GIRD Doesn't Matter
In baseball sports medicine there has existed a mythical creature known as Glenohumeral Internal Rotation Deficit (GIRD) since before I was born. It’s considered normal for throwing athletes to present with some abnormal shoulder range of motion (ROM) findings. But just how Patellofemoral Pain Syndrome (PFPS) tells me nothing more than someone’s knee hurts, GIRD simply tells me, “these shoulders don’t match.” I don’t even want to get into defining GIRD because that’s the point of this article. It doesn’t matter and here’s why.
Note: but if you want, here’s a link to 11,300 Google Scholar search results for GIRD. No matter the diagnosis, what’s the #1 priority with any treatment plan or training program? The patient/client’s end goal. In this particular case throwing a baseball might be the goal. As a coach or therapist, if an athlete or patient doesn’t have something to support their end goal, we give it to them. So a diagnosis of GIRD, in the absence of meaningful and identifiable pathology, is not useful. GIRD is not a diagnosis or a particularly meaningful construct. If GIRD insinuated a soft tissue injury which requires the respect of a tissue healing timeline and subsequent precautions, this article could have been called “Hip vs Knee Dominance Doesn’t Matter.” Different “diagnosis” but same article content. Who cares? Give the person in front of you what they don’t have in order to succeed. But all GIRD speaks to is a snapshot in time of a patient presenting with asymmetrical findings in shoulder internal and external rotation ROM. This snapshot in time doesn't matter if it can be reversed quickly as it often is. What’s most important is the end goal, can all the joints required to achieve a performance goal access the positions necessary to perform?
Okay, but what should I do about GIRD? Fine. Because I don’t want to trash something without proposing a solution. Here’s a quick example scenario I might find myself in with patients seeing me for GIRD.
- For a right-handed baseball player their shoulder exam finds left shoulder ER and IR both about 90°.
- Right shoulder ER is about 110-120° (required for throwing health and performance) while IR is about 40-50°.
- These athletes also tend to present with other asymmetries or joint limitations throughout their body but these can vary greatly. Some of these additional findings might make me choose different interventions but this isn’t the place to expand on that. However, another common limitation in this patient is reduced right trunk rotation. Going beyond the scope of this article, this reduced trunk rotation can affect scapular movement and alter the throwing sequence. But who cares? If something is limited that’s required for performance, fix it however you like.
Note: all the “right” and “left” words could be reversed. Use your tests to guide your interventions. And here’s my first go-to fix for this common example I often utilize which helps nullify the GIRD diagnosis.
Trunk Lift Holds - 3x30sec
- Performed in left sidelying
- Focus on right trunk rotation
- Not in video: right hand behind the head pressing into the head isometrically as if internally rotating
- Hold and breath slowly expanding the right chest
- They should sense contraction of the left abdominals and right lower trap
I’ve seen this one exercise alone restore full ROM for the above patient but that’s not always the case. Test-retest it like anything else. What’s improved or hasn’t? And move on from there to continue chasing the range they need to be successful. I’m not going to get any further into potential treatment specifics here because subsequent inputs vary greatly between providers and isn’t the point of this article. That being said, some general recommendations would be addressing any lasting limitations through exercise-based interventions and/or manual work which might include rib cage mobilizations promoting right trunk rotation or soft tissue to the posterior cuff and pecs. Then, throw in some Arm Bar Screwdrivers and above interventions into the warm-up and get back to work on an appropriate throwing and training program.
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