NISMAT Arm Care Program: Comprehensive Guide for Throwing Athletes

For experts at the Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), Arm Care Program goes beyond simple exercises for the shoulder and upper extremity. Rooted in the philosophy of linkage by NISMAT founder Dr. James A. Nicholas, their approach emphasizes the interconnectedness of the entire body in maintaining a healthy throwing arm. This comprehensive arm care program provides evidence-based exercises that focus on strength, flexibility, and endurance throughout the body, from the ground up to the point of baseball release.

Unlike the Thrower’s Ten Program, which targets major upper extremity muscles based on general knowledge, the NISMAT arm care program is uniquely designed using electromyography (EMG) studies. These studies identify the muscles with maximal activity during throwing, ensuring the program targets the most crucial areas. Furthermore, NISMAT integrates stretching and mobilization exercises to enhance and preserve the mobility essential for proper throwing biomechanics, making it a holistic arm care program.

Similar in accessibility to the Thrower’s Ten Program, the NISMAT arm care program requires minimal equipment – just an elastic resistance band. This makes it convenient for athletes to perform anywhere, whether at home or traveling. It’s versatile enough for in-season maintenance, post-injury rehabilitation, and pre-season arm development, establishing itself as a truly adaptable arm care program.

Below are detailed exercises of the NISMAT arm care program to integrate into your routine:

Push-up plus (optional band)

Enhance your shoulder stability with the Push-up plus exercise.

How to perform:

1. Wrap a resistance band around your mid-back torso and assume a plank position on your hands and toes. Keep your elbows straight and feet together.
2. Lower your chest by bending your elbows, then push back up by straightening them.
3. Once your elbows are straight, push further down, protracting your shoulder blades forward.

Bilateral ER with scap retraction

Improve shoulder external rotation and scapular control with Bilateral ER with scap retraction exercise, an essential part of any arm care program.

How to perform:

1. Sit or stand and loop a resistance band around both wrists.
2. Bend your elbows to 90 degrees.
3. Pull the band apart by moving your hands outwards, simultaneously retracting your shoulder blades.

Standing horizontal abduction with neutral

Strengthen posterior shoulder muscles with Standing horizontal abduction with neutral exercise, crucial for a comprehensive arm care program.

How to perform:

1. Stand and hold the ends of a resistance band with palms facing inwards.
2. Keep elbows straight and move arms out to pull the band apart while retracting your shoulder blades.
3. Slowly return arms to the starting position.

Standing diagonal band pull-apart

Enhance dynamic shoulder stability with Standing diagonal band pull-apart exercise, a key component of an effective arm care program.

How to perform:

1. Stand and hold the ends of a resistance band.
2. Keep elbows straight, move one arm diagonally up and out while the other moves diagonally down and out.
3. Repeat for repetitions, then switch arm directions.

Standing row + 90/90 ER

Combine rowing and external rotation for comprehensive shoulder strength with Standing row + 90/90 ER exercise, a valuable addition to your arm care program.

How to perform:

1. Anchor the middle of a resistance band at waist height.
2. Stand back until band is taut, holding both ends.
3. Perform a row, pulling the band and bringing elbows back to chest level.
4. With elbows bent at 90 degrees, twist arms back, raising hands upwards.
5. Reverse the motion to return to the starting position.

Lawnmower

Improve rotational strength and core engagement with the Lawnmower exercise, an integrated part of the arm care program.

How to perform:

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

Side plank + shoulder ER

Enhance core stability and shoulder external rotation simultaneously with Side plank + shoulder ER exercise, maximizing efficiency in your arm care program.

How to perform:

1. Lie on your side with the arm underneath your body, band wrapped around each hand.
2. Lift into a side plank, supported by elbow and ankle in a straight line from ear to ankle.
3. Pin top arm against your side with shoulder blade retracted.
4. Rotate top hand towards the ceiling, keeping elbow pinned and lower hand anchoring the band.
5. Rotate as high as possible without compensation, and slowly return to start.

