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The NISMAT Arm Care Program: A Comprehensive Guide to Shoulder Health and Enhanced Performance

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For those dedicated to sports and activities that rely heavily on arm strength and mobility, ensuring optimal arm care is paramount. It’s not merely about performing a few shoulder exercises; it’s a holistic approach that considers the entire kinetic chain of the body. This is the philosophy at the heart of the Nismat Arm Care Program, developed by the experts at the Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT). Rooted in the pioneering work of Dr. James A. Nicholas, the program emphasizes the concept of linkage – the interconnectedness of the body from the ground up to the throwing arm.

Unlike generic arm strengthening routines, the NISMAT program is built upon evidence-based practices and extensive research. It moves beyond simply targeting major upper extremity muscles, like the Thrower’s Ten Program, to incorporate exercises selected based on electromyography (EMG) studies. These studies pinpoint the muscles that are most actively engaged during throwing motions, ensuring that the program directly addresses the key areas for throwers and overhead athletes. Furthermore, flexibility and mobility are integral components, recognizing their crucial role in proper throwing biomechanics and injury prevention.

Whether you’re an athlete looking to enhance performance, recovering from an injury, or aiming to proactively safeguard your arm health, the NISMAT Arm Care Program offers a versatile and effective solution. Requiring only a resistance band, this program can be seamlessly integrated into any setting – from your home to the gym or even while traveling. It’s designed to be adaptable for in-season maintenance, post-injury rehabilitation, and pre-season arm development, making it a truly comprehensive approach to arm care.

Understanding the NISMAT Philosophy: The Linkage Concept

The cornerstone of the NISMAT approach to arm care is the principle of “linkage.” This concept underscores that the health and function of the throwing arm are not isolated to the shoulder alone. Instead, it’s intricately linked to the entire body, starting from the ground up. Proper biomechanics in throwing and overhead movements involve a coordinated sequence of motion originating from the legs and core, transferring power through the torso and shoulder, and finally culminating in the arm and hand.

Ignoring this linkage and solely focusing on isolated shoulder exercises can be a critical oversight. The NISMAT Arm Care Program recognizes that limitations in flexibility, strength, or endurance in any part of this kinetic chain can negatively impact the shoulder, potentially leading to injury or reduced performance. Therefore, the program incorporates exercises that address the entire body, ensuring that all components of the linkage work harmoniously to support a healthy and powerful throwing motion.

Key Components of the NISMAT Arm Care Program

The NISMAT Arm Care Program stands out due to its evidence-based and comprehensive nature. Here are the key elements that define its effectiveness:

  • Evidence-Based Exercise Selection: Unlike programs based on anecdotal evidence, the NISMAT program meticulously selects exercises based on scientific research, particularly EMG studies. These studies identify the specific muscles that are most active during throwing and overhead movements, ensuring that the exercises directly target the critical muscle groups for optimal arm function and injury prevention.
  • Holistic, Full-Body Approach: Recognizing the “linkage” principle, the program doesn’t isolate the shoulder. It incorporates exercises that engage the entire body, from the legs and core to the shoulder and arm. This ensures that all parts of the kinetic chain are strengthened and conditioned to work together efficiently and effectively.
  • Emphasis on Flexibility and Mobility: Beyond strength, the NISMAT program places significant emphasis on flexibility and mobility exercises. These are crucial for maintaining proper throwing biomechanics, allowing for a full range of motion, and reducing the risk of injury. Stretching and mobilization exercises are integrated to improve joint movement and muscle elasticity.
  • Convenient and Accessible: The program is designed for practicality. Requiring only a resistance band, the exercises can be performed virtually anywhere, making it easy to adhere to the program whether you are at home, in the gym, or traveling. This accessibility promotes consistent training and program adherence.
  • Versatile Application: The NISMAT Arm Care Program is adaptable to various needs and stages of training. It can be used:
    • In-Season: To maintain arm strength, flexibility, and overall shoulder health throughout the competitive season.
    • Pre-Season: To build a solid foundation of arm strength and conditioning before the demands of the season begin.
    • Post-Injury Rehabilitation: As a crucial component of a comprehensive rehabilitation plan to restore arm function and strength after injury.

