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Glenohumeral internal rotation deficit (GIRD) is a loss of inward rotation of the throwing shoulder compared with the other shoulder. It is seen in baseball pitchers, softball players, tennis players, volleyball players and other overhead athletes, and is usually caused by tightness of the back of the shoulder capsule and muscles from repeated throwing. GIRD matters because it has been linked to shoulder and elbow injuries in throwers. Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, evaluates throwing athletes and treats GIRD with a targeted stretching and strengthening program.

On this page:What it is · Why it matters · Diagnosis · Treatment · FAQs · Research
At a glance

  • GIRD is classically defined as a loss of 20° or more of internal rotation in the throwing shoulder compared with the other side
  • Some gain in outward rotation in throwers is normal; the concern is when total motion is also lost
  • GIRD has been associated with shoulder and elbow injuries in overhead athletes
  • Daily posterior-shoulder stretching, such as the sleeper and cross-body stretches, improves internal rotation

What is GIRD?

Throwers commonly gain external (outward) rotation and lose some internal (inward) rotation in the throwing shoulder. This is partly a normal adaptation, including changes in the bone, and partly due to tightness at the back of the shoulder. GIRD is classically defined as a loss of 20° or more of internal rotation compared with the non-throwing shoulder.1 A loss of total rotational motion (internal plus external rotation) may also matter.1

Why GIRD matters

In professional pitchers followed over 3 seasons, those with GIRD were nearly twice as likely to be injured as those without (although the difference was not statistically significant), and pitchers who lost more than 5° of total rotational motion had a higher rate of injury.1 A meta-analysis of 819 overhead athletes found more internal rotation loss in injured athletes than uninjured athletes, with a stronger link in adults than adolescents, and noted that the traditional 20° threshold may be too conservative.2 Throwers with shoulder or elbow problems such as SLAP tears, partial rotator cuff tears and UCL injuries of the elbow are routinely checked for GIRD.

Diagnosis

Dr. Dold measures internal and external rotation in both shoulders with the arm out to the side and the shoulder blade stabilized, and compares total motion. He also checks shoulder-blade control, rotator cuff strength, the labrum and the elbow, and asks about pitch counts, training load and throwing mechanics. Imaging is used when pain, weakness or loss of velocity suggests a structural injury.

Treatment

  • Posterior shoulder stretching: the cross-body stretch and the sleeper stretch, done daily. In a randomized trial, the cross-body stretch improved internal rotation by an average of 20° over 4 weeks.3 A 2026 meta-analysis of randomized trials in overhead athletes with GIRD found that sleeper and cross-body stretching improved internal rotation compared with no stretching.4
  • Rotator cuff and shoulder-blade strengthening, with attention to the muscles that slow the arm down after release
  • Throwing load management: following age-appropriate pitch counts and rest days and avoiding year-round throwing without breaks
  • Mechanics review with a coach or therapist

Surgery is rarely needed for GIRD itself. When GIRD is associated with a structural injury such as a labral or rotator cuff tear that does not respond to rehabilitation, that injury is treated on its own merits.

What the research shows

  • Some loss is normal: throwers develop more external and less internal rotation in the throwing shoulder, partly because the upper arm bone twists (humeral retroversion) during growth. What matters is whether the total arc of rotation is also reduced compared with the other side.
  • When it becomes a problem: studies in professional pitchers link a total rotation deficit of more than 5 degrees to higher shoulder and elbow injury rates, and in adolescent pitchers, preseason deficits in internal rotation and cross-body motion identified those at 4 to 6 times higher injury risk. Not every study agrees, so motion is one part of a broader assessment.
  • Stretching works: randomized trials show that the cross-body stretch and the (modified) sleeper stretch restore internal rotation, and a stretching program helped high school pitchers limit motion loss over a season.
  • A complete program: rehabilitation also restores scapular control, rotator cuff strength, core and hip function and throwing mechanics. A randomized trial in young players found that external rotation strengthening prevented arm injuries at least as well as stretching. Weighted-ball programs can raise velocity but were associated with more injuries in a trial.
  • Volleyball and other sports: internal rotation differences in some overhead athletes appear to be normal adaptations that do not cause symptoms.

Why see Dr. Dold

  • Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
  • Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
  • Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
  • Author of a SLAP repair book chapter (Springer, 2017) and research on shoulder suture anchors (KSSTA, 2013)
  • Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
  • D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google

Frequently asked questions

What is GIRD?

A loss of inward (internal) rotation of the throwing shoulder compared with the other shoulder, classically 20° or more.1

Does GIRD cause injuries?

