Fast facts — what athletes need to know
GIRD in one line | A loss of ≥ 20° of internal rotation in your throwing arm versus your other arm, usually paired with extra external rotation. |
Who gets it? | Baseball / softball pitchers, tennis servers, volleyball hitters, swimmers, javelin throwers, CrossFit lifters. |
Why it matters | Pathologic GIRD steals velocity, invites pain, and multiplies your risk for rotator-cuff tears, SLAP lesions & elbow UCL sprains. |
How it develops
- Repetition & speed
Late-cocking and early acceleration yank the arm into extreme ER thousands of times a year. - Posterior capsule tightens
Micro-scarring shrinks the back-inferior capsule, pulling the humeral head off-center. - Humerus & socket remodel
More retroversion (humerus) and retroversion (glenoid) shift the total arc of motion posteriorly. - Chain reaction
→ Internal rotation disappears.
→ Scapula wings (“SICK” scapula).
→ Rotator cuff and labrum get pinched (“internal impingement”).
Red-flag signs & symptoms
- Deep, vague posterior shoulder ache—worse after long throws / serves
- “Dead-arm”: sudden drop in velocity or control
- Stiff, hard-to-warm up shoulder; loss of reach across the body
- Clicking, catching, or night pain lying on that side
In-clinic assessment
Test | What we’re looking for |
IR/ER goniometer test (supine, 90-90) | ≥ 20° IR deficit and disproportionate ER gain |
Total rotation arc | Loss of > 5° vs. opposite side → pathologic GIRD |
Cross-body adduction & posterior tightness | < 20° adduction or > 4 cm gap |
Posterior impingement sign | Sharp posterior pain in 90-110° ABD + max ER |
Scapular motion screen | Inferior-medial border prominence, dyskinesis |
Full kinetic-chain check | Core, hips, thoracic spine, stride length |
If imaging is needed, we order MRI-ABER to catch undersurface cuff frays or hidden SLAP tears.
Gold-standard, non-surgical care
Goal | Key tools |
Unlock IR | ★ Sleeper stretch (daily, 3×30 s) |
Re-balance cuff & scapula | Band ER/IR at 90°, prone “T/Y/W”, serratus “plus” push-ups |
Restore chain power | Medicine-ball hip-to-hand throws, anti-rotational core drills |
Fix mechanics & workload | High-speed video, pitch-count tracking, serve-volume log |
90 % of committed throwers regain motion & ditch pain within 6-8 weeks of our program.
When surgery steps in
Indication | Procedure | Typical comeback |
Posterior capsule won’t budge | Arthroscopic posterior-inferior capsular release | Throwing at 3 mo, full competition 4-6 mo |
Large SLAP tear | Anchor repair or biceps tenodesis | 6-9 mo (throwers) |
> 50 % articular cuff tear | Completion & double-row repair | 8-12 mo; return rates variable |
Surgery aims to restore functional baseline, not create a “textbook” shoulder that can’t throw.
Stay ahead of GIRD
- Pre-season screen every year (IR, TRM, scapular control)
- Daily 5-minute stretch routine for all overhead athletes
- Intelligent workload: respect pitch counts, serve limits, recovery days
- Whole-body strength: legs & core generate 50-60 % of throwing velocity—don’t blame the shoulder for a weak trunk
Call to Action
If you have pain, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated in May 2025