GIRD

GIRD is a rather meaningless diagnosis for a pitcher.  Glenohumeral internal rotation deficit is present is pretty much every pitcher who has thrown a ball seriously.   It is a diagnosis of range of motion, not a finding of actual trauma.  Find an ortho who specializes in treating overhand athletes and shoulders in particular.  Your average ortho that sets broken bones from playground injuries is not going to have the experience or expertise to treat a throwing shoulder.

My kid's elbow fracture is related to GIRD. He is about to start PT on it as well as dealing with very tight traps that is also contributing to torquing his elbow. This is the ortho's Dx, he is a solid guy trained at Andrew's facility.

My son struggled with intermittent shoulder pain for a couple years in HS.  He was diagnosed a various times with bicep tendonitis and impingement.  He was told flexibility (GIRD) was a root cause.  He saw multiple orthos and physical therapists and was pretty religious about stretching but it would still flair up from time-to-time.

I am not a doctor but the approach we took was to NOT take any Advil or Aleve.  I wanted him to feel the symptoms and stop throwing if his shoulder was tight.  I don't think taking cortisone or prednisone would be a good idea because it could mask pain and lead to causing injury - just my opinion.

He got through it by finding a really good PT who understood shoulder physiology and regained the flexibility he needed.  I should add that both his HS and travel coaches were fully aware and always took him out when he told them he felt pain.  He now stretches regularly and added hanging to his regiment and hasn't had a problem in a couple years.

I think it's really important to stress finding a physician with a direct, regular practice of treating overhead throwing athletes.  

Smitty how long would the bouts with GIRD last? in other words if it flared up, would he miss a few days? weeks? This has been going on since July but the only thing that gave him temporary relief was a cortisone injection that lasted appx 2 months...he just started a medrol pack yesterday and was told to do a ton of sleeper stretches

the doctors hes been seeing seem qualified, ie doctors for the Olympic team, the local D1 Universities sports team as well as the local AAA baseball team...when I call a dr office should I specifically ask for a dr. that specializes in overhand sports and/or baseball? I think if I asked that they'd all say yes....

@edcoach posted:

Smitty how long would the bouts with GIRD last? in other words if it flared up, would he miss a few days? weeks? This has been going on since July but the only thing that gave him temporary relief was a cortisone injection that lasted appx 2 months...he just started a medrol pack yesterday and was told to do a ton of sleeper stretches

I can’t stress this enough.  GIRD does not “flair up”. Your son’s shoulder pain is not GIRD.  GIRD is an adaptation of the shoulder range of motion.  As you increase your shoulder external range of motion, the layback throwers get when they throw, you lose internal rotation range of motion.  Here is an illustration that compares a typical thrower’s off hand and dominant hand.  Both arms have 180’ range of motion yet the throwing hand has greater ER and “deficit” of  IR.

I would encourage you to read Mike Reinold’s article to understand what a diagnosis of GIRD means.

https://mikereinold.com/gird-g...al-rotation-deficit/

@edcoach posted:

the doctors hes been seeing seem qualified, ie doctors for the Olympic team, the local D1 Universities sports team as well as the local AAA baseball team...when I call a dr office should I specifically ask for a dr. that specializes in overhand sports and/or baseball? I think if I asked that they'd all say yes....

A quick google search found this guy in Oklahoma City:

Dr. Jimmy Conway is a leading expert in the treatment of throwing injuries for baseball and softball players.

http://jimmyconwaymd.com/staff/

A doctor’s bio is easy to find online.  They should list shoulders as a specialty or better if they mention a particular interest in throwing athletes.

thanks 22and25 I just called his office and he has an appointment there in the morning!

Just to be clear, I know nothing about this particular doctor and I am not endorsing him in any way.  He was just an example of the ease with which you can find a shoulder specialist in your area who has an interest in baseball injuries.  

Please read the GIRD article I posted and go armed with good questions.  Being your own best advocate is important with any medical issue.  

I know you werent endorsing but ive never seen a dr around here specifically advertising specialty in baseball/throwing injuries...before this I also made an appoinment at a place called ortho plus

edcoach - glad to see you getting aggressive with this and contacting a specialist.  My son suffered from this (looking at 22and25s diagram) and missed his whole junior season.....it was all about flexibility and range of motion on his pitching side.   He was supposed to start against UNC in the NCAA regionals in 2012.  It got to be so bad that he only pitched part of an inning in relief in the NCAA regional pool play....they had to shut him down immediately.

