Question 1

What is internal impingement and how is it different from regular shoulder impingement?

Accepted Answer

Internal impingement occurs inside your shoulder joint when your arm is overhead and rotated backward (the throwing position). The rotator cuff tendons on the underside contact and rub against the labrum (cartilage rim) at the back of the socket, causing damage to both. This is different from 'regular' (subacromial) impingement, which occurs when the rotator cuff rubs on the bone (acromion) on top of your shoulder. Internal impingement is specific to overhead throwing athletes, while subacromial impingement is more common in older adults with everyday activities.

Question 2

What is GIRD and why does it matter?

Accepted Answer

GIRD stands for Glenohumeral Internal Rotation Deficit. It means you've lost the ability to rotate your throwing shoulder inward compared to your non-throwing shoulder. Throwers typically lose 15-25 degrees of internal rotation due to posterior capsule tightness from repetitive throwing. This matters because when you can't rotate inward, your humeral head (ball) shifts forward and upward when you throw, increasing contact between rotator cuff and labrum. GIRD is the main modifiable risk factor for internal impingement. Stretching to improve internal rotation is the cornerstone of treatment.

Question 3

Can I continue throwing with internal impingement?

Accepted Answer

No - it's strongly advised to stop throwing if you have symptoms of internal impingement. Continuing to throw with pain will progressively damage your labrum and rotator cuff, potentially ending your throwing career. What might be manageable with 3-6 months of rest and rehabilitation becomes a career-ending injury if you play through it. Many professional pitchers have learned this the hard way. Rest, rehabilitate properly, address underlying causes (GIRD, mechanics), then return under supervision.

Question 4

How long until I can throw again?

Accepted Answer

With non-surgical treatment: typically 3-6 months from initial rest to full competitive throwing. You'll progress through: 4-8 weeks complete rest from throwing, 2-3 months interval throwing program (gradually increasing distance and intensity), 1-2 months return to practice throwing, then competition. After surgery: 9-12 months to full competitive throwing. Sling for 4-6 weeks, gentle exercises 0-3 months, strengthening 3-4 months, start throwing 4-6 months, competitive throwing 9-12 months. Rushing back is the main cause of failure.

Question 5

What is an interval throwing program?

Accepted Answer

An interval throwing program is a structured, gradual return to throwing that slowly increases distance, intensity, and volume over 2-3 months. You start with very light, short-distance throws (30-40 feet) and progressively increase distance (45, 60, 90, 120, 150, 180 feet) every 1-2 weeks if pain-free. Only when you can throw long distance comfortably do you begin throwing from the mound or returning to your sport. Each stage must be pain-free before progressing. Your physiotherapist or athletic trainer provides the specific program.

Medical Disclaimer

Internal Shoulder Impingement

📖What is Internal Shoulder Impingement?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention