Shoulder injuries are very common in many areas of sport and fitness. They are particularly common in swimming, shoulder workouts and other overhead activities (Javelin etc). These injuries can be irritating and debilitating as well as enforcing prolonged stints on the sideline. The most common shoulder injury is the rotator cuff injury. The shoulder joint is a ball and socket joint and allows the most range of movement of any joint in the body. The rotator cuff supplies the shoulder with connection, protection and mobility of the joint. These actions are performed by the SITS complex (Subscapularis, infraspinatus, teres minor and supraspinatus). The rotator cuff monitors and allows the following movements:

• Internal/ External Rotation of arm.
• Stabilise Humerus.
• Allow arm be horizontally abducted to 180°.

There are a range of injuries that can affect the rotator cuff muscles and tendons. A typical tear is normally categorised as an acute injury, thus not from overuse or repetitive loading. There are certain injuries that can occur, all being the result of overuse (generally in rotator cuff). Impingement of the supraspinatus becomes apparent from forward and internal rotation of the arm. This is common in swimming and the end of throwing phase. This results in tenderness and inflammation of this tendon, which, in addition to being uncomfortable and painful, will also result in decreased performance. The increased range of movement in the shoulder joint also results in decreased shoulder stability, which is the basis of many other injuries.

Rotator cuff injuries can be divided into three phases, they are as follows

• 1. In overhead athletes such as swimmers, small muscles are susceptible to fatigue early or even absence altogether. This is usually treated with rest.
• 2. Mainly in 25-40 years old, tendons have become over used and are inflamed and thickened. Aching increases. Physio may be needed as well rehabilitation exercises and even cortisone injections.
• 3. Increase with age, most predominant after 40. Overuse and ageing process are the major factors affecting stage 3. This stage would almost indefinitely lead to surgical procedures.

In order to decrease the occurrence/susceptibility of these injuries, maintain strong shoulders and rotator cuff muscles. Pre-habilitation. All these exercises are to be done with the assistance of resistance tubing (Unless otherwise stated). All exercises should be done 15-30 times on each arm:

Initial Position	Exercise Name	Description
Secure tubing to object, so can reach with arm extended above head.	Throwing acceleration	Face away from anchor point and grasp overhead (thumb down). Pull arm down toward opposite hip.
Shoulder Extension	Face toward anchor. Arm forward, pull back as far possible.
Secure to level in line with fingers, with arm at side.	External humeral rotation	Arm abducted to 90°, elbow flexed 90° with maximal int rotation. Rotate shoulder to be external rotation.
Throwing deceleration	Face anchor, shoulder flexed 30°. Cock shoulder, arm and elbow 90° and shoulder ext rotated. Move as in throwing motion.
Shoulder flexion	Face away, straight arm externally rotated. Move to fully flexed position, keep straight. Repeat.
Scapular row	Face, elbow extended, shoulder flexed, scapula protracted. Pull back on tube by squeeze scapula and flex elbow.
Scapular punch	Face away. Arm by side, elbow flexed and scaps together. Punch forward extending elbow.
Tube centre underneath feet.	Full can	Abduct arm away from side with thumb upward in scap plane (30° from body horizontal). Flex till arm 90°.
General Stretches	Chest Stretch	On back arms out stretched, knees bent with feet on ground. Allow knees to fall to ground whilst try keep shoulders planted. Hold for one minute.
Posterior capsule stretch	Reach arm around body and try touch opposite shoulder blade. With other hand push elbow. Hold for one minute.

If these exercises are performed correctly and frequently they should increase shoulder stability and strength. This will lead to a decrease in shoulder injuries.