Exercises in the NISMAT Arm Care Program

The NISMAT Arm Care Program includes a series of carefully selected exercises, primarily utilizing resistance bands, to target key muscle groups and improve overall arm health. Below is a breakdown of the exercises with instructions:

Shoulder Strengthening Exercises

These exercises focus on strengthening the muscles around the shoulder joint, crucial for stability and power.

Push-up Plus (Optional Band)

Alt text: Performing a push-up plus exercise with resistance band for shoulder blade protraction in the NISMAT Arm Care Program.

  1. Wrap a resistance band around your mid-back torso and assume a plank position with hands and toes, elbows straight, and feet together.
  2. Bend your elbows to lower your chest towards the floor.
  3. Push back up by straightening your elbows.
  4. At the top, with elbows straight, push further down to protract your shoulder blades forward, rounding your upper back slightly.

Bilateral ER with Scap Retraction

Alt text: Bilateral external rotation exercise with scapular retraction using resistance band to strengthen rotator cuff and scapular muscles in the NISMAT Arm Care Program.

  1. Sit or stand, and loop a resistance band around both wrists.
  2. Bend elbows to 90 degrees.
  3. Pull the band apart by moving your hands outwards.
  4. As you pull, move your shoulder blades back together (scapular retraction).

Standing Horizontal Abduction with Neutral Grip

Alt text: Demonstrating standing horizontal abduction with neutral hand position using a resistance band to target posterior shoulder muscles in the NISMAT Arm Care Program.

  1. Stand holding the ends of a resistance band, palms facing each other (neutral grip).
  2. Keep elbows straight and move arms out to the sides, pulling the band apart.
  3. Simultaneously, move your shoulder blades back.
  4. Slowly return arms to the starting position.

Standing Diagonal Band Pull-Apart

Alt text: Performing standing diagonal band pull-apart exercise with resistance band to improve shoulder and scapular muscle activation in the NISMAT Arm Care Program.

  1. Stand holding ends of a resistance band.
  2. Keep elbows straight and move one arm diagonally up and out while moving the other arm diagonally down and out, pulling the band apart diagonally.
  3. Repeat for desired repetitions, then switch arm directions and repeat.

Standing Row + 90/90 ER

Alt text: Combination exercise of standing row and 90/90 external rotation with resistance band to enhance shoulder and upper back strength in the NISMAT Arm Care Program.

  1. Anchor the middle of a resistance band at waist height.
  2. Stand back, holding both band ends, so the band is taut.
  3. Perform a row: pull the band, bringing elbows back to chest level.
  4. From the row position, with elbows bent at 90 degrees, externally rotate arms by twisting hands upwards.
  5. Reverse the motion to return to the starting position.

Lawnmower Exercise

Alt text: Demonstrating lawnmower exercise with resistance band to improve rotational strength and core engagement in the NISMAT Arm Care Program.

  1. Anchor band at ankle level and stand slightly wider than shoulder-width, 90 degrees sideways to the anchor.
  2. “Mini-Squat” and grab the band with the hand furthest from the anchor.
  3. Allow the band to rotate your hips and spine towards the anchor. Feet stay still, chest faces the anchor.
  4. Pull back on the band using shoulder muscles, rotating your trunk back to the starting position, band finishing at shoulder height.

Side Plank + Shoulder ER

Alt text: Performing side plank with shoulder external rotation exercise using resistance band to strengthen core and rotator cuff muscles in the NISMAT Arm Care Program.

  1. Lie on your side, bottom arm underneath body. Wrap a resistance band around both hands.
  2. Lift into a side plank, supported by your elbow and ankles, maintaining a straight line from ear to ankle.
  3. “Pin” top arm against your side, shoulder blade pinched down and back.
  4. Rotate top hand towards the ceiling, keeping elbow pinned to your body and band anchored by the lower hand.
  5. Rotate as far as possible without compensating, and slowly return to starting position.

Shoulder IR at 90/90 Position

Alt text: Shoulder internal rotation exercise at 90/90 position with resistance band to strengthen internal rotators of the shoulder in the NISMAT Arm Care Program.