It has been linked to shoulder and elbow injuries in overhead athletes, although the research is still evolving.1,2

How do I fix GIRD?

Daily posterior shoulder stretching, such as the cross-body and sleeper stretches, along with strengthening and workload management.3,4

Should my child stop throwing?

Not necessarily. Many young athletes keep throwing with a stretching program and appropriate pitch counts. Pain, loss of velocity or elbow pain should be evaluated. See also Little Leaguer’s shoulder.

Is some loss of internal rotation normal in throwers?

Yes. Some change is a normal adaptation to throwing. The concern is a large loss of internal rotation or a loss of total motion.1

Do you accept my insurance?

Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.

Research cited on this page

  1. Wilk KE, Macrina LC, Fleisig GS, et al. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39(2):329-335. PubMed
  2. Johnson JE, Fullmer JA, Nielsen CM, et al. Glenohumeral Internal Rotation Deficit and Injuries: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2018;6(5):2325967118773322. PubMed
  3. McClure P, Balaicuis J, Heiland D, et al. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007;37(3):108-114. PubMed
  4. Iida N, Velasquez Garcia A, Kuroiwa T, et al. Role of stretching interventions in enhancing the shoulder range of motion in overhead athletes with glenohumeral internal rotation deficit: A systematic review and meta-analysis. PM R. 2026;18(2):200-209. PubMed
  5. Burkhart SS, Morgan CD, Kibler WB. Shoulder injuries in overhead athletes. The “dead arm” revisited. Clin Sports Med. 2000;19(1):125-58. PubMed
    Classic review: loss of internal rotation from posteroinferior capsule tightness is associated with the dead-arm syndrome and SLAP injury in throwers.
  6. Manske R, Wilk KE, Davies G, et al. Glenohumeral motion deficits: friend or foe?. Int J Sports Phys Ther. 2013;8(5):537-53. PubMed
    Review: pathologic GIRD is defined as internal rotation loss over about 18–20 degrees with total rotation loss over 5 degrees compared with the other side.
  7. Zajac JM, Tokish JM. Glenohumeral Internal Rotation Deficit: Prime Suspect or Innocent Bystander?. Curr Rev Musculoskelet Med. 2020;13(1):86-95. PubMed
    Review: humeral retroversion explains much of the internal rotation difference in throwers; early treatment of pathologic GIRD may lower risk.
  8. Wilk KE, Macrina LC, Arrigo C. Passive range of motion characteristics in the overhead baseball pitcher and their implications for rehabilitation. Clin Orthop Relat Res. 2012;470(6):1586-94. PubMed
    Study: pitchers have more external and less internal rotation in the throwing shoulder, with similar total rotation.
  9. Wilk KE, Macrina LC, Fleisig GS, et al. Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study. Am J Sports Med. 2014;42(9):2075-81. PubMed
    Study: total rotation deficits over 5 degrees increased elbow injury risk 2.6-fold in professional pitchers.
  10. Wilk KE, Macrina LC, Fleisig GS, et al. Deficits in Glenohumeral Passive Range of Motion Increase Risk of Shoulder Injury in Professional Baseball Pitchers: A Prospective Study. Am J Sports Med. 2015;43(10):2379-85. PubMed
    Study: insufficient external rotation, rather than GIRD, was linked to shoulder injury and surgery in professional pitchers.
  11. Shanley E, Kissenberth MJ, Thigpen CA, et al. Preseason shoulder range of motion screening as a predictor of injury among youth and adolescent baseball pitchers. J Shoulder Elbow Surg. 2015;24(7):1005-13. PubMed
    Study: preseason side-to-side horizontal adduction deficit over 15 degrees and internal rotation deficit over 13 degrees identified adolescent pitchers at 4 to 6 times injury risk.
  12. Keller RA, De Giacomo AF, Neumann JA, et al. Glenohumeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes: A Meta-Analysis and Systematic Review. Sports Health. 2018;10(2):125-132. PubMed
    Meta-analysis: pooled shoulder motion measurements did not significantly predict shoulder or elbow injury.
  13. Pozzi F, Plummer HA, Shanley E, et al. Preseason shoulder range of motion screening and in-season risk of shoulder and elbow injuries in overhead athletes: systematic review and meta-analysis. Br J Sports Med. 2020;54(17):1019-1027. PubMed
    Meta-analysis: preseason external rotation screening may identify professional pitchers and swimmers at risk.
