Table 3. Exercise Examples and Rationale for Employment*.

Guidelines	Goal(s)	Examples	Rationale
Establish proper postural alignment and proper motion.	Eliminate postural deficiencies: rounded shoulders, forward head, thoracic kyphosis, and lumbar lordosis. Improve motion deficiencies in glenohumeral, scapular, spinal, and lower extremity segments.	Programs designed to target all kinetic chain segments using manual therapy such as joint mobilization, passive stretching, active stretching using an exercise ball, and/or massage as well as home-based patient programs. Following immobilization, do not immediately mobilize the AC joint.	Malalignment and limitation of fluid motion throughout the kinetic chain can place loads and stresses in areas where excessive or repetitious loading is not tolerated.
Facilitation of scapular motion via exaggeration of lower extremity/trunk movement.	Use of the legs and trunk to perform trunk rotation or move from flexion to extension to gain scapular retraction.	Lawnmower with arm close to body Low row (seated or standing) Sternal lift Robbery	Using larger muscles and motions to facilitate smaller muscles and motions aim to decrease loads and stresses at smaller joints. Also, these movements mimic kinetic chain functioning.
Exaggeration of scapular retraction in controlling excessive protraction.	Assure the scapula is retracted or able to be easily retracted when performing arm movements. Limit the amount of protraction that occurs early which can decrease the function of the rotator cuff muscles.	Low row standing Wall washes	Assists with realigning the acromion and clavicle and establishes a firm foundation for rotator cuff muscle activation.
Utilize closed chain exercise before advancing to open chain exercise.	Decrease the forces acting on the arm and increase sensory feedback by utilizing closed chain exercise	Lawnmower with arm away from the body Fencing	Decreases traction on the arm and lessens the risk of ‘anterior-inferior-medial’ motion of the acromion in relation to the clavicle.
Work in multiple planes.	Utilize the previously established motion and strength to work on advanced motor control using open chain exercise(s) in multiple planes of motion.	Standing abduction Internal rotation and external rotation at 0°and 90°of abduction Standing forward elevation Standing elevation in plane of the scapula	Permits the introduction of longer levers and open chain movements in a controlled manner.
Incorporate long lever maneuvers.	Build muscle endurance and higher levels of strength utilizing maneuvers that require the arm to be further away from the body.		Perform challenging yet functional exercises that simulate activities of daily living and work/sport maneuvers. Incorporate trunk rotation with arm motion to increase shoulder and scapular muscle activation.

*Adapted from Sciascia and Cromwell Rehabil Res Pract 2012⁹¹