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GIRD AND ROM DEFICITS IN THE THROWER? N Ellen Shanley PhD, PT, OCS 1 - - PowerPoint PPT Presentation
GIRD AND ROM DEFICITS IN THE THROWER? N Ellen Shanley PhD, PT, OCS 1 - - PowerPoint PPT Presentation
GIRD AND ROM DEFICITS IN THE THROWER? N Ellen Shanley PhD, PT, OCS 1 - Director, Athletic Injury Research, Prevention and Education In order to throw a baseball Generate Forces Dissipate Transfer Forces Forces Perfect Timing Stresses
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In order to throw a baseball…
Generate Forces Transfer Forces Perfect Timing Dissipate Forces
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Stresses of baseball cause adaptations
Stresses > to deform &
change soft tissue & bone*
(Sabick AJSM ’05)
Elite throwers need tissue to
adapt for max performance
(Meister AJSM ’05; Lesniak AJSM ‘13)
Common adaptation- Shift in
the arc of ROM Strike a balance between injury & performance
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In order to perform at the highest level…
Manage Force Large ROM Repeated over time
Mobility Stability
Controlled mobility
Skill
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So…
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What is GIRD?
Historically, a side-to-side
difference IR ΞGIRD
20° GIRD - clinical concern Case-Control studies
Scapula stabilized
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How & why- understanding evolved?….
Burkhart 2000 Tyler 2000* Myers 2006* Ruotolo 2006 Dines 2009
HISTORICALLY PERSPECTIVE
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Evidence: GIRD
Retrospective
- Yes
- 14-29○
Prospective
- Maybe
- 20○
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How does the evidence impact thoughts?
Can the measure stand on its own ? Probably not
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Evidence: S-S TARC
Case-Control
- Maybe
- 7-10○
Prospective
- Maybe
- 5○
- Ruotolo ‘06
- Garrison ‘12
- Myers ’06
- Dines ‘09
- Kibler ‘13
- Wilk ‘11
- Shanley ’11
- Wilk ’14
- Wilk ‘15
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So then if its more complicated than IR?
How much?
Symmetric Sufficient
Where?
Intra vs extra-articular Isolated versus composite
Quantity vs Control
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Therefore,
To assist clinicians
S-S motion must reflect a deficit & not just a shift in motion
The definition we use:
Concurrent deficits - IR difference 15° + total arc of motion
10° or >
Based on: Myers AJSM 2006, Wilk et al. AJSM 2011, Kibler et al Arthroscopy
2013
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GIRD an Adaptation?
Acceptable level of GIRD
(Burkhart ‘03)
Healthy Overhead Athletes
(Ellenbecker ‘02, Meister ‘05, Hurd 11, Tokish ’08,Wilk ‘12)
Transient- healthy pitchers
(Reinold ‘08; Tokish ’08, Shanley ‘12)
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GIRD reflect specific tissue?
HT, PI capsule, & posterior tightness
(Burkhart ‘03)
PI Capsule thickening, Loss of IR w plication
(Tuite ’07; Thomas‘11; Gates ‘12)
HT associated- GIRD ≠ TARC (Osbahr
’02; Shanley ’12; Noonan ‘15)
ROM △ ⇢ stretching/ soft tissue
(Reinold ’08, Laudner ’08; Moore ’11; Bailey ’15; Escamilla ’16)
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Preventing Adaptation from becoming Pathology?
Good genes Balanced loading, exposure
& recovery
Resiliency
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In Summary then is GIRD…?
Pathological A Risk Factor A Symptom An Impairment Causative
YES NO PROBABLY PROBABLY NOT
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Summary of the additional ROM evidence
Longitudinal or progressive motion loss is concerning
ER, Horizontal Adduction, & flexion deficits-(Wilk ‘15)
Injury risk may not be related to just to IR or TARC difference
GIRD lives in Healthy Pitchers too & may be transient (Tokish ’08) Pitchers with GIRD differences HT (Noonan ‘15)
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Purpose?
Originally a retrospective observation of overhead
athletes presenting with pathology (Burkhart/Morgan ’00)
Define and id a risk factor for injury
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How & when should we consider ROM?
Screening Prevention
Treatment
RTS Testing ITP
Returning to Sport Risk Profiling
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Similarities & Differences
Adolescent Youth Pros
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If ROM differences are risk factors…
Screen a population @ risk of injury
Customized prevention program
Treatments (stretching & mobilization) are:
Easy & inexpensive Minimal side effects Highly effective
Cut off value-set low to include all of those @ high risk for injury
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If ROM is a impairment/risk factor…
Assessment is critical Apply algorithm to identify tissue contribution Id hypomobility Id implications of the deficit in motion Specify Treatment
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Summary
GIRD - asymptomatic S-S difference in IR not necessarily bad Assess shoulder motion (S-S) longitudinally
Rotational deficits with a reduction in total arc may increase risk of injury Cardinal plane deficits flexion & horizontal adduction may increase arm
injury risk
Risk factors may be group specific
Torsion is important in understanding shoulder motion present.
Screening is the starting point!
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