What is G.I.R.D.?
G.I.R.D. stands for Glenohumeral Internal Rotation Deficit. As the name implies, it is a condition in which one side (usually the dominant side) is lacking internal rotation in the shoulder (glenohumeral) joint when compared with the opposite side.
This condition is usually seen in athletes that perform excessive overhead motions. G.I.R.D. is especially common in baseball pitchers. G.I.R.D. in pitchers is caused by repetitive throwing and is thought to occur during the late cocking and acceleration phase.
Wind-up Cocking Late-cocking Acceleration Deceleration
There have been several theories as to why G.I.R.D. occurs; however, there is one that is most commonly agreed upon. This theory states that the posteroinferior capsule (the backside of the shoulder) becomes repeatedly stretched as the ball is being released. During the release period, the capsule experiences a violent distraction motion. Each time this happens, microtearing of the capsule can occur. This results in a loose anterior capsule (front of the shoulder) and a tight posterior capsule. A tight posterior capsule is what causes the G.I.R.D. to occur.
Signs and Symptoms:
G.I.R.D. is often an overlooked condition. Sometimes its symptoms can be confused with glenohumeral instability or internal impingement. This is why it is important to be able to recognize the signs and symptoms. Early warning signs include: soreness in the back of the shoulder that persists longer than 3 days after throwing, soreness that takes a long time to be relieved when pitching, and/or soreness that cannot be relieved with rest. Of course, the most obvious sign of G.I.R.D. is a deficit of internal rotation 25 degrees or greater when compared to the opposite side. However, some pitchers or overhead athletes will have an internal rotation deficit and never have any problems.
Why should we care?
If G.I.R.D. is left untreated, it can result in other injuries like rotator cuff impingement, ulnar collateral ligament tears, SLAP lesion, or biceps tendinitis. It can also affect overall pitching performance. Velocity and ball control usually coexist with G.I.R.D.
What can be done?
There are several treatments that can be done to for G.I.R.D. One of the main treatments is rest, accompanied with a physical therapy program. Athletic trainers can develop a physical therapy program that will aid in treating the underlying problems of G.I.R.D. (i.e. posterior capsule joint mobilizations and strengthening of the serratus anterior and subscapularis muscles, etc.) Pitching coaches can identify improper throwing mechanics that need to be corrected. Finally, athletes can be proactive in their stretching to ensure G.I.R.D. does not occur. The posterior capsule of the shoulder and the pectoralis minor muscle need to be stretched several times a day. One way this can be done is by the two stretches pictured below:
Sleeper Stretch Series:
For a detailed explanation of the sleeper stretches please visit: http://www.shoulderdoc.co.uk/article.asp?article=1330
Pectoralis Minor Muscle Stretch Series:
Hold each position for 30 seconds. Perform entire series three times.
If non-operative treatment does not work, surgical release is possible but used rarely.