Prior too this episode, my wife and I knew nothing about it...he never complained.   He was absolutely devastated at how his season ended.  He worked his way back his senior year.   This isn't something to mess around with.

Good luck!

PS....great stuff 22and25

thanks fenwaysouth....im sorry about your son but glad he made it back....im definitely at my wits end and definitely not messing around...hopefully tomorrow answers are gained...its been almost 7 months..one common denominator so far is all 3 orthos have said no surgery required so I guess thats good...I think many may push surgeries but not so far.

I would second the Reinold recommended read.  I've found Mike (and his partner Lenny) to be a good resource, and a very good guy.

@Smitty28 posted:

My son struggled with intermittent shoulder pain for a couple years in HS.  He was diagnosed a various times with bicep tendonitis and impingement.  He was told flexibility (GIRD) was a root cause.  He saw multiple orthos and physical therapists and was pretty religious about stretching but it would still flair up from time-to-time.

I am not a doctor but the approach we took was to NOT take any Advil or Aleve.  I wanted him to feel the symptoms and stop throwing if his shoulder was tight.  I don't think taking cortisone or prednisone would be a good idea because it could mask pain and lead to causing injury - just my opinion.

He got through it by finding a really good PT who understood shoulder physiology and regained the flexibility he needed.  I should add that both his HS and travel coaches were fully aware and always took him out when he told them he felt pain.  He now stretches regularly and added hanging to his regiment and hasn't had a problem in a couple years.

Excellent point about hanging (from a bar, a door or whatever). It is a must for keeping bicep muscles elongated and not near enough emphasis is put on it IMO.

@Fenwaysouth, I am not sure if you read the linked article but the point is that the pitcher in that diagram is not suffering from anything.  The problem with many GIRD diagnosis is this:

Pitcher presents to ortho with “shoulder pain”.

Ortho compares internal rotation of throwing shoulder and non throwing shoulder.  Notes IR deficit in throwing shoulder and declares a finding of GIRD.

Player with hurt shoulder reports to PT with prescription for stretching to correct GIRD.

Did the ortho compare external rotation?  Note a loss of total range of motion when adding ER and IR as compared to the non throwing shoulder?

In actuality, shoulder pain is likely caused by something completely unrelated to the loss of internal rotation.

ive literally gone from never hearing the word GIRD 24 hrs ago to knowing way more than I need to :-)     Im thinking my son's injury isnt GIRD for one because it happened (popped) on a long throw from the outfield.  I do agree he hasnt stretched appropriately or thoroughly before games for years...but GIRD seems to be incorrect...he swears the pain is when he ER's the shoulder not the IR

@edcoach posted:

Smitty how long would the bouts with GIRD last? in other words if it flared up, would he miss a few days? weeks? This has been going on since July but the only thing that gave him temporary relief was a cortisone injection that lasted appx 2 months...he just started a medrol pack yesterday and was told to do a ton of sleeper stretches

He would have to take it easy for a couple days then ease back into throwing, so he might have to DH or play OF for a game or two before going back behind the plate during HS season.  In the summer he had to skip a tournament a few times. He could go months with no pain and the BAM it flared up again.  It was always scary and I was convinced he must have a tear or something, but it always went away.  One piece of info we got from a very experienced ortho surgeon was that if he could throw at all without pain it's not a tear.

@adbono posted:

Excellent point about hanging (from a bar, a door or whatever). It is a must for keeping bicep muscles elongated and not near enough emphasis is put on it IMO.

No doctor, physical therapist, coach, trainer or anyone ever mentioned this.  He picked it up from an Instagram post by Michael Lorenzen.

the dr. Colby saw yesterday said no more deadlifts, hang cleans or really any olympic lifts...sound right?

@edcoach posted:

the dr. Colby saw yesterday said no more deadlifts, hang cleans or really any olympic lifts...sound right?

This was the same guy who diagnosed GIRD?  What was his logic for eliminating deadlifts, etc?  Did he want these lifts eliminated until the shoulder is healthy or did he think they should never be done again?

yes same guy...he was saying until the injury was healed but he kind of scoffed at deadlifts in general...

btw I dont remember his logic but he never mentioned anything about hanging either...