  1. Anchor band behind you at head level. Hold band in the hand of the exercising arm, facing away from the anchor. Bend elbow to 90 degrees.
  2. Lift arm to shoulder height (90 degrees elevation), elbow pointing straight out from the shoulder.
  3. Stagger stance, with the opposite foot forward as if throwing. Engage core.
  4. Slowly rotate hand forward and down until parallel to the ground.
  5. Slowly return to starting position and repeat.

Standing Scaption

Alt text: Performing standing scaption exercise with resistance band to strengthen shoulder abduction in the scapular plane in the NISMAT Arm Care Program.

  1. Hold band ends in both hands and anchor under both feet. Start with hands on thighs.
  2. Engage core and raise arms in the scapular plane (45° forward from the side), thumbs pointing up.
  3. Continue raising arms to approximately 100 degrees.
  4. Slowly return to starting position and repeat.

Spinal Mobility Exercises

These exercises focus on improving the mobility of the spine, particularly the thoracic spine, which is essential for efficient power transfer in throwing motions.

Quadruped Thoracic Rotation

Alt text: Quadruped thoracic rotation exercise to improve upper back mobility and spinal rotation in the NISMAT Arm Care Program.

  1. Start in quadruped position (hands and knees). Rock back onto heels to limit lower back motion.
  2. Place one palm on the base of your head.
  3. Rotate your torso, trying to point your armpit towards the ceiling. Exhale during rotation.
  4. For a combined movement, after rotation upwards, return to neutral, remove hand from head, and “thread the needle” by reaching under your body, extending your arm as far as possible. Repeat the upward rotation followed by the thread the needle movement.

Wall Walk with Theraband

Alt text: Performing wall walk exercise with theraband to improve shoulder range of motion and thoracic spine mobility in the NISMAT Arm Care Program.

  1. Position a theraband loop without slack, shoulder-width apart.
  2. Place hands at shoulder height and width on a wall, holding the band.
  3. Alternately walk hands up the wall, leading with the pinky side of your hand.
  4. Continue until elbows are at eye level (slightly flexed).
  5. Reverse the walk back down to the starting position.

Forearm and Wrist Exercises

These exercises target the forearm muscles, which are important for grip strength, wrist stability, and injury prevention, particularly in throwing and racquet sports.

Seated Forearm Pronation with Theraband/CLX

Alt text: Seated forearm pronation exercise using theraband to strengthen forearm pronator muscles in the NISMAT Arm Care Program.

  1. Sit with forearm resting on your thigh, hand/wrist past your knee, palm up.
  2. Position elastic resistance from the outside of your foot, grasp it between thumb and first finger, band running across palm, resting past pinky finger.
  3. Grasping band with palm up, pronate your forearm, trying to turn palm down against the band’s resistance.

Wrist Ulnar Deviation with Theraband/CLX

Alt text: Wrist ulnar deviation exercise with theraband to strengthen wrist and forearm muscles involved in ulnar deviation in the NISMAT Arm Care Program.

  1. Flex shoulders to 90 degrees, elbows fully extended. Wrap a resistance band around both hands, palms down, band slightly stretched.
  2. Keep palms facing down and move both thumbs away from each other, towards ulnar deviation (bending wrist towards pinky finger).

Posterior Shoulder Stretch

This stretching exercise improves flexibility in the posterior shoulder muscles, often tight in overhead athletes.

Standing Crossbody Adduction Posterior Shoulder Stretch (Shoulder Against Wall)

Alt text: Standing crossbody adduction posterior shoulder stretch against a wall to improve posterior shoulder flexibility in the NISMAT Arm Care Program.

  1. Lean your upper back (thoracic spine) against a wall.
  2. Bring right arm to 90 degrees flexion in front of you (sagittal plane), shoulder internally rotated (thumb pointing down).
  3. Place left arm over right arm and grasp your right elbow.
  4. Gently apply pressure through your left elbow to pull your right arm further into internal rotation, feeling a stretch in the back/outside of your right shoulder.
  5. Then, pull your right arm across your chest so your right hand goes under your left armpit, intensifying the stretch in the back of your shoulder. Hold for 30 seconds and repeat.