  14. Helmkamp JK, Bullock GS, Rao A, et al. The Relationship Between Humeral Torsion and Arm Injury in Baseball Players: A Systematic Review and Meta-analysis. Sports Health. 2020;12(2):132-138. PubMed
    Meta-analysis: humeral torsion did not differ between injured and uninjured players and accounts for part of internal rotation differences.
  15. Challoumas D, Stavrou A, Dimitrakakis G. The volleyball athlete’s shoulder: biomechanical adaptations and injury associations. Sports Biomech. 2017;16(2):220-237. PubMed
    Systematic review: GIRD in volleyball players appears anatomical and not associated with symptoms.
  16. Mine K, Nakayama T, Milanese S, et al. Effectiveness of Stretching on Posterior Shoulder Tightness and Glenohumeral Internal-Rotation Deficit: A Systematic Review of Randomized Controlled Trials. J Sport Rehabil. 2017;26(4):294-305. PubMed
    Systematic review: the cross-body stretch improves posterior shoulder tightness and GIRD in the short term.
  17. Chepeha JC, Magee DJ, Bouliane M, et al. Effectiveness of a Posterior Shoulder Stretching Program on University-Level Overhead Athletes: Randomized Controlled Trial. Clin J Sport Med. 2018;28(2):146-152. PubMed
    Randomized trial: an 8-week posterior shoulder stretch increased internal rotation in athletes with a deficit of 15 degrees or more.
  18. Reuther KE, Larsen R, Kuhn PD, et al. Sleeper stretch accelerates recovery of glenohumeral internal rotation after pitching. J Shoulder Elbow Surg. 2016;25(12):1925-1929. PubMed
    Study: a sleeper stretch program helped high school pitchers recover internal rotation and limit seasonal loss.
  19. Wilk KE, Hooks TR, Macrina LC. The modified sleeper stretch and modified cross-body stretch to increase shoulder internal rotation range of motion in the overhead throwing athlete. J Orthop Sports Phys Ther. 2013;43(12):891-4. PubMed
    Technique paper: modified sleeper and cross-body stretches to protect the shoulder.
  20. Gharisia O, Lohman E, Daher N, et al. Effect of a novel stretching technique on shoulder range of motion in overhead athletes with glenohumeral internal rotation deficits: a randomized controlled trial. BMC Musculoskelet Disord. 2021;22(1):402. PubMed
    Randomized trial: both stretches improved internal rotation in overhead athletes with GIRD.
  21. Bailey LB, Shanley E, Hawkins R, et al. Mechanisms of Shoulder Range of Motion Deficits in Asymptomatic Baseball Players. Am J Sports Med. 2015;43(11):2783-93. PubMed
    Study: motion gains came with reduced rotator cuff stiffness; soft-tissue mobilization plus stretching improved motion more.
  22. Shitara H, Tajika T, Kuboi T, et al. Shoulder stretching versus shoulder muscle strength training for the prevention of baseball-related arm injuries: a randomized, active-controlled, open-label, non-inferiority study. Sci Rep. 2022;12(1):22118. PubMed
    Randomized trial: in young baseball players, external rotation strength training was not inferior to stretching for preventing arm injuries (injury rates 9.8% vs 22.6%).
  23. Wilk KE, Arrigo CA, Hooks TR, et al. Rehabilitation of the Overhead Throwing Athlete: There Is More to It Than Just External Rotation/Internal Rotation Strengthening. PM R. 2016;8(3 Suppl):S78-90. PubMed
    Review: multiphase rehabilitation restores strength, mobility, endurance and power in the overhead athlete.
  24. Reinold MM, Macrina LC, Fleisig GS, et al. Effect of a 6-Week Weighted Baseball Throwing Program on Pitch Velocity, Pitching Arm Biomechanics, Passive Range of Motion, and Injury Rates. Sports Health. 2018;10(4):327-333. PubMed
    Randomized trial: a weighted-ball program increased velocity but also external rotation and injury rate.
Ready to get it checked? Request an appointment online or call 469-850-0680. Our staff will contact you by phone and text within an hour of your request (during business hours, Monday–Friday, 8 am–5 pm). Walk-in visits are welcome Monday, Wednesday and Friday, 8:30–10:30 am at 6700 Dallas Parkway, Suite 100, Frisco, TX 75034. We see patients from Frisco, Plano, McKinney, Prosper, Little Elm, The Colony, Allen, Dallas and across North Texas. Same-day appointments available.

Request an AppointmentCall 469-850-0680

Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Individual results vary.