@edcoach posted:

the dr. Colby saw yesterday said no more deadlifts, hang cleans or really any olympic lifts...sound right?

I’m in the same court of opinion on this issue. IMO (and the opinion of many Ortho specialists) it’s a bad idea for baseball players to perform any Olympic lifts. The risk is too great for the reward. There are many safer ways for baseball players to get stronger.

Demands of overhand athletes are general in most senses and very specific in others.  I would love to hear the rationale behind the notion that deadlifts, front squats, split squats, etc are bad for baseball players.  If lifting heavy is bad for baseball players why does every college and professional clubhouse look like a Gold’s Gym?

Why did the Yankees hire Eric Cressey?  

@Smitty28 posted:

One piece of info we got from a very experienced ortho surgeon was that if he could throw at all without pain it's not a tear.

I'm not saying this statement is completely wrong but definitely not entirely true.  My son had a torn labrum which he rehabbed and continued to play with for a few months.  The first month or so he didn't have any pain.  It didn't feel 100%, but no shooting pain like he had before PT.  After a few months months he ended up having surgery and 4 anchors put into his shoulder.  

@edcoach posted:

awhile back I posted about son's shoulder injury. He got mri and had bicep strain, small tears nothing deemed worthy of surgery and has since had cortisone injection. 2 months later it wore off and hes in pain so went to a new ortho as his other one is out having surgery. Today he was diagnosed with Gird and was given prednisalone and told to do stretches. I found another post about Gird on here but does anyone have recent experience with it? He was going to pt for a long while with no relief. The only positive I see is that it doesn't effect him swinging the bat

I haven't read through this thread yet, just addressing the OP for now.

GIRD, or glenohumeral internal rotation deficit, isn't pathological. Meaning, "Okay you have a 10 degree difference between sides, you're now going to get injured!" or 19 degrees or 20.

Below I'll share with you some information I use on presentations regarding the shoulder.

There was limited evidence that a lack of external rotation (but no other shoulder joint range of motion measures) may be a risk factor for shoulder injuries in baseball pitchers. There was limited evidence for an increased risk of shoulder injury when training and match load in youth handball players increased >60% in the week before injury compared with the average load of the preceding 4 weeks or if youth baseball players participated in a high volume of training each week.

Since there is limited evidence for which potential risk factors to assess or what prevention strategy to employ, the main purpose of screening shoulder parameters in overhead sports should be to evaluate current shoulder status, measure improvements in performance or to serve as normative values to reach before return to play after injury.

What does that mean? It means there's some evidence that says if you have 93 degrees of ER on your throwing arm and 91 degrees of ER on your non throwing arm, you may want to try to get a couple more degrees (this is only seen in professional pitchers, not in high school pitchers). There's no other evidence that GIRD is causative of shoulder injuries, nor TROM (total range of motion, which is ER + IR).

https://bjsm.bmj.com/content/52/20/1312.long

Another study published in 2020, they included 15 prospective studies (meaning they follow them from the start before any injuries happen), and most studied included looked at baseball.

They concluded that there is limited evidence that preseason range of motion screening cannot predict shoulder or elbow injuries in volleyball, softball, tennis or handball athletes – aside from, perhaps, external rotation for professional pitchers (but not adolescents) or swimming athletes (Pozzi et al., 2020).

Their finding were that swimmers with less than 93 degrees of ER, or more than 100 may be susceptible to injury, and that professional baseball pitchers with less than a five-degree increase of external rotation on their throwing arm are also slightly at risk.

What does that mean? Again, the only thing that may be helpful is at least 5 degree of ER more in the throwing than non-throwing shoulder, but that's only for professional pitchers.

https://bjsm.bmj.com/content/54/17/1019

Long story short, GIRD isn't causative of shoulder injuries. It's not a mediating factor of recovery. And what we measure on the table isn't indicative of what happens while throwing. Prime example, study done on elite handball players looked at their ER on the table, ER while pulling as far as they could, and ER while throwing. What they measured had no association between the ER seen while throwing and velocity. The conclusion speaks volumes: It was concluded that ROM of the external rotation measured on the bench does not give any information about the maximal throwing performance or the external rotation angle during throwing and therefore cannot be used to identify potential fast throwers or injuries in elite team handball players.  

