GIRD…NOT THE REFLUX KIND
If you have ever been in physical therapy for shoulder pain, you have probably heard the term “GIRD”. In the world of physical therapy, GIRD is Glenohumeral Internal Rotation (IR) Deficit and it is associated with a myriad of other shoulder pathologies like SICK scapula, instability, impingement and structural pathologies due to compensatory changes.
GIRD is commonly associated with overhead athletes and individuals with poor posture. In its true sense, GIRD is more than just a deficit in IR range of motion; rather it is defined as the loss of IR with a total decrease in rotational range of motion compared to the contralateral shoulder. That means, both sides need to be assessed and compared before diagnosing. This loss in range will often lead to a compensatory increase in external rotation, especially in the throwing athlete. It may also lead to a change in humeral head position through retroversion as the posterior rotator cuff muscles become tight.
But is “GIRD” used too liberally with patients? I would argue most throwing athletes need some loss of internal rotation in order to achieve that increase in external rotation in their dominant arm. If the total arc of motion is within 10 degrees of the non-dominant arm, maybe there isn’t much pathology after all. It is critical to look at the whole picture. What is the total arc of motion? Is it the capsule or the posterior rotator cuff that is tight? Is there humeral retroversion leading to glenoid retroversion and compensatory change in anatomical positioning?
So what if you really do have a true glenohumeral internal rotational deficit? Your physical therapist should assess the cause of the problem and create a treatment plan which will likely include soft tissue mobilization to the posterior rotator cuff, pec and surrounding musculature. If there is a muscle imbalance, strengthen the weak areas and provide shoulder stabilization. Lastly, stretch the tight structures. Many patients who present with a limitation in internal rotation range are instructed to crank on their arm via a “sleeper stretch” and report increased shoulder pain or pinching due to impingement. An alternative to this would be a cross-body stretch as shown while stabilizing the scapula to target the posterior rotator cuff and increase IR to the point of symmetrical rotational arcs of motion between both sides.
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