Understanding GIRD: The Hidden Threat to Throwers Uncovered at SSI Sports Science Conclave 2025

At the SSI Sports Science Conclave 2025, one of the most insightful and clinically relevant sessions focused on a silent yet widespread injury risk among throwers — Glenohumeral Internal Rotation Deficit (GIRD). The session was delivered by Dr. Renu Londhe, Consultant Physiotherapist, Shoulder & Sports Injury Department, Deenanath Mangeshkar Hospital, Pune, who offered a deep dive into the biomechanics of throwing and the devastating impact of untreated shoulder imbalance.

Throwing Begins from the Ground: The Power of the Kinetic Chain

Dr. Londhe emphasized that throwing is not just a shoulder action — it is a full-body movement driven by the kinetic chain. Every throw begins with:

• The reaction force from the ground

• Transfer of energy through the feet, legs, hips, trunk, and finally the shoulder

• Any break in this chain increases stress on the shoulder joint

“If force is not efficiently transferred from the lower body, the shoulder is forced to compensate — and that’s where injuries begin,” she explained.

The Crucial Role of the Scapula and Force Couples

A major focus of the session was on scapular balance and force couples — coordinated muscle groups that stabilize and move the shoulder:

• The Trapezius and Serratus Anterior act as a key force couple

• The Supraspinatus and Deltoid must remain balanced

• The Supraspinatus neutralizes and stabilizes the humeral head, preventing unwanted translation

Any weakness or imbalance in these force couples disrupts optimal shoulder movement, leading to:

• Shoulder instability

• Increased friction

• Eventual dislocation or tendon injury

What is GIRD and Why is it Dangerous?

Glenohumeral Internal Rotation Deficit (GIRD) is a condition seen commonly in throwers and overhead athletes, where:

• Internal rotation of the shoulder is significantly reduced

• External rotation increases abnormally

• The total arc of shoulder motion (normally ~180°) becomes distorted

Dr. Londhe demonstrated how:

• Normal athletes maintain balanced rotation

• Pitchers and throwers show excessive external rotation and restricted internal rotation

• This imbalance directly alters throwing biomechanics

Ligaments Under Stress: AIGHL and PIGHL

The session also explained how shoulder ligaments adapt — and often suffer — during repeated throwing:

• AIGHL – Anterior Inferior Glenohumeral Ligament

• PIGHL – Posterior Inferior Glenohumeral Ligament

With continuous high-velocity throwing:

• These ligaments tighten, stretch, or shift

• This leads to micro-instability and internal joint damage

From Tightness to Tears: The Spectrum of Pathology

Referencing the landmark research

“The Disabled Throwing Shoulder: Spectrum of Pathology”

by Dr. Stephen S. Burkhart, Dr. Craig D. Morgan, and Dr. W. Ben Kibler,

Dr. Londhe highlighted that:

• Simple posterior capsule tightness can snowball into major injury

• GIRD is directly linked to:

• SLAP tears

• Rotator cuff tears

• Labral injuries

• What starts as stiffness often ends in surgery if ignored

Rehabilitation Goals: Fix the Chain, Not Just the Pain

Dr. Londhe stressed that rehabilitation must go beyond local treatment. The primary goals include:

• Restoring internal rotation

• Strengthening the scapula and rotator cuff

• Improving core stability

• Emphasizing kinetic-chain-based rehabilitation

• Using:

• Proprioceptive training

• Plyometric exercises

• Functional movement retraining

“Without correcting the movement chain, pain relief alone is meaningless,” she noted.

The Pune Shoulder Rehabilitation Program: A Proven Model

The session also showcased the success of the Pune Shoulder Rehabilitation Program, which follows evidence-based kinetic-chain rehabilitation. Two athletes were cited as success stories:

• Ravi Kumar (Odisha)

• Dishant Patil (Maharashtra)

Both athletes suffered from throwing-related shoulder dysfunction and returned to sport successfully after structured GIRD-focused rehabilitation.

Key Takeaway from SSI Conclave 2025

Dr. Renu Londhe’s session made it clear that:

• GIRD is common, dangerous, and often overlooked

• Throwing injuries are not “just shoulder problems”

• Early detection, biomechanical correction, and kinetic-chain rehab can prevent career-threatening injuries

The session stood out as a powerful reminder that modern sports medicine is about movement science, not just pain management.