What does that mean? It means unless we have a lab we're probably not getting a ton of useful information through range of motion. Even then, the studies show there may be a benefit at having at least 5 degrees more of ER on your throwing arm compared to your non-throwing arm (but this result is only seen in professional pitchers). Total range of motion and GIRD are not causative of injury or increasing the likelihood of getting injured.

https://pubmed.ncbi.nlm.nih.gov/26902748/

And why is that, about GIRD? Well, this study that at high school-aged players and found that those who DID NOT HAVE an IR deficit were more likely to get injured. Those who had at least a 20 degree GIRD were protected from injury.

Now, would I use that above study to say everyone should lose 20 degrees? No, but it goes to show that, with the totality of evidence, GIRD isn't something that necessarily needs "fixing". Rather the physiotherapist should look at what the person in front of them is having difficulty with, and build them up from there. Stretching isn't going to prepare the tissues to handle throwing 70, 80, 90 MPH.

http://europepmc.org/article/MED/24893778

Another root cause of impingement is poor posture. Pretty common these days with the use of cell phones, iPads, video games, online classes...

Xfactor great post thank you....let me ask you...why would ortho have diagnosed that? Laziness? Lack of knowledge? What if the specialist tomorrow says the same thing? Just trying to get some knowledge to know how to respond and question.  The initial diagnosis per mri was strained bicep

Is gird an impingement??

edcoach,

There is a physical therapist ( in Oklahoma City, i believe) that specializes in sports, by the name of Mark Brown. He is the physical therapist of choice for several highschool teams as well as the local Ballet Company. I've attended several of his On-line Continuing Education Seminars and the guy really knows his stuff. You can look him up on-line, and maybe give him a call. He showed me ( virtual) that there is always a big difference in external rotation/ internal rotation Range Of Motion, in Throwing shoulder vs non-throwing shoulder , of pitchers. This is normal and should not be construed as needing correction ( unless there are other factors). Stability is of prime concern for shoulders.

Xfactor, presented an excellent post and i looked up the referenced material -excellent resources. Thx for posting!

Best Of Luck!

Just got back from specialist. He said he has gird and said he has a sick scapula. Showed how much lower and weaker throwing side is than the other. Also got injection right into the joint  so will have that plus the medrol dose pack plus told him hes got to up the reps on stretches daily and showed him the stretches

I would focus on the portion of diagnosis concerning the scapula.  The scapular muscles play a critical role in shoulder stability, particularly in maintaining the position of the glenoid (this is the socket that the ball of the humerus rides in).  Without strong scapular muscles the biomechanics of the shoulder break down.

Here is a paper that explains the role of scapular stability in the throwing shoulder. The introduction will tell you all that you need to know but I would encourage you to click the link and digest as much as possible of the entire article.

“In normal upper quarter function, the scapula provides a stable base from which glenohumeral mobility occurs.^1,2 Stability of the scapulothoracic joint depends on coordinated activity of the surrounding musculature. The scapular muscles must dynamically position the glenoid so that efficient glenohumeral movement can occur. When weakness or dysfunction of the scapular musculature is present, normal scapular positioning and mechanics may become altered.^1,2 When the scapula fails to perform its stabilization role, shoulder complex function is inefficient, which can result not only in decreased neuromuscular performance but also may predispose the individual to injury of the glenohumeral joint.^1,2”

^{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811730/}

^{As for treatment, you won’t stretch your way to scapular stability. This will require some strength training.  I would find a PT or trainer with overhand athlete experience and have them write some training programming to help build those back of the shoulder muscles.}

@edcoach posted:

Just got back from specialist. He said he has gird and said he has a sick scapula. Showed how much lower and weaker throwing side is than the other. Also got injection right into the joint  so will have that plus the medrol dose pack plus told him hes got to up the reps on stretches daily and showed him the stretches

I looked up SICK scapula since I don't recall ever hearing the term and sure enough it is very similar to how my son's shoulder posture looked when he first began having shoulder issues.  As I said early, this issue took a couple years to fully resolve itself, during which time he had periodic flare-ups followed by ortho visits and PT sessions.  As he learned how to stretch, warm up properly, ease into hard/long throws, and strengthen his shoulders and back muscles it no longer became a problem.  It's been about 3 years now since he's had an issue and his arm is stronger and more accurate than ever.

