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Glenohumeral internal rotation deficit (GIRD) in the throwing athlete

Posted By  
09:00 AM

GIRD is a common condition in overhead or throwing athletes, particularly baseball pitchers. This condition is caused by excessive overload of the shoulder in end of range external rotation and abduction. The athlete shown in the picture to the right is in an extreme range of external rotation at the shoulder. His forearm is almost horizontal… try getting your arm into this position!

How does this happen?

GIRD is characterised by a loss of internal rotation at the shoulder compared to the other arm. When the shoulder is constantly externally rotated to end of range in this throwing or overhead position, a number of physical changes can occur in the shoulder over time:

  • Tightness through the capsule in the back of the shoulder joint due to too much external rotation and not enough internal rotation
  • Constant loading of the rotator cuff muscles on the back of the shoulder blade (leading to further tightness through the back of the shoulder)
  • Bony adaptations can also occur in the shoulder joint in the early years of overhead throwing due to excessive load

An individual with GIRD may not actually experience any physical pain or symptoms.

So, if I’m not getting pain, why is this a problem?

Although an athlete with GIRD may not actually be experiencing a lot of physical pain, it is important to address the biomechanical consequences of GIRD. The physical changes in the shoulder with GIRD, as described above, have the potential to cause a number of other conditions in the shoulder joint.

Tightness of the muscles and capsule in the back of the shoulder joint causes the head of the upper arm bone to be shifted forwards in its socket. This then causes the capsule at the FRONT of the shoulder to be STRETCHED. Over time, this stretching of the front of the shoulder capsule can lead to a tear of the shoulder labrum (also known as a “SLAP lesion”). GIRD has also been linked to other shoulder conditions including rotator cuff tears, instability of the shoulder joint and various forms of shoulder impingement.

How can I fix this?

  • A physiotherapist will examine both of your shoulders through their full range of motion to determine the difference between sides. They will assess whether the difference in range is significant enough to diagnose you with GIRD
  • To treat GIRD, your therapist will use various techniques to stretch the posterior capsule of the shoulder and will also provide you with exercises to strengthen the shoulder musculature and improve the mechanics of the shoulder blade
  • A shoulder arthroscopy may be performed in athletes or patients who do not see an improvement with non-operative management