end of the movement(*)
3. Endorotation of the upper arm while sitting or standing with an upper arm held at shoulder height with the other arm and a Theraband fixed to the ceiling
   Working range: up to 180°
   Maximum load: due to the progressive resistance at the end of the movement(*)
4. Variation of the last exercise by placing the upper body on a normal or inverted incline bench. There is no need for an incline bench if the Theraband can be attached flexibly in terms of height. The additional effort compared to the last exercise is hardly worth it.
   Working range: up to 180°
   Maximum load: due to the progressive resistance at the end of the movement(*)

Dumbbell

1. Endorotation of the upper arm with dumbbell in a lying position with the elbow placed at 90° laterally, with the forearm raised from the floor to just under 90° (vertical). Pay close attention to the retraction and depression of the shoulder blade.
   Working range: 90°, if the ability to exorotate is sufficient for this
   Maximum load: at the start of the movement and therefore with a long sarcomere length of the endorotators

Cable pull

1. End rotation of the upper arm on a cable pulling machine with the upper arm supported on the flank and the cable running over the pulley not too close to the floor, preferably at least at the same height as the shoulder, preferably on an adjustable incline bench
   Working range: approx. 90°
   Maximum load: with forearm perpendicular to the rope
2. the same as before, but with the frontal plane of the body turned towards the attachment point.
   Working range: if the attachment point is dorsal, the exorotation capacity of the upper arm is generally not sufficient,
   Working range: the working range is limited as a result; furthermore, the angle between the frontal plane and the distance between the elbow and the attachment point must be subtracted from the theoretical 90°.
   Maximum load: with forearm 90° to the rope

Frontal abduction

Theraband

1. sitting or standing with dumbbells
   Working range: 0° to 180° frontal abduction. If only work in shorter sarcomere lengths is required, the dumbbell can be placed on the same side of the leg in a seated position instead of returning the arm to 0° frontal abduction.
   Maximum load: due to the progressive resistance at the end of the movement(*)
2. Sitting or standing (depending on the length of the Theraband) with the Theraband fixed to the floor (with foot, chair leg or floor eyelet)
   Working range: from 0° to 180° frontal abduction
   Maximum load: due to the progressive resistance at the end of the movement(*)
3. lying on your back on the floor or, even better, on a weight bench. From the floor, the working range is 90°,
   Working range: on the floor: 90°, on the weight bench up to 180° theoretically, depending on its height and the retroversion capacity of the shoulder joint, but less in practice
   Maximum load: due to the progressive resistance at the end of the movement(*)
4. on an adjustable inclined bench.
   Working range: between 90° (horizontal backrest) and 180° (vertical backrest)
   Maximum load: due to the progressive resistance at the end of the movement(*)

Dumbbell

1. Sitting or standing with dumbbells
2. Working range: 0° to 180° frontal abduction. If only work in shorter sarcomere lengths is required, the dumbbell can be placed on the same side of the leg in a seated position instead of returning the arm to 0° frontal abduction.
3. Maximum load: with horizontal upper arm

Cable pull

Own weight / asanas

1. upface dog with feet upside down
2. salabhasana: hands pressed to the floor

Frontal adduction

Theraband

1. Sitting or standing with a Theraband attached high up, e.g. to the ceiling
   Working range: 180°
   Maximum load: due to the progressive resistance at the end of the movement(*)
2. Standing or sitting on both sides from the overhead position
   Working range: maximum of approx. 90° per arm
   Maximum load: due to the progressive resistance at the end of the movement(*)
3. lying on a weight bench or on the floor from the overhead position of the arm when attached to the wall. This corresponds to the dumbbell pull-ups. Caution if the shoulder is still quite unstable: always pay strict attention to maximum exorotation of the arm!
   Working range: 180°
   Maximum load: due to the progressive resistance at the end of the movement(*)

Dumbbell

1. Pull-ups: on a weight bench or an inverted incline bench, with both arms in an overhead position. Be careful if the shoulder joint is still quite unstable, as you must always ensure maximum exorotation of the arm! The overhand grip is considerably less risky than the underhand grip.
   Working range: theoretically 180+x° to x° frontal abduction, i.e. 180°.
   Maximum load: with the arm horizontal, but subjectively usually in the starting position in maximum frontal abduction due to the force-length function