I point this out to suggest to you that there's probably not a quick fix to this.  It may take months or years but it can get better, and he can function if he prepares himself properly.  Forgive me if I'm overstepping here, but it concerns me that he's taken cortisone, prednisone and another injection, none of which would make me comfortable.  I am not a doctor but my doctor friends have always warned me against pain killers, particularly in young people, as they could mask conditions that could lead to serious injury.

thanks for the responses Guys.  22and25 I agree with the strengthening that will be needed...the ortho did say that and referred him to pt and said we need one with that experience in strengthening the back of the shoulder muscles but he said the guy he uses is out of business because he was bought out and has a no competition clause or something so im going to look hard for a trainer that can do this....Smitty...hes taking the Medrol pack and got the injection today..im assuming the injection was cortisone but im not sure.  He was throwing a ton of info at me that I was trying to digest.  He said he has worked with many many mlb players and was the team ortho for many oklahoma baseball and football teams and he focuses on the shoulder mainly...ive got to trust him as now in the last 2 days I basically have 2 guys telling me the same thing...rest, stretching, strengthening of the scapula, etc...

@edcoach posted:

Just got back from specialist. He said he has gird and said he has a sick scapula. Showed how much lower and weaker throwing side is than the other. Also got injection right into the joint  so will have that plus the medrol dose pack plus told him hes got to up the reps on stretches daily and showed him the stretches

I would venture to say that almost every ballplayer (I know mine does) with significant time playing the game will have a shoulder that is lower than the other side.  His throwing arm will also have greater ER and “deficit” of  IR as referenced in the images at the beginning of the post.  Neither of those mean you have or will get a should/arm injury.

As previously mentioned I would pay special attention to the scapula.  Focus on strengthening all the surrounding muscles in the shoulder.  My own personal opinion I would not use injections or pain killers.  

I think time, rest and PT are going to be your best friends for a while.  

The only thing about that SocalOG is that he's had time, rest and PT and things didn't improve. Trying to get him through feb-april and shut down throwing til August.  Are there strength trainers that could help the scapula and back shoulder muscles? I'm assuming yes obviously but didn't know if that's better than pt or not. He probably did 20 pt sessions yet the situation was not resolved

It’s as important to find a PT or trainer with shoulder expertise as it was to find a doctor with shoulder expertise.  And again, someone who works with overhand athletes in particular.  The shoulder is probably the most complex joint structure in the body.  Scapular issues can be caused by one or more of several different muscles.  You need a PT or a trainer who has the experience to observe your son’s movements, diagnose the specific deficiencies and write effective programming to strengthen the appropriate areas in a targeted way.  

Eric Cressey literally wrote the book (ok, a book🙂) on healthy shoulders in throwers.  If money and time were no object, I would put my kid on a plane to Florida and have Cressey asses him and start him on a program.

@edcoach posted:

The only thing about that SocalOG is that he's had time, rest and PT and things didn't improve. Trying to get him through feb-april and shut down throwing til August.  Are there strength trainers that could help the scapula and back shoulder muscles? I'm assuming yes obviously but didn't know if that's better than pt or not. He probably did 20 pt sessions yet the situation was not resolved

Sorry about that.  I know how frustrating it can all be.  Fortunately, for my son the diagnosis was really easy, a torn labrum.  At least we knew the exact issue and how to go about the healing process.  

Like 22and25 said, the shoulder is very complicated.  Everyones situation is different and there is not a 1 size fits all solution.  Be vigilant and keep looking for the solution that is best for your situation.  

Just curious, how many MRI's has he had?  Sometimes it takes a few to spot the issue.  

22and25 you are in the medical field I take it?  I'd love to find a trainer or pt here like Cressey. Socal I'm sorry about your son. You're right though at least you know what you're dealing with. Colby has had 1 mri back in Sept.  I have a feeling if there is still trouble in a few months there may be another one coming. I do think he'll take the summer off and focus on healing up

@edcoach posted:

22and25 you are in the medical field I take it?  I'd love to find a trainer or pt here like Cressey. Socal I'm sorry about your son. You're right though at least you know what you're dealing with. Colby has had 1 mri back in Sept.  I have a feeling if there is still trouble in a few months there may be another one coming. I do think he'll take the summer off and focus on healing up

I would definitely, 100% get another MRI to be on the safe side.  The Dr's can only go by what they see in the MRI and the symptoms.  

When we started the process with my son his labrum tear appeared to be small, by the time we got around to surgery it was almost a 50% tear.  

