Primary lever should be positioned back with lever handle resting forward on elbow pad. Lift lever handle and sit on seat with arm pads and lever to side. Place elbow in elbow pads at shoulder height and grip handle with over hand grip so forearm is orientated upward and back. With opposite hand, grasp seat handle if available, for added stability.
Pull lever handle forward and downward as far as possible by rotating upper arm. Allow lever to return to original position. Repeat. Continue with opposite arm.
Turn seat facing inward at 45° if external rotation ROM of shoulder is limited. Consequently placing the upper arm in this plane limits internal rotation ROM of shoulder and Supraspinatus will assist slightly in interal rotation.