Cable pull

1. sitting or standing with the rope running over the high pulley.
   Working range: 180°
   Maximum load: with horizontal arm
2. lying on a weight bench or on the floor from the overhead position of the arm. Be careful if your shoulder is still quite unstable: you must always ensure maximum exorotation of the arm! The underhand grip is considerably less risky than the overhand grip. Working range: 180+x° to x° , i.e. 180°
   Maximum load: when the arm is 90° to the rope

Asanas / self-weight exercises

1. Back extension performed as a frontal adduction, i.e. with the hands pressing down on the wall, which is countered by a force from the hip flexors so that the upper body does not lift up

Lateral abduction

Theraband

1. Standing with Theraband fixed under the foot or sitting with Theraband fixed under the foot or chair leg or with attachment point near the floor according to installation suggestion
   Working range: approx. 180°
   Maximum load: due to the progressive resistance at the end of the movement(*)
2. Sitting with the Theraband fixed under the chair leg or under a weight bench
   Working range: approx. 180°
   Maximum load: due to the progressive resistance at the end of the movement(*)
3. on both sides with a common Theraband, with bent or stretched arms, placed around the upper arms near the elbows or wrists or held with the hands. It is also possible to attach it to one of the two legs (ipsilateral or, more favourably, contralateral). Working range: greater sarcomere lengths of the deltoid, trains the supraspinatus very well
   Working range: depending on the version: if the arms are laterally adducted in front of the body in the starting position, over 90° can be achieved for each arm
   Maximum load: due to the progressive resistance at the end of the movement(*)
4. in lateral position with a Theraband fixed under the foot of a weight bench (at the end of the leg)
   Working range: up to 180°
   Maximum load: due to the progressive resistance at the end of the movement(*)

Dumbbell

1. Side raises standing or sitting, on one side or preferably on both sides, with an underhand grip or preferably with an overhand grip.
   Working range: almost complete ROM, i.e. approx. 180° depending on mobility.
   Maximum load: approximately at the horizontal line connecting the shoulder andwrist joints
2. Side raise on one side in lateral position on weight bench, optionally with start in lateral adduction, i.e. in front of or behind the body.
   Working range: x° lateral adduction to 180-x° lateral abduction, i.e. 180°
   Maximum load: in long sarcomere lengths with the arm approximately horizontal (or the line connecting the shoulder andwrist joints)

Cable pull

1. Lateral raise standing or sitting with pulley approximately behind the ispilateral foot
   Working range: up to 180°
   Maximum load: approximately with the arm horizontal or the line connecting the shoulder andwrist joints
2. Side raise on one side in lateral position on weight bench, optionally with start in lateral adduction, i.e. in front of or behind the body.
   Working range: x° lateral adduction to 180-x° lateral abduction, i.e. 180°
   Maximum load: approximately with the arm horizontal or the line connecting the shoulder andwrist joints

Asanas / self-weight exercises

1. ardha vasisthasana with pressure from the supporting hand away from the same side foot
2. vasisthasana with pressure of the supporting hand away from the lateral foot

Lateral adduction

Theraband

1. Lateral adduction, standing with the Theraband fixed to the ceiling or high according to the installation suggestion
   Working range: up to 180°
   Maximum load: due to the progressive resistance at the end of the movement(*)
2. on a weight bench in a lateral position with the Theraband fixed overhead, preferably with an underhand grip, especially if the shoulder is still unstable
   Working range: up to 180°
   Maximum load: due to the progressive resistance at the end of the movement(*)

Dumbbell

(pure lateral adductions cannot be performed with dumbbells)

Cable pull

1. Lateral adduction, seated or standing with high deflection point
   Working range: up to 180°
   Maximum load: approximately with horizontal arm or connecting line between shoulder andwrist joint
2. Lateral adduction, in lateral position with deflection point approximately overhead, the height of the deflection point shifts the possible working range, the less stable the shoulder is, the higher the deflection point should be selected
   Working range: up to 180°
   Maximum load: approximately with the arm horizontal or the line connecting the shoulder andwrist joints