If your son had a very small tear that didn't show on the MRI the first time, perhaps it is more visible now.  

Edit: and thank you.  He is all good and now a sophomore in college still playing ball!

@edcoach posted:

22and25 you are in the medical field I take it?  I'd love to find a trainer or pt here like Cressey. Socal I'm sorry about your son. You're right though at least you know what you're dealing with. Colby has had 1 mri back in Sept.  I have a feeling if there is still trouble in a few months there may be another one coming. I do think he'll take the summer off and focus on healing up

I am not a physician, I work in healthcare on the commercial side.  I have taken my son to both Boston and Florida to work with Cressey for a pitcher specific training program.  He is the best in the business, in my opinion, at assessing and programming the individual needs of pitchers.

@SoCal OG posted:

I would definitely, 100% get another MRI to be on the safe side.  The Dr's can only go by what they see in the MRI and the symptoms.  

When we started the process with my son his labrum tear appeared to be small, by the time we got around to surgery it was almost a 50% tear.  

If your son had a very small tear that didn't show on the MRI the first time, perhaps it is more visible now.  

Edit: and thank you.  He is all good and now a sophomore in college still playing ball!

Definitely get the MRI. It is only way to know for sure. Speaking from experience of watching 2021 do 3 months of PT, just to find out it was a tear. 2 x-rays showed nothing. Insurance was our biggest hurdle—they required the PT prior to MRI.

Just a little inside knowledge when it comes to repeat radiological studies. Sometimes the real reason for a repeat scan is because a different radiologist is reading on that day. Not my intention to call anyone out, because I know from experience that very subtle changes can be very easily misread and/or overlooked. From a legality standpoint things can get very muddy when it comes to what should or shouldn't have been seen on certain films. Reading scans at times it isn't as black and white as a lay person would like to believe. As to life, there is quite a bit of grey area.

Or, just as likely, the ortho group has a cheap low gradient open MRI in their office so they can do their own scans and make money.  The scanner sucks and you get crappy images that miss pathology.

@ReluctantO'sFan posted:

Just a little inside knowledge when it comes to repeat radiological studies. Sometimes the real reason for a repeat scan is because a different radiologist is reading on that day. Not my intention to call anyone out, because I know from experience that very subtle changes can be very easily misread and/or overlooked. From a legality standpoint things can get very muddy when it comes to what should or shouldn't have been seen on certain films. Reading scans at times it isn't as black and white as a lay person would like to believe. As to life, there is quite a bit of grey area.

This is my understanding as well, the images are interpreted.  Much like cancer, you want the right person doing this.

@22and25 posted:

Or, just as likely, the ortho group has a cheap low gradient open MRI in their office so they can do their own scans and make money.  The scanner sucks and you get crappy images that miss pathology.

If you get a chance, look into perceptual vs cognitive errors when it relates to radiology. There has been a ton of studies on this topic, and it's really interesting how the human mind works while trying to decode raw information. "Crappy scanner" is usually a scape goat as the abnormality is often seen in retrospect, especially after being pointed out by another Radiologist. This ties back to a perceptual error.  @Smitty28 Those that keep making cognitive errors tend to loose their licensure pretty quickly

@ReluctantO'sFan posted:

If you get a chance, look into perceptual vs cognitive errors when it relates to radiology. There has been a ton of studies on this topic, and it's really interesting how the human mind works while trying to decode raw information. "Crappy scanner" is usually a scape goat as the abnormality is often seen in retrospect, especially after being pointed out by another Radiologist. This ties back to a perceptual error.  @Smitty28 Those that keep making cognitive errors tend to loose their licensure pretty quickly

Yes, I am aware.  I am also aware that an outdated .5 Tesla open scanner shoehorned into an office produces substandard imaging.  It does however provide the same reimbursement as the 1.5T or 3T magnet at the imaging center down the street but the ortho practice keeps the money😉

Don’t get me started on the ortho doc doing a wet read to make treatment decisions.....

While I'm sure quacks, snake oils, and scammers do exist, this is not indicative of the medical profession at large. Basically, I was just trying to point out to @edcoach that there is power in numbers (without giving actual medical advice). Things can be seen in retrospect with the help of a colleague that can take on a completely different meaning within the field of radiology.   