Benefits of the NISMAT Arm Care Program

Integrating the NISMAT Arm Care Program into your training or rehabilitation regimen offers a multitude of benefits:

  • Reduced Risk of Injury: By addressing muscle imbalances, improving flexibility, and strengthening key muscle groups throughout the kinetic chain, the program helps minimize the risk of common arm injuries, particularly in overhead sports.
  • Enhanced Athletic Performance: A healthy and strong arm is crucial for optimal sports performance. The program helps athletes generate more power, improve throwing accuracy and velocity, and enhance overall arm function.
  • Effective Rehabilitation: For individuals recovering from arm injuries, the NISMAT program provides a structured and evidence-based approach to regain strength, mobility, and function, facilitating a smoother and more complete recovery.
  • Improved Shoulder Mechanics: The program promotes proper shoulder biomechanics by focusing on scapular stability, rotator cuff strength, and overall shoulder muscle balance. This leads to more efficient and safer movement patterns.
  • Increased Arm Endurance: Through targeted exercises, the program enhances the endurance of arm muscles, allowing athletes to maintain performance and reduce fatigue during prolonged activity or competition.

Scientific Evidence Underpinning the Program

The effectiveness of the NISMAT Arm Care Program is grounded in scientific evidence and research. The exercises are selected based on EMG studies that analyze muscle activation during throwing and related movements. These studies, such as those published in the International Journal of Sports Physical Therapy, have investigated the effectiveness of band exercises and specific movement patterns in activating key shoulder and forearm muscles.

References:

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20part%20of%20their%20arm%20care%20program.%22%2C%22date%22%3A%222023%22%2C%22language%22%3A%22eng%22%2C%22DOI%22%3A%2210.26603%5C%2F001c.68073%22%2C%22ISSN%22%3A%222159-2896%22%2C%22url%22%3A%22%22%2C%22collections%22%3A%5B%22S56ZU2DB%22%5D%2C%22dateModified%22%3A%222023-06-19T19%3A33%3A15Z%22%7D%7D%5D%7DMullaney, M., Nicholas, S., Tyler, T., Fukunaga, T., & McHugh, M. (2021). Evidence Based Arm Care: The Throwers 10 Revisited. *International Journal of Sports Physical Therapy*, *16*(6), 1379–1386. [https://doi.org/10.26603/001c.29900](https://doi.org/10.26603/001c.29900) [Cite](https://nismat.org/wp-content/plugins/zotpress/lib/request/request.cite.php?api_user_id=2488608&item_key=B9SR6RKD "Cite in RIS Format") [Download](https://nismat.org/wp-content/plugins/zotpress/lib/request/request.dl.php?api_user_id=2488608&dlkey=MS8T773A&content_type=application/pdf "Download")





Fukunaga, T., Fedge, C., Tyler, T., Mullaney, M., Schmitt, B., Orishimo, K., McHugh, M., & Nicholas, S. (2022). Band Pull-Apart Exercise: Effects of Movement Direction and Hand Position on Shoulder Muscle Activity. *International Journal of Sports Physical Therapy*, *17*(3), 400–408. [https://doi.org/10.26603/001c.33026](https://doi.org/10.26603/001c.33026) [Cite](https://nismat.org/wp-content/plugins/zotpress/lib/request/request.cite.php?api_user_id=2488608&item_key=ZQH5J6TS "Cite in RIS Format") [Download](https://nismat.org/wp-content/plugins/zotpress/lib/request/request.dl.php?api_user_id=2488608&dlkey=PRNCCNX5&content_type=application/pdf "Download")





Fukunaga, T., Fedge, C., Tyler, T., Mullaney, M., Schmitt, B., Orishimo, K., McHugh, M., & Nicholas, S. (2023). Flexor-Pronator Mass Training Exercises Selectively Activate Forearm Musculature. *International Journal of Sports Physical Therapy*, *18*(1), 208–214. [https://doi.org/10.26603/001c.68073](https://doi.org/10.26603/001c.68073) [Cite](https://nismat.org/wp-content/plugins/zotpress/lib/request/request.cite.php?api_user_id=2488608&item_key=YG5YDUWB "Cite in RIS Format") [Download](https://nismat.org/wp-content/plugins/zotpress/lib/request/request.dl.php?api_user_id=2488608&dlkey=HLP2BZG5&content_type=application/pdf "Download")

By integrating the NISMAT Arm Care Program into your routine, you’re investing in the long-term health and performance of your arm, backed by the expertise of a leading sports medicine institute and the rigor of scientific research.

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