Quadruped thoracic rotation

Increase spinal mobility with Quadruped thoracic rotation exercise, improving overall flexibility in this arm care program.

How to perform:

1. Start kneeling with hands on the ground, rock back onto heels to limit lower back motion.
2. Place palm on the base of your head, rotate to point your armpit towards the ceiling, exhaling during rotation.

Quadruped thread the needle

Further enhance spinal mobility with Quadruped thread the needle exercise, complementing the rotation exercise in this arm care program.

How to perform:

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

Combined Quadruped Thoracic Rotation

For advanced mobility, combine both movements into Combined Quadruped Thoracic Rotation exercise, maximizing spinal flexibility in your arm care program.

How to perform:

1. Start with hand on the back of your head and rotate upward (thoracic rotation).
2. Return to neutral, remove hand from head and perform “thread the needle”.
3. Return to neutral quadruped position and repeat.

Shoulder IR at 90/90 Position

Strengthen internal rotation muscles with Shoulder IR at 90/90 Position exercise, vital for balanced shoulder strength in your arm care program.

How to perform:

1. Anchor band behind you at head level.
2. Hold band in exercising arm, facing away from anchor, bend elbow to 90 degrees.
3. Lift arm parallel to ground (90 degrees elevation), elbow aligned with shoulder.
4. Stagger stance, opposite foot forward as if throwing. Engage core.
5. Slowly rotate hand forward until parallel to ground, then return to start.

Standing Scaption

Target shoulder abduction in the scapular plane with Standing Scaption exercise, enhancing functional shoulder movement in your arm care program.

How to perform:

1. Hold band in both hands, anchored under feet.
2. Start with hands on thighs, engage core, raise arms in the scapular plane (45° from frontal).
3. Raise arms to approximately 100°, thumbs pointing up.
4. Slowly return to start.

Standing crossbody adduction posterior shoulder stretch (shoulder against wall)

Improve posterior shoulder flexibility with Standing crossbody adduction posterior shoulder stretch exercise, essential for a complete arm care program.

How to perform:

1. Lean thoracic spine against a wall, bring right arm to 90° flexion and internal rotation.
2. Place left arm over right and grasp right elbow.
3. Apply pressure through left elbow to further internally rotate right arm, feeling stretch in the back of the shoulder.
4. Pull right arm across chest, hand under left armpit to deepen stretch. Hold for 30 seconds and repeat.

Wall walk with theraband

Enhance shoulder and scapular upward rotation with Wall walk with theraband exercise, beneficial for overhead movements in your arm care program.

How to perform:

1. Loop a band without slack, shoulder-width apart.
2. Hands at shoulder height and width, alternate walking hands up a wall with the pinky side of the hand leading.
3. Walk up until elbows are slightly flexed at eye level, then reverse walk back down.

Seated forearm pronation with theraband/CLX

Strengthen forearm pronator muscles with Seated forearm pronation with theraband/CLX exercise, crucial for wrist and elbow stability in your arm care program.

How to perform:

1. Sit with forearm resting on thigh, hand/wrist past knee, palm up.
2. Position resistance band from outside of foot, grasp between thumb and first finger, band resting past pinky finger in palm.
3. Pronate forearm, turning palm down against band resistance.

Wrist ulnar deviation with theraband/CLX

Strengthen wrist ulnar deviators with Wrist ulnar deviation with theraband/CLX exercise, important for wrist function in your arm care program.

How to perform:

1. Flex shoulders to 90 degrees, elbows extended. Wrap resistance band around hands, palms down, band slightly stretched.
2. With palms down, move thumbs away from each other towards ulnar deviation.

Scientific Basis

The NISMAT arm care program is grounded in scientific research. EMG studies have played a crucial role in selecting these exercises, ensuring they effectively target the muscles most active during throwing motions. Research articles supporting the efficacy of specific exercises within this arm care program include:

• 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. https://doi.org/10.26603/001c.29900
• 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
• 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

By incorporating the NISMAT arm care program into your training regimen, you are taking a proactive, evidence-based approach to arm health, ensuring longevity and peak performance.