Explained: GIRD in Throwers

GIRD is an adaptive process in throwers that takes place due to constant repetitive anterior elongation of the shoulder capsule in the late cocking phase of the throwing

Throwing motion overuse injuries frequently include the shoulder, elbow, and less frequently the wrist. Sports medicine professionals, physical therapists, and doctors must have a thorough understanding of the biomechanics of throwing to treat throwing athletes.

The six phases of throwing include windup, stride, arm cocking, acceleration, deceleration, and follow-through. Any area where there is a weakness could cause the thrower’s shoulder and elbow to be under more strain. Understanding the dynamic phases of throwing is crucial for comprehending how overhead athletes’ overuse issues develop. Each stage applies force to a different part of the body, possibly harming it.

We attempt to explain and comprehend Glenohumeral Internal Rotation Deficit (GIRD) in this piece – The evaluation, treatments, and exercises for a healthy arm and shoulder when you are a thrower.

Introduction

In the case of throwers, the throwing shoulder loses the normal range of internal rotation (IR) due to a process which is known as glenohumeral internal rotation deficit (GIRD). The most common way to define GIRD is by a >20° IR loss when compared to the opposite shoulder.

When diagnosing the rotational deficit, the value of total rotational motion (TRM), which is the sum of internal and external rotation (ER), of the shoulder may be more significant than the absolute value of IR loss.

GIRD is an adaptive process in throwers that takes place due to constant repetitive anterior elongation of the shoulder capsule in the late cocking phase of the throwing (Fig-1) where the athlete acquires excessive ER and horizontal abduction resulting in a lack of IR ROM in the shoulder joint.

Phases of throwing

Moreover, GIRD is not always pathologic, and when the shoulders’ total rotational motion (TRM) is symmetric, decreased IR (as compared to the nonthrowing shoulder) can exist without coexisting shoulder pathology. On the other hand, a loss of TRM >5° compared to the contralateral shoulder indicates the presence of pathologic GIRD. Reduced shoulder strength and higher injury rates, mostly in baseball pitchers, have been linked to this 5° change.

Due to the repetitive cocking that takes place during the overhead throwing motion, posterior capsular and rotator cuff tightness is the most common pathologic process in GIRD.

The static and dynamic stabilizers of the shoulder joint, including the rotator cuff, joint capsule, and labrum, are put under a lot of strain by these repetitive, extreme movements. These structures are subjected to loads with each throw that are dangerously close to the point of failure, leaving them open to injury. While a single traumatic event may result in a shoulder injury, repeated overuse seems to be more frequently to blame for several pathologic conditions, such as posterior labral tears, partial articular-sided posterosuperior rotator cuff tears, and superior labral anterior-to-posterior (SLAP) tears.

How to assess pathologic GIRD

The initial complaints in athletes with pathologic GIRD are frequently shoulder stiffness, the need for a lengthy warm-up, and loss of velocity (dead arm).

The late cocking position is frequently provoking, and the pain frequently localizes to the posterior shoulder. Pain can be reproduced by palpating the soft tissues close to the posterior joint line.

Any throwing athlete who presents the above symptoms in the shoulder joint must be highly suspected of GIRD, as there is a high prevalence of GIRD in overhead throwers.

As a result, it is imperative to evaluate the shoulder’s passive IR and TRM in all throwers who are experiencing shoulder pain. Having the patient lie supine on the exam table is the preferred position for determining the loss of IR of the shoulder. Following that, the examiner can flex both elbows and abduct both shoulders to 90 degrees. The throwing shoulder’s maximum passive ER and IR are then evaluated in relation to the opposite extremity, with differences between the two being quantified with a goniometer (Fig-2).

Assessing TRM

The crucial point at which the scapula starts to lift from the examining surface is known as maximum passive IR. In general, GIRD is diagnosed by a difference between the affected side and the contralateral side of 20° or more. The shoulder’s TRM is equal to the product of the maximum ER and IR.

Nonsurgical or Conservative Treatment of GIRD

Stretching and strengthening of the posterior capsular muscles to improve scapular mechanics is the cornerstone of treatment for people with GIRD.

The sleeper and cross-body stretches are typically used for active stretching in throwing athletes.

Strengthening exercises followed by stretching exercises target various muscles around the shoulder joint such as the supraspinatus, trapezius, pectoralis, deltoids, rhomboids, etc for strengthening and preventing further risks of GIRD.

Physiotherapy Interventions for GIRD

• Stretching Exercises

1. Sleeper (Posterior Capsule) Stretch
2. Cross-body (Posterior Capsule) Stretch
3. Corner (Pectoralis Major) Stretch
4. Triceps (Inferior Capsule) Stretch

• Strengthening Exercises

1. Scapular muscle strengthening (I’s, Y’s, Ts with weight)
2. Ceiling Punch with weight
3. Rhomboid rows with weight
4. TheraBand Throwing Exercises

Conclusion

Tennis players and baseball pitchers are two top athletes who frequently exhibit Glenohumeral Internal Rotation Deficit (GIRD). When compared to the opposing, non-dominant shoulder, GIRD describes a loss of internal rotation range of motion in the shoulder joint. It’s crucial to keep in mind that GIRD is not always pathological and that it may, in some athletes, represent a typical response to the demands of their activity. To improve performance and lower the risk of shoulder injuries, GIRD must be addressed and managed if it is excessive, asymmetrical, or linked with pain or dysfunction. Individuals can benefit from assessing their condition and developing an appropriate treatment plan in collaboration with a skilled healthcare provider, such as a sports medicine doctor or physical therapist.