I am not suggesting anyone is a quack, selling snake oil or scamming anyone.  I am only suggesting that, if an MRI is needed I would take my son to a center with modern equipment and insure that the scans are read by a radiologist before making any treatment decisions.  Plain X-ray in a doctors office, sure.  MRI in a doctors office, hard pass.

You guys might as well be speaking greek, lol!  

For the OP, I think it's been long enough and the situation hasn't improved or changed much.  Probably well past time for a 2nd MRI.  Hopefully, its conclusive and the Ortho can give a solid diagnosis and recovery plan, even if that involves surgery.  

Just my opinion, but I did stat at a Holiday Inn Express once.  

https://vimeo.com/51166685

I'd add that the player's positioning of the shoulder during the scan can potentially impact the results of what can be seen.  Yet another reason to have care managed by a doc who routinely works with overhead throwing athletes.

@9and7dad posted:

I'd add that the player's positioning of the shoulder during the scan can potentially impact the results of what can be seen.  Yet another reason to have care managed by a doc who routinely works with overhead throwing athletes.

The biggest factor in MRI is the coil.  Do they have a dedicated shoulder coil?  How many channels in the coil?  Do they try to get by with a flex coil to keep from buying a dedicated shoulder coil?  

@Dallas2020 posted:

Another root cause of impingement is poor posture. Pretty common these days with the use of cell phones, iPads, video games, online classes...

While this thought process is common, especially in the general population, it doesn't actually hold much validity. Posture isn't causative of pain and shouldn't be vilified (this doesn't mean you can't modify symptoms by changing positions or postures, rather just because you can change something doesn't mean that it was the cause of the issue to begin with [post hoc ero propter hoc fallacy]). It definitely isn't causative of impingement, and impingement (as a pathoanatomical diagnosis) does not exist.

@edcoach posted:

Xfactor great post thank you....let me ask you...why would ortho have diagnosed that? Laziness? Lack of knowledge? What if the specialist tomorrow says the same thing? Just trying to get some knowledge to know how to respond and question.  The initial diagnosis per mri was strained bicep

It's difficult to stay up on current literature. If you were to ask me 10 years ago I would be fully on board with GIRD being the cause of pain. So I'm not going to throw the ortho under the bus and just say they're lazy or stupid or whatever. It can be difficult to stay up to date on things. And there's also bias involved that shades things.

It may very well be that there is decreased range of motion, but GIRD isn't pathological. However they may have a rationale of, "Let's calm things down a bit, and build up from where he's at." and whether they call it GIRD or SHITS (something hurts in the shoulder) or whatever, if they have a good treatment plan that aligns with what's important to you and your son, then that's awesome.

Bottom line I'd want to know is,

What's the prognosis?

What will be done to help my son be able to handle the volume of throwing and will the tissues be trained appropriately so they can handle throwing 70/80/90+ MPH?

Thx for all the responses. GIRD is different than the sick scapula correct? I'm really concerned about finding a pt that works with overhand athletes exclusively.  Would a good trainer be able to strengthen the scapula and rear shoulder muscles?

@edcoach posted:

Thx for all the responses. GIRD is different than the sick scapula correct? I'm really concerned about finding a pt that works with overhand athletes exclusively.  Would a good trainer be able to strengthen the scapula and rear shoulder muscles?

Depends. Cressey is one of if not the best with this. A close friend owns another facility close to Cressey and the first thing he did when my son started there was put him on a scap/shoulder plan to strengthen those areas. Still has a basic scap workout to do everyday. I would look for a trainer who focuses on athletes/sports, not a trainer focused on fitness and weight loss.

Zach Dechant had a good Instagram post this morning showing some great band exercises to do warming up and after throwing and during your workout

Tbpt I'm going to go get son those bands and show him that workout. It looks Excellent.

We have a guy in town that used to be strength and conditioning for several different D1s and now he has a private gym he trains athletes. Im going to contact him today.

Have you given any thought to going to see Cressey?  Flights and hotels are cheap right now.  An in person assessment, initial programming and a few days of in person training with his staff is around $400.  Your son will leave with a written program tailored specifically to him and a video library of all of the exercises.  

Add flight, food and hotel for two and you are maybe $1,500 all in. Not insignificant money but compared to what we spend on baseball, not crazy money either.

@edcoach posted:

Tbpt I'm going to go get son those bands and show him that workout. It looks Excellent.

We have a guy in town that used to be strength and conditioning for several different D1s and now he has a private gym he trains athletes. Im going to contact him today.

