NISMAT Arm Care Program

For the staff at the Nicholas Institute of Sports Medicine and Athletic Trauma, arm care is not just about a group of exercises to strengthen the shoulder and the upper extremity. For the NISMAT staff it goes back to our founder, James A. Nicholas, MD, and the concept of linkage. In order to keep the throwing shoulder healthy, we need to provide evidence-based exercises that address not only strengthening but also flexibility and endurance for the whole body from the ground to the release point of the baseball. The NISMAT Arm Care Program is different from The Thrower’s Ten Program which was designed to exercise the major muscles of the upper extremity necessary for throwing based on the inventors’ knowledge.  The NISMAT Arm Care Program activities were chosen based on EMG studies that demonstrate the maximal muscular activity for the specific muscles used during throwing. In addition, the NISMAT Arm Care Program incorporates stretching and mobilization exercises to improve and maintain mobility for throwing biomechanics. Similar to Wilk’s & Andrews’ Thrower’s Ten Program, the NISMAT Arm Care Program can be performed in any setting whether at home or on the road with an elastic resistance band, without any other equipment. It can be performed in-season to maintain arm strength and flexibility, as well as after injury as part of a rehabilitation program and even prior to the season for arm development.

Push-up plus (optional band)

Wrap a resistance band around your torso at the level of mid-back and assume plank position on hands and toes, with straight elbows and feet together. Bend your elbows to lower your chest, then push up by straightening your elbows. Once your elbows are straight, push further down to bring your shoulder blades forward.

Bilateral ER with scap retraction

While sitting or standing, tie a loop with a resistance band and wrap around both wrists. With elbows bent to right angles, pull the looped band apart by moving your hands out. Move your shoulder blades back as you move your hands apart.

Standing horizontal abduction with neutral

While standing, hold two ends of a resistance band with your palms facing inward. Keeping your elbows straight, move your arms out to pull the band apart while moving your shoulder blades back, then slowly move your arms in towards the middle.

Standing diagonal band pull-apart

While standing, hold two ends of a resistance band. Keeping your elbows straight, move one arm diagonally up and out while you move the other arm diagonally down and out. After the number of repetitions in this pattern, switch directions for your arms and repeat.

Standing row + 90/90 ER

Anchor the middle of a resistance band on a secure object at about waist height. Stand back so the band is taut as you hold both ends of the band. Perform a row by pulling the band and bringing your elbows back to the level of your chest. With your elbows bent at right angles, twist your arms back so your hands come up on top. Come back to the start position by doing all of the above backwards.


Anchor band at ankle level and stand slightly wider than shoulder width, rotated 90 degrees away from the band. “Mini-Squat” and grab band with hand furthest from anchored band. Allow band to rotate hips/spine towards the anchored band. Your feet should not move, but your chest should end up facing the band. Pull back on band using your shoulder muscle, and rotate “trunk”  back towards starting position, with band finishing at shoulder height.

Side plank + shoulder ER

Set up in side-lying with arm underneath body. Have band wrapped around each hand. Lift into a side plank position, so that the elbow and ankle are the only points of contact on ground. Emphasis on a straight line from ear, shoulder, hip, knee, and ankle from the front and top down view. Once in this position, “pin” top arm against the side of the body with shoulder blade pinched down and back. Rotate top hand towards the ceiling, while keeping top elbow pinched against body, and band anchored with lower hand. Rotate as high as possible without compensation, and slowly return to starting position. 

Quadruped thoracic rotation

In kneeling with hands on the ground rock back onto heels, as this will limit the motion in the low back. Put your palm on the base of your head, and rotate to try to point your armpit towards the ceiling. Exhale on rotation.

Starting from the quadruped position, reach with hand through “window” created by opposite arm and leg as far as possible. 

These can be combined to increase and maintain spinal mobility: start your hand on the back of your head and rotate upward (as in first video). On returning to neutral, remove your hand from your head and “thread the needle” by reaching as in the second video. Return to neutral quadruped position and repeat.

Shoulder IR at 90/90 Position  

Anchor band behind person so that it is level with the top of the head. Hold band in hand of exercising arm, face away from band, and  bend elbow to 90 degrees. Lift arm so that it is parallel to the ground (90 degrees of elevation) and elbow should be sticking straight out of the shoulder (not forward or behind). Stagger stance, with opposite foot in front as if throwing a ball. Engage core (pull ribs down), and slowly rotate the hand forward until it is parallel to the ground. Slowly return to the starting position and repeat.

Standing Scaption

Hold band in both hands and anchor under both feet.  Start with both hands on thighs, engage core and begin to raise arms up in the scapular plane (approximately 45° from frontal plane).  Continue to raise arms in this position, with thumbs pointed towards the ceiling, until you reach approximately 100°. Slowly return to the starting position and repeat.

Standing crossbody adduction posterior shoulder stretch (shoulder against wall)

Leaning thoracic against wall, bring right arm to 90° of flexion in the sagittal plane  with shoulder internal rotated.  Place left arm over right arm and grasp your right elbow.  Gradually put pressure through your left elbow to further pull your right arm into internal rotation.  You will begin to feel a pull in the outside/back of your shoulder.  Now proceed to pull your right arm across your chest so your right hand goes under your left armpit.  This will increase the stretch in the back of your shoulder.  Hold 30 seconds and repeat.

Wall walk with theraband

Position your band in a loop, without slack, bring the band out to shoulder width.  With your hands are placed at shoulder height and shoulder width alternate walking up the wall with the pinky side of the hand.  Once your elbows get to the same level of your eyes (elbows should be slightly flexed), reverse the walk back down to the starting position.

Seated forearm pronation with theraband/CLX

In a seated position place your forearm resting on your thigh so your hand/wrist is past your knee.  With your palm up, position the elastic resistance from the outside of your foot and grasp it between your thumb and first finger continuing the band through your palm so it comes to a rest past your pinky finger.  Grasping the band with palm up you will now pronate or try to turn palm down.  You will feel the resistance from the band as you attempt to rotate your palm down.

Wrist ulnar deviation with theraband/CLX

With your shoulders flexed to 90 degrees and elbows fully extended, wrap the resistance band around both hands so palms are facing down and the resistance band is already on mild stretch.  With palms facing down try to bring both thumbs away from each other towards ulnar deviation.

Scientific Basis

Mullaney, 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. Cite 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. Cite 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. Cite Download