Glenohumeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes: Systematic Review

Abstract

Objective: To systematically review the literature on the efficacy of addressing glenohumeral internal rotation deficit (GIRD) and risk of upper-extremity injury in overhead athletes.

Data sources: A search was conducted for relevant studies published in PubMed, Medline, CINAHL, Cochrane, Embase, Ovid, Google Scholar, and Web of Science.

Study selection: The review focused on randomized controlled trials (RCTSs) and quasi-experiments conducted in English language that assessed the effectiveness of GIRD and the risk of upper-extremity injury in athletes performing overhead movements. The review included 7 RCTs and 2 quasi-experiments out of 5403, which involved a total of 360 participants.

Data extraction: Two reviewers independently screened the articles, assessed methodological quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews. All studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database Scale for RCTs.

Data synthesis: The efficacy of different types of techniques was evaluated, including joint mobilization, sleeper stretch, cross-body stretch, myofascial release, kinesio taping, and rigid taping. These techniques showed improvement in pain score and range of motion. Furthermore, self-myofascial release tends to improve internal rotation; sleeper stretch and cross-body stretch tend to improve internal rotation with 40 percent decline in pain. However, kinesio taping and rigid taping showed positive results for internal rotation. Acute results determined that the metabolic equivalent (MET) group had significantly more horizontal adduction range of motion posttreatment compared with the control group (P=.04). No significant differences existed between MET and joint mobilizations or between joint mobilizations and the control group for horizontal adduction (P>.16). No significant between-group differences existed acutely for internal rotation (P>.28). There were no significant between-group differences for either horizontal adduction or internal rotation at the 15-minute posttests (P>.70).

Conclusions: The study evaluated the efficacy of various techniques in improving pain score and range of motion in individuals with GIRD. Joint mobilization, sleeper stretch, cross-body stretch, myofascial release, kinesio taping, and rigid taping all showed improvements in pain score and range of motion. However, no significant between-group differences were found for horizontal adduction or internal rotation at the 15-minute posttests. These findings suggest that a combination of these techniques may be effective in treating individuals with GIRD.

Keywords: Glenohumeral internal rotation deficit (GIRD); Internal rotation; Pain; Posterior shoulder tightness (PST); Rehabilitation; Shoulder joint.