Massage therapy · Kitchener–WaterlooGlenohumeral Internal Rotation Deficit (GIRD)

GIRD is a loss of internal rotation of the shoulder. Internal rotation is the movement you use when reaching for your bra strap, tucking a shirt into your trousers or reaching behind your lower back. In throwing athletes, GIRD is usually defined as a loss of more than 20 degrees of internal rotation in the throwing shoulder compared with the other shoulder (Rose and Noonan, 2018). Please note that some texts or articles will refer to internal rotation as medial rotation.

The Thrower's Shoulder

How to Treat Glenohumeral Internal Rotation Deficit (GIRD)

Studies suggest that about 90 percent of throwers with GIRD respond to a stretching programme for the back of the shoulder (Codding et al., 2015), and rehabilitation usually progresses from stretching to strengthening, and eventually a return to play (Rose and Noonan, 2018). I can guide you through this with stretches such as the sleeper stretch and cross-body stretch, hands-on work for the back of the shoulder, strengthening, and a graded return to throwing worked out with your coach. See the My Approach tab for how I work.

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

• When the back of the shoulder tightens, the shoulder loses internal rotation, which can lead to pain.
• GIRD is a common finding in athletes who throw regularly. It is often found in baseball players, but can also be found in tennis players and other athletes who use overhead motions (Rose and Noonan, 2018).
• Most of the time, the condition develops gradually over time, rather than following an acute injury.
• Early complaints are often shoulder stiffness and needing a longer warm-up (Rose and Noonan, 2018). The pain may not be obvious at first, which is why the condition can keep developing slowly.
• Throwers might find that they lose speed (velocity) or control in their throws, which can accompany the loss of range of motion (Rose and Noonan, 2018).
• Throwers with GIRD can develop SLAP tears (a tear in the rim of cartilage at the top of the shoulder socket) (Rose and Noonan, 2018).

GIRD builds up slowly, so it often shows up as a stiff shoulder or a longer warm-up before it really hurts. My aim is to get back the internal rotation you've lost, build the strength that slows your arm down after a throw, and get you back to throwing, working with your coach.

I start by measuring how far both shoulders turn in and out and comparing them. I also test your rotator cuff and shoulder blade strength, check your neck, upper back, trunk and hips, and look at how you throw.

Restoring Rotation

• Hands-on work for the muscles at the back of the shoulder, including trigger point and myofascial work and pin-and-stretch
• Gentle joint mobilisation for the back of the shoulder joint, with no quick or forceful movements
• Stretching your shoulder for you while your arm stays relaxed, and contract-relax stretches where you gently push against my hand and then let go
• Teaching you the sleeper and cross-body stretches to do safely every day, kept gentle, because forcing them can pinch the front of the shoulder
• Self-massage with a lacrosse ball

Building Strength

• Rotator cuff strength, especially the muscles that slow the arm down after release
• Shoulder blade control, building from simple holds to rows and push-up variations
• Trunk and leg strength, including gym-based lifting when you're ready, so the shoulder isn't doing all the work

Return to Throwing

1. Rose, M.B. and Noonan, T. (2018) 'Glenohumeral internal rotation deficit in throwing athletes: current perspectives', Open Access Journal of Sports Medicine, 9, pp. 69–78. doi: 10.2147/OAJSM.S138975.
2. Codding, J. et al. (2015) 'Arthroscopic posterior-inferior capsular release in the treatment of overhead athletes', American Journal of Orthopedics, 44(5), pp. 223–227. PMID: 25950537.