Seated Stability Ball External Rotation w/ Manual Resistance

Dynamic shoulder stability is extremely important in both rehabilitation and prevention.  Unfortunately, all too often we get comfortable prescribing low level rotator cuff exercises that the patient gets bored with.  For those patients that are ready to advance or need more dynamic stability of the shoulder, this exercise will most definitely challenge them.  There are multiple ways to progress this difficult exercise which is why it is so valuable to have in your toolbox.  It is especially useful for your high level athletes, such as baseball players, who often are in need of dynamic stability of the shoulder.     

Have the patient seated on a stability ball with their feet close together to challenge the core immediately.  Using a cable or theraband, have the patient assume the starting position for shoulder external rotation with a towel roll in between their arm and body.  Next, have them perform external rotation to adjust to the stability ball.  When ready, begin each repetition with manual resistance throughout the concentric portion of ER.  It is important to begin the resistance at the beginning of the exercise where often the theraband is more slack or the cable is providing less resistance.  
There are multiple ways you can challenge and progress this exercise:
   - Have the patient perform external rotation and hold at a certain degree (45, 60, 90) against manual resistance (good for when a certain range of the motion is weaker)
   - Have the patient extend their opposite knee to increase core activation and further challenge the shoulder stabilizers
   - Have the patient hold a dumbbell with their opposite arm in an abducted position while performing the exercise to increase co-contraction of the shoulder musculature, increase endurance of the shoulder stabilizers, and promote physiologic overflow.