See a photo gallery here. STRONGSVILLE, Ohio — Repeatedly throwing a baseball can be hazardous to your health.
A ballplayer diagnosed with glenohumeral internal rotation deficit (GIRD) goes through a drill at Strongsville High School designed to combat the physical condition. GIRD affects athletes who repeatedly throw overhand and results in one shoulder blade (throwing side) being higher than the other. Athletes with GIRD increase their risk of injury. - (Peggy Turbett, PD)
See a photo gallery here.
STRONGSVILLE, Ohio — Repeatedly throwing a baseball can be hazardous to your health.
Strongsville baseball coach Josh Sorge, athletic trainer Steve Pritchard and strength coach and trainer Joe Kopacz have the papers and pictures to prove it.
More importantly, they are doing something about it.
Using information gathered through a ream of reports published in medical journals, attending medical and pitching seminars and conducting physical examinations, they have learned about -- and are on the cutting edge locally of treating -- a condition known as glenohumeral internal rotation deficit (GIRD).
And, they say, it probably is impacting a pitching staff near you.
"It would be hard to estimate how many kids -- locally or nationally -- have this condition," said Pritchard, who has been studying and treating GIRD since 2009. "But, I think it's safe to say that if you have a thrower, an athlete who uses the same arm motion over and over, there are going to be changes between his throwing shoulder and non-throwing shoulder."
Over time, athletes with GIRD increase their risk of injury. And they can lose command and velocity and will require more time to recover following activity.
Pritchard and Kopacz, employees of Southwest General Health Center in Middleburg Heights, have worked with Sorge and pitching coach Jason Frederick to establish preventive medicine plans and recovery plans for the team, especially pitchers. An overhand throwing motion is abnormal to the human body.
Strongsville pitchers engage in a series of intense workouts using truck tires, sledgehammers and kettlebells designed to help prevent or recover from GIRD. And, pitchers are not permitted to throw curveballs or changeups until their sophomore seasons. The athletes are subjected to examinations by Pritchard and Kopacz three times a year.
Sorge, in his ninth year as head coach, was the first in the group to learn of the condition after attending a pitching camp in Houston conducted by renowned pitching guru Ron Wolforth and former Indians pitcher Brent Strom in 2008.
"When Wolforth started talking about this, I had no idea what he was talking about, but it became increasingly more interesting," said Sorge, who has become so enamored with the medical side of athletics he has toyed with the idea of returning to college. "So, I began looking into it deeper and I approached Steve and Joe with the information. They ran with it."
Pritchard speaks both as a medical professional and a parent. His son, Austin, is one of Strongsville's top pitchers and has been exposed to his father's examinations since his freshman year.
"The whole idea is to learn how we can become safer, decrease the risk of injury, have our pitchers develop better command, throw harder and extend their careers," said Pritchard.
It's easy to spot GIRD in athletes. Exams are conducted with the athlete lying face down, with his hands behind his back and his chin resting on the table. The shoulder blade of a player with GIRD will be elevated from the non-throwing blade. Consequently, it throws many other internal alignments out of whack.
Pritchard and Kopacz want to help athletes at other schools and shared more information to give players, coaches and parents additional insight into the issue.
Q: In layman's terms, what does the phrase "glenohumeral internal rotation deficit" mean?
Pritchard: "It refers to a shift in the total range of motion of the shoulder on the throwing arm vs. the non-throwing arm."
Q: What causes GIRD? What does it affect?
Pritchard: "GIRD is caused by repetitive overhead throwing. If left untreated, it affects the relationship between the scapula, the thorax and the humerus."
Note: The scapula is a medical term for the shoulder blade. The thorax are the ribs and the humerus is the upper-arm bone in the shoulder socket.)
Q: What are the consequences if it goes undiagnosed/untreated?
Pritchard: "It depends on how much the athlete performs the activity, whether the activity is performed with the proper technique and if the athlete allows time to recover from workouts. The damage occurs over years of repetitive activity. Frequently damaged are the rotator cuff, the glenoid labrum, the shoulder capsule and the medial ligament on the inside portion of the elbow."
Q: When you initially examined Strongsville athletes in 2009, were you surprised at what you found?
Pritchard: "Not really. We assessed nine pitchers that year and every one of them had some differences between the throwing side and non-throwing side. Over half the assessed pitchers had positive clinical findings for GIRD."
