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Throwing away your injury… GIRD

Ok, so you love tennis, cricket or baseball? If you play a sport that involves either throwing a ball or racquet, try this little experiment. Take your throwing arm or racquet arm and see how far you can reach behind your back (from below). Now try this with your other arm. Any difference?

If you are able to reach your non-throwing arm significantly further up your back than the other side, you may be suffering from glenohumeral internal rotation deficit (GIRD). GIRD is a condition that leads to the loss of internal rotation in shoulder joint (the movement that allows you to put your hand behind your back). Lets look at a little shoulder anatomy and biomechanics.

Shoulder Structure

The shoulder joint is surrounded by a thin layer of tissue called capsule. The capsule is responsible for sealing the joint space, providing stability by limiting movements. It also helps with our joint position awareness and proprioception. When we put our shoulder through repetitive throwing motions over a long period of time, our capsule is distorted, leading to GIRD.

To understand why this happens better, lets look at what happens during a tennis serving motion.

Kinetic Chain Theory

The tennis serve is a kinetic chain which has five different phases:

  1. Wind up (knee flexion, trunk rotation)
  2. Early cocking
  3. Late cocking
  4. Acceleration phase (including long axis rotation)
  5. Follow through
tennis action Throwing away your injury... GIRD

During phase 2 and 3 of the serve (as demonstrated by the red rectangle), our shoulder is in a position of maximal abduction and external rotation. It is this position that causes the front (anterior) portion of the capsule to stretch, whilst the back (posterior) becomes tighter. This posterior capsule tightness is what eventually restricts our movement.

Why does GIRD matter?

You may be thinking ok, so what if I can’t get my hand behind my back? If anything, you may have greater external rotation (movement in the opposite direction) with your throwing arm which makes you more flexible, right?

Unfortunately, that’s not how it works. If you suffer from GIRD, you are at a higher risk of injuring your shoulder in the long run. If the limitation of internal rotation exceeds the gain you may get in external rotation, there is a decrease in your rotational arc. This leaves the shoulder is susceptible to injury. Some studies suggest you are 25% more likely to suffer from a tear to the cartilage in the shoulder, or a SLAP tear. Also, there is more chance of developing instability and impingement symptoms in the shoulder

The Sleeper Stretch

If you think you suffer from GIRD, don’t despair. First principles are always keep your shoulders, back and core muscles well balanced with conditioning and strength work. Avoid over loading one particular side of your body without working on the other side too. For example, when we throw the muscles of our rotator cuff that help us internally rotate our shoulder become very strong, so be sure to work on the external rotators too. They can easily be isolated using the cable machine in the gym. Also, working on technique to minimise injury is vital. By using the whole kinetic chain when throwing we use the bigger muscles in our legs and torso to generate power rather than the shoulder.

There are basic stretches you can do to improve the loss of internal rotation. The first is to practice trying putting your hand behind your back and reaching as far up as you can. Try getting into the habit of doing this regularly, for example in the shower.

start finish Throwing away your injury... GIRD

The Sleeper Stretch is a specific exercise that works on increasing the amount of internal rotation of the shoulder. Here is a brief description of how to do it (see diagram above).

  • Lie on your affected shoulder side on a firm flat surface.
  • Put a pillow under your head for support.
  • Have your shoulder at 90 degrees to your body with your forearm pointing up into the air.
  • Push the forearm of your affected arm down towards the bed, again at 90 degrees to the upper arm.
  • If your affected arm can reach the surface, great. If it can’t, feel the point where there is a deep stretch and hold for 30 seconds.
  • Repeat as often as possible.

Keep a measure of how your internal rotation movement improves by seeing how far you can get it up your back. Ideally, you want both sides to be the same.

​I hope this blog has introduced the concept of GIRD to you and please do get in touch if there is anything you would like to discuss. In the meantime, remember it is always important to accompany your chosen sport with strength and flexibility work. This will keep you playing injury-free for longer!

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    Orla Mulligan
    Administration and Social Media Manager
    Administration, LBSM

    Orla Mulligan is the administration and social media manager for LBSM. She has a strong background in sport having herself played netball at an elite standard for the U21s Northern Ireland team in the European Championships as well as the U21s competition for Saracen Mavericks.

    She understands youth sport pathways having herself played and training in the netball Kent regional pathway. She has a keen interest in most sports and a good understanding of how injury and illness can impact on the mind and body, as well as rehabilitation pathways.

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    Associate, LBSM
    Musculoskeletal and Sports Podiatrist

    Maddie treats and manages complex foot and ankle injuries in London and Surrey.

    She is particularly interested in helping her patients improve their quality of life and achieve their personal goals, working closely with Foot and Ankle Consultants, Sports Medicine Doctors and Physiotherapists.

    Maddie has a sporting background herself having previously represented England in Hockey. She understands the demands of elite sport and the importance of physical and mental health. In her spare time, Maddie continues to enjoy an active lifestyle by running, cycling and attending a Pilates class.

    Having graduated from University of Brighton with a MSc (hons) in Podiatry, Maddie focused her career in Podiatric Sports Injuries and Biomechanics. Previously she completed a BSc (hons) in Sport Science at Loughborough University.