My trainer friend told me right away a couple years ago he had to develop his scaps more. He does that stuff almost everyday.

Also, 22&25 is 100% right. If you can swing it I’d bring him to Cressey. I live here so we’re there all the time. They will find every weak part of the body/kinetic chain and program to strengthen it. It is truly amazing to see what they can do.

Does Cressey also set up a throwing program?? I'd definitely go down there in a heartbeat

They will definitely do a throwing program. Their staff works with a ton of top MLB guys. Just scroll through Cressey Instagram and you’ll see it. Crazy to see HS kids getting instruction from the same guy working with Scherzer/Syndegard/Verlander/Kluber, etc.

If you go now there will be a ton of MLB guys there training.  My son went last January and had Mad Max and Klubber there every day.  Just call them and see if he can get on Eric’s schedule to do the assessment, tell them you will wait if necessary to have Eric do the assessment and write the program.  He is at the Florida location now.

The crazy thing about Cressey is they make your HS kid feel just as important as the Cy Young winning pitcher. They put a lot of pride into their work

400 seems cheap...

Due to personal reasons he missed over a week of class already and can't miss more but I will have him down there the day after school is out

@edcoach posted:

400 seems cheap...

I just went back and looked, was working off memory. The initial assessment, programming, on-site initial training, etc... was $499.00.  

Thats not bad at all honestly

I heard from the ex d1 strength coach today.  I told him of the sick scapula diagnosis and his reply below...worth checking into??

We can work some deep tissue stretching in the area.
I like to find the cause, ie: tight pec, over use, weak rear delts, throwing mechanics, etc.

Can’t hurt. My son’s right side of his body was much stronger than his left in the core and back. The trainer added exercises that made the left side stronger (in addition to the scap work). The weak left side wasn’t able to pull to match the right resulting in hitting and throwing with his left shoulder up. That resulted in the Teres Major/Minor scap area getting sore and vulnerable. Had he continued without fixing it he would have likely made his own adjustments resulting in a different injury.

Good trainers will evaluate the entire body and chain to see where you are going to break down. Then they plan to strengthen those areas before implementing things like velo programs.

To All those familiar with Cressey,

We have family members in Florida and would love to combine a trip there to see Cressey , as well as our extended family. My son is 14 . What age, time would you recommend, to get the most out of the visit( and the $400)?

Is he in 8th grade? I’d say now would be a great time. He could get the workout plan and have several months to implement and see the progress. What position does he play? They also provide hitting and pitching instruction. Friday night my son was taking turns in BP with a big time MLB slugger. It’s funny to see them getting tips and drills that my son does.

Just for a little fill in information - Cressey Sports Performance home is actually in Hudson, Mass.  The second location is Florida.  I have no idea how he's splitting his time, in addition to his duties with his new position with the Yankees.  For what it's worth the Yankees pitching coach, Matt Blake, was pitching coordinator at Cressey's in Massachusetts up until about 2015 when he got into professional baseball with the Indians.

Eric heads to Florida in October, when the MLB season ends and it starts getting cold in Boston, and works there until pitchers and catchers report to spring training, at least that has been his MO in the past.

@Adams Baseball posted:

To All those familiar with Cressey,

We have family members in Florida and would love to combine a trip there to see Cressey , as well as our extended family. My son is 14 . What age, time would you recommend, to get the most out of the visit( and the $400)?

This is very much dependent on your son’s physical and mental maturity and to some degree your ability to support and sometimes supervise the training.  It’s a 6 day per week commitment on top of anything else he is doing.  There are equipment requirements that necessitate a commercial gym or a heavy financial commitment and space to outfit your home gym.

If he isn’t starting to mature physically I would wait.

if he is not abnormally disciplined and self motivated for a 14 year old I would wait.

If there is not an adult in the house with the time and resources to support him daily I would wait.

My wife put in countless hours charting workouts, helping with manual resistance exercises and driving back and forth to the gym before COVID hit and we built the home gym.

Ok, thx. I think i Will wait. I've got a "little" gym at my house, but it seems to be making a difference. There is a Sports Specific GYM just down the block that i think we'll join as soon as we have the time. He's physically developing very rapidly , but i'm not sure he ready to add that much time to an already crowded schedule ( private lessons, Select team practices, 8th grade swim team, school, etc.)

Thx