Q: How prevalent do you believe GIRD is in high school athletes?
Pritchard: "That is a tough question to answer without seeing them. However, I believe the majority of these athletes who are not doing preventative-type activities to slow down or correct these abnormalities will consequently have significant differences. So, yes, it is probably pretty prevalent."
Q: Should middle school athletes be concerned?
Pritchard: "Without question. I have evaluated throwing athletes in this age group and have seen these changes already occurring. Over time, these athletes will develop the changes we've talked about and increase their risk of injury. And, they will lose command, velocity and will take longer to recover after activity."
Q: What types of exercises do you prescribe to help prevent GIRD?
Kopacz: "From the strength and conditioning standpoint, there is evidence that strength programs increase velocity in pitchers. Steve, Josh, Jason and I discuss past programs and outcomes, as well as future goals. That includes designing specific exercises that address soft tissue work, mobility, dynamic warm-up, strength, endurance, power, balance and flexibility. There are specific exercises that we avoid with our pitchers, such as barbell back squats and incline bench presses. They use barbells, dumbbells, medicine balls and some unconventional methods involving kettlebells, weighted baseballs, ropes, sleds, tires, sledgehammers and fire hoses."
Q: Why differ the training?
Kopacz: "From an athletic trainer standpoint, the exercises that are prescribed to our pitchers are specific to the deficits and issues that are found during each player's evaluation. We take on a whole body concept and do not strictly look at the shoulder by itself."
Q: Have you seen any correlation between GIRD and incidence of injury?
Kopacz: "There have been several pitchers over the years who've experienced shoulder and/or elbow problems. An examination cannot predict when or if a problem will occur, however, it will tell us that without corrective exercises, the athlete will eventually have a greater chance for problems. Also, there is a rapidly growing number of high school throwing athletes nationwide who are getting Tommy John surgery -- the reconstruction of the ligament on the inside of the elbow -- who may exhibit some of the changes we've talked about. This is an adult-type injury occurring in a high school athlete. That is a big problem."
Q: Once you determine an athlete has GIRD, what is your first mode of treatment?
Pritchard: "The athlete is put on an exercise/stretching program designed to address the abnormalities. These exercises are to be performed 5-6 days a week."
Q: What advice would you give area coaches and parents to help guard against GIRD?
Pritchard: "Three things. Do not overuse your throwing athletes, follow the stretching exercises prescribed and encourage athletes to play other sports. There are recommended pitch-count guidelines with corresponding rest days available from reputable medical groups. Use them. Athletes limited to one sport are more susceptible to overuse, such as GIRD. The message is that kids should play more than one sport."
Q: Strongsville pitching candidates are not permitted to throw curve balls or changeups until their sophomore year. What is the benefit of that policy?
Pritchard: "The reason is related to health and fastball command. The shoulder is not designed to perform overhead activities, so even throwing fastballs can cause problems. Throw other pitches, such as curves, changeups, etc., and the forces through the shoulder and elbow can further enhance wear and tear. Couple that with the fact that many young pitchers do not throw these pitches correctly and you have a recipe for problems. Therefore, we instruct the freshmen to focus on their two-seam and four-seam fastballs and work on location."
To reach this Plain Dealer reporter: trogers@plaind.com; 216-999-5169
On Twitter: @TimRogersPD
OHSAA rule
The Ohio High School Athletic Association's baseball regulations state players may not pitch in more than 10 innings during a three-day period. Any part of an inning counts as one inning.
National pitch count recommendations
Here are pitch-count guidelines based on research by renowned sports physician Dr. James Andrews, one of the founding members of the Andrews Sports Medicine and Orthopaedic Center, and Dr. Glenn Fleisig, the research director of the American Sports Medicine Institute.
Recommended pitch counts by age
Age -- maximum pitches per start
7-8 50
9-10 75
11-12 85
13-16 95
17-18 105
Days of rest recommended based on pitch count
Ages 7-16
1-20 pitches: 0 days
21-40 pitches: 1 day
41-60 pitches: 2 days
61 or more pitches: 3 days
Ages 17-18:
1-25 pitches: 0 days
26-50 pitches: 1 day
51-75 pitches: 2 days
76 or more pitches: 3 days