    A day in the life of Maddie involves consulting patients in clinic, performing gait and biomechanical assessments, measuring and fitting orthotics and braces. She also regularly teaches and presents at sports medicine and podiatry conferences.

    Outside of work, Maddie still finds time to play hockey and enjoys running and skiing.

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    MBBS, PhD, FRCS
    Consultant Partner, LBSM
    Consultant in Vascular Surgery

    Mr Prakash Saha is a Consultant Vascular Surgeon at LBSM. He takes pride in providing the best possible results for his patients by using the most appropriate non-surgical and surgical methods based on clinical evidence, patient results and satisfaction.

    He treats fit and active people suffering with a range of cardiovascular issues, from painful leg swelling associated with exercise to venous insufficiency, post-thrombotic syndrome and leg ulcers. He also treats people with arterial system problems including poor circulation, compression syndromes and aneurysms. He carries out both endovascular and open aortic repair and has some of the best outcomes in the country.

    Mr Saha studied medicine at the United Medical & Dental Schools at Guy’s and St. Thomas’ Hospitals before completing his higher surgical training in London and the South East. During this time, he was awarded the prestigious NIHR Clinical Lectureship in Vascular Surgery at St. Thomas’ Hospital, giving him comprehensive training in open and endovascular techniques for treating arterial and venous disease. Prakash completed his aortic surgery training at the St. George’s Vascular Institute before carrying out a specialist fellowship at the Royal Prince Alfred Hospital, Sydney.

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    A day in the life of Mr Saha involves seeing patients in clinic, operating in surgical theatre or lecturing at his university. He also regularly teaches and presents at vascular and sports medicine conferences.

    Mr Saha is an avid cyclist and tennis player (although yet to get a set of Dr Seth!). Outside of work, he spends time with his family who consists of 3 children and enjoys travelling.

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    MBBS, FRCR
    Consultant Partner, LBSM
    Consultant in Sports and Musculoskeletal Radiology

    Dr Gajan Rajeswaran is a Consultant Musculoskeletal Radiologist at LBSM, with an extensive background of working in elite sport. He is one of the most recognised radiologists in the sports medicine field. He provides top level imaging and medical diagnostic services for patients and athletes.

    Dr Gajan Rajeswaran completed his undergraduate medical training at Imperial College London and his radiology training at Chelsea & Westminster Hospital. He has obtained two post-CCT fellowships in musculoskeletal imaging. He was appointed as a consultant at Chelsea & Westminster Hospital in 2011.

    He has a passion for all sports having worked as a radiologist at the Glasgow Commonwealth Games and London World Athletic Championships and continues to support The Championships, Wimbledon. He also continues to work with a number of Premier League and Championship Football Clubs, Premier League Rugby Clubs, England Sevens Rugby, British Athletics and the Lawn Tennis Association.

    A day in the life of Dr Rajeswaran involves giving his expert opinion on investigations such as MRI and CT scans, x-rays and ultrasound. He also performs injection lists under ultrasound, CT and X-ray including spinal injections. He also regularly teaches and presents at sports medicine conferences.

    Dr Gajan Rajeswaran is an avid football fan and life-long fan of Tottenham Hotspur (for which he offers no apologies!). Outside of work, he spends time with his family and has a keen passion for photography.

    Dr Ajai Seth
    MBBS, BSc, MSc, MRCS, MRCGP, FFSEM
    Medical Director, LBSM
    Consultant in Sport and Exercise Medicine

    Dr Ajai Seth is a Sport and Exercise Medicine Physician. He has dedicated his career to helping people with sport and exercise related injury and illness. He consults and treats everyone from the elite athlete to the weekend warrior.

    Dr Ajai Seth is part of the British Tennis Sports Physician team at the LTA and has also provided cover to elite athletes at Wimbledon Tennis, European Tour Golf, Premier League Football, British Athletics, and the Men’s England Football academies as part of the FA.

    He also prides himself for working in disability sport and is currently the Chief Medical Officer for Team GB Wheelchair Tennis which has taken him to the Olympics and Paralympics.

    Dr Ajai Seth is dedicated to education, training and research and is a Senior Lecturer in Sports Medicine at King’s College London where he lectures in all aspects of Sports Medicine and Science.

    He also has a passion for travel and Expedition Medicine, which has seen him accompany medical, scientific and charity expeditions all around the world. He also has vast experience in treating musculoskeletal injuries from children and adolescents to veteran exercisers, both male and female.

    Dr Seth also has positions in leading Sport Medicine organisations, including the non-executive board for the UK’s largest Sports Medicine charity, BASEM and Past President for the Royal Society of Medicine. 

    A day in the working life of Dr Seth involves consulting his patients in clinic, performing diagnostics and ultrasound guided injections. He also regularly lectures and tutors students and presents at sports medicine conferences internationally. He also spends part of the working week at the National Tennis Centre, LTA, supporting British Tennis players.

    Outside of work, Dr Seth enjoys playing club tennis, triathlon, golf, running and skiing (but will give any sport a go!). He enjoys keeping fit and active and good quality family time with his wife and three children.