Glenohumeral internal rotation deficit (GIRD)

What it is

Measured lying on your back with the elbow bent to a right angle and the upper arm out to the side, the hitting shoulder rotates inwards less far than the other one. Part of that is bone: in players who started overhead sport young, the upper arm bone itself twists slightly as it grows, trading inward rotation for outward rotation, which is an adaptation rather than a fault. The rest is soft tissue, a thickened capsule at the back of the joint and a stiff, overworked posterior cuff. The soft tissue part is the part that can change and the part that matters.

How volleyball causes it

Every swing finishes with the back of the shoulder braking a very fast moving arm. Those tissues respond to repeated eccentric load by getting stiffer, and in season the arm never gets a long enough break for that to reverse, so the deficit builds across a season and jumps after tournament weekends. It matters because losing inward rotation changes where the ball sits in the socket at the top of the swing, crowding the cuff and the labrum against the back rim. GIRD is not an injury by itself. It is a measurable risk state sitting underneath internal impingement, labral tears and cuff problems in hitters.

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What it feels like

• Lying on your back with the elbow bent, the hitting arm rotates noticeably less far towards the floor than the other arm
• You cannot reach as far up your back with the hitting hand as with the other hand
• The shoulder feels blocked or tight through the follow through rather than painful
• Tightness that is worse in season and much worse in the days after a tournament
• The back of the shoulder feels permanently tight and tender to press
• Often no pain at all, which is why this is usually found by measuring rather than by symptoms

Stop and get it seen if

• Loss of rotation together with pain, catching, or a sense of the joint slipping, which suggests a labral problem rather than simple stiffness.
• Stiffness developing in every direction over weeks, including outward rotation and lifting the arm. That pattern fits a frozen shoulder or joint disease and stretching is not the answer.
• Stiffness alongside a visible hollow in the muscle behind the shoulder blade, or with clear weakness, which points at a nerve problem.
• A sudden loss of range after one specific incident rather than a gradual drift.

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Getting the range back

   2 to 8 weeks

   Restore the soft tissue portion of the deficit with regular posterior shoulder work, accepting that the bony portion will not change and does not need to

   • The gap between sides shrinking on a repeated measurement
   • Total rotation arc, inward plus outward, closer to matched between shoulders
   • Follow through feels less blocked
   • Back of the shoulder less tender to press

2. 2. Holding it through a season

   Ongoing, rechecked every few weeks in season

   Maintain the range against the daily stiffening effect of hitting, which means measuring it rather than assuming it

   • Range holds steady after heavy hitting weeks
   • No creeping back of shoulder pain during full effort swings
   • Stretching feels like maintenance rather than chasing lost ground

Ready to play again when

• Internal rotation gap between sides down to a level that stays stable week to week
• Total rotation arc close to matched between the two shoulders
• Full follow through with no blocked or pinching sensation
• No back of shoulder pain during full effort hitting

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Cross body stretch with the shoulder blade held down, plus the sleeper stretch, done after hitting while the tissue is warm rather than cold before play.
• Get measured. Lying on your back with the elbow at a right angle, compare how far each arm rotates. A gap of more than roughly 15 to 20 degrees, or a total arc clearly smaller on the hitting side, is the number people act on.
• Strengthen the posterior cuff with side lying external rotation and prone horizontal abduction so it decelerates the arm without living in a permanent state of guard.
• Soft tissue work on the back of the shoulder, such as a ball against a wall on the posterior cuff, before stretching it.
• Ramp hitting volume gradually. Range drops fastest in the weeks where volume jumps hardest.