Glenohumeral internal rotation deficit in overhead throwing athletes: Evidence and perspectives of osteopathic manipulative treatment

The shoulder is one of the most commonly injured joints among overhead athletes playing volleyball, tennis, swimming, baseball or softball. A potential mechanism contributing to shoulder injuries in overhead throwing athletes involves limitations in the range of motion (ROM) of the glenohumeral (GH) joint. Glenohumeral internal rotation deficit (GIRD) is defined as a loss in degrees of GH internal rotation (IR) of the throwing shoulder compared with the non-throwing shoulder. The substantial speeds and forces occurring at the posterior shoulder during the deceleration phase may result in altered GH joint ROM and posterior shoulder tightness in throwing athletes. Adaptive changes to bone and soft tissue believed to occur as a result of the repetitive throwing motion contribute to the presence of GIRD. Therefore, soft tissue tightness of the posterior shoulder can result in decreased GH IR, reduced horizontal adduction and a higher risk of injury, such as superior labral lesions, subacromial impingement and pathological internal impingement in the throwing shoulder. Several studies have shown that osteopathic manipulative treatment (OMT) can represent a useful therapeutic approach for overhead sports, particularly in the preventive phase with asymptomatic athletes. Muscle energy and myofascial release techniques have proven effective in reducing posterior soft tissues tightness and increasing shoulder IR. According to previous results, a reduction in GIRD following the application of osteopathic techniques may prevent injury and improve pain and function in overhead throwing athletes.