Asanas / self-weight exercises

1. ardha vasisthasana with pressure from the supporting hand towards the foot at the side
2. vasisthasana with pressure from the supporting hand towards the foot at the side
3. trikonasana with the lower arm pressed against the lower leg
4. parsvakonasana with the hand supporting the floor pressed towards the foot of the outstretched leg
5. caturkonasana

Retroversion

Theraband

1. Standing or seated with the attachment point frontally centred or laterally offset, with the arm extended or bent, with an underhand or overhand grip
   Working range: depending on the available retroversion
   Maximum load: due to the progressive resistance at the end of the movement(*)
2. in supine position on a weight bench with attachment point above the body
   Working range: depending on the available retroversion and the height of the weight bench
   Maximum load: due to the progressive resistance at the end of the movement(*)
3. on an incline bench with the Theraband fixed not too low to the side in front of the body
   Working range: depending on the available retroversion, usually well over 90° in the sum of frontal adduction and retroversion
   Maximum load: due to the progressive resistance at the end of the movement(*)
4. in prone position on a weight bench with Theraband fixed to the floor (see installation suggestion)
   Working range: depending on the available retroversion
   Maximum load: due to the progressive resistance at the end of the movement(*)

Dumbbell

1. in prone position to the side of the body
   Working range: depending on the available retroversion
   Maximum load: approximately at 0° retroversion
2. in prone position on an inclined bench to the side of the body
   Working range: depending on the available retroversion, usually well over 90° in the sum of frontal adduction and retroversion
   Maximum load: with horizontal arm

Cable pull

1. Standing or sitting in the sagittal plane to the side of the body
   Working range: depending on the available retroversion
   Maximum load: where the line connecting the shoulder andwrist jointsis perpendicular to the rope
2. on an inclined bench with the pulley positioned laterally in front of the body below head height
   Working range: depending on the available retroversion, usually well over 90° in the sum of frontal adduction and retroversion
   Maximum load: where the line connecting the shoulder andwrist joints is perpendicular to the rope

Asanas / self-weight exercises

1. upface dog with feet upside down
2. jathara parivartanasana

Transverse abduction

Theraband

1. with the attachment point lying contralaterally at shoulder height in the frontal plane, with the arm extended or bent, also with the attachment point offset forwards in relation to the frontal plane or rotated around the longitudinal axis of the body in relation to the attachment point. Only the upper grip (rather supinated forearm) should be used here because the lower grip not only requires pronation but also limits exorotation in the shoulder joint, which can be very unfavourable or even risky, especially for unstable shoulders.
   Working range: depending on the position of the body in relation to the attachment point, but usually approx. 180°
   Maximum load: due to the progressive resistance at the end of the movement(*)
2. on both sides with bent or stretched arms at shoulder height
   Working range: theoretically up to 90° per arm
   Maximum load: due to the progressive resistance at the end of the movement(*)
3. in a prone or lateral position on a weight bench with the Theraband fixed sideways on the floor, seen transversely just at shoulder height
   Working range: depending on the length of the band and height of the bench up to a maximum of around 90°
   Maximum load: due to the progressive resistance at the end of the movement(*)

Dumbbell

1. in lateral position on a weight bench
   Working range: usually approx. 135° depending on the height of the bench
   Maximum load: with horizontal arm

Cable pull

1. with the attachment point positioned contralaterally at shoulder height in the frontal plane, with the arm stretched or bent, also with the attachment point offset forwards in relation to the frontal plane or with the body rotated around the longitudinal axis in relation to the attachment point
   Working range: approx. 180°
   Maximum load: with arm 90° to the cable pull

Asanas / self-weight exercises

Transverse adduction

Theraband

1. in supine position with Theraband fixed laterally at shoulder height
   Working range: up to a maximum of 180°
   Maximum load: due to the progressive resistance at the end of the movement(*)
2. Standing or seated with attachment point contralateral approximately in the frontal plane at shoulder height
   Working range: up to a maximum of approx. 180°
   Maximum load: due to the progressive resistance at the end of the movement (*)

Dumbbell

Transverse adduction can hardly be performed with the dumbbell.

Cable pull

1. standing or sitting with pulley contralaterally approximately in the frontal plane at shoulder height

Asanas / self-weight exercises

1. namaste with pressure of the hands against each other
2. Swivel seat on the wall