If you’re reading this, chances are you are in pain and have probably already seen a doctor or therapist who hasn’t helped you much. You’ve probably even had injections… even surgery with little or no improvement!

A Frozen Shoulder is an extremely painful and debilitating condition characterised by intense pain and stiffness of the shoulder and has the medical profession stumped.  There’s lots of theories about the cause and pain killers are prescribed by the bucket load, but from my experience, nothing works. If there was a medicinal cure for Frozen Shoulders, the chemist shops would have walls covered with the stuff.

Some doctors say “Leave a Frozen Shoulder alone for 18 months or so and it will get better on its own”. I’ve heard of others saying “You have what’s called a Frozen Shoulder.  Get used to it, because you’ll have it for two years.”
It will eventually get better on it’s own… but never completely.  In reality, a Frozen Shoulder will take a bit longer than that to heal itself.
X-rays can’t reveal the cause of shoulder stiffness in most cases of primary adhesive capsulitis, and an MRI (Magnetic Resonance Image) shows soft tissue and may be used in cases in which another disorder is suspected, such as a torn Rotator Cuff.   So when nothing shows up, it’s frustrating to be told there’s nothing wrong with your shoulder when it’s really hurting like blazes.

At this point, let me say that I was sent for a MRI when I had the condition.  I listened to the technicians discussing their findings and heard the boss say “Write your report and say muscles appear to be normal, and leave it at that.”
The technician then went on to say he did find a thickening in the Synovial Fluid around the Gleno-Humeral Joint.
The response?  An off-handed  “So what?”
That told me everything I needed to hear… that’s what.  I was then sure of what I was dealing with!

Signs and symptoms of Frozen Shoulder.

The pain of a Frozen Shoulder can be horrendous. Ask a sufferer what the pain would be on a scale between 1 and 10 and you’ll often hear 20.

The major symptoms of Frozen Shoulder are:

• Pain and loss of motion:

• Night pain and especially when trying to lay on the affected side.

• Severe sharp catching pain at the front of the shoulder when you inadvertently extend the arm and lasting up to a minute or so. (You have to protectively hold the shoulder tightly.)

• Pain reaching for the hip pocket, (not necessarily a bad thing if it’s your shout), putting on or taking off a coat, brushing the hair and inability to do up a bra.

• Pain down the outer upper side of the arm.

• Inability to drive.

• Swelling of tendons causes severe limitation in movement, especially reaching up behind the back.

Immobility / Stiffness

This is the key diagnosis of a Frozen Shoulder. You can’t move the arm and neither can anyone else if they attempt to lift the arm for you. If they do try, it’s very painful and you want to kill them for their effort.

From when you first notice the pain, the shoulder becomes stiff or stuck for a period that could be between 48 hours to a month and it’s all downhill from there. If your shoulder is not ‘stuck’ you may not have a true Frozen Shoulder. Many people are forced to give up work as a result of the pain and stiffness that commonly persist for many years.

The inability to work and the constant pain and stiffness can have a considerable impact on you psychologically as well as financially, and you can become extremely depressed and anxious as a result.

Frozen Shoulder Facts:

• 2-5% of the population suffer from it. This doesn’t mean 98-95% enjoy it.

• It is more common in women (60%)

• It is five times more common in diabetics

• It is common, but not limited to people with Dupuytren’s contracture (an uncommon hand condition where the connective tissue under the skin of the palm contracts and hardens over time.

• It may be genetic. i.e it can run in the family.

• It seems to affect 40-70 year olds.

• About 15% of people get it on both sides.

There are three phases to Frozen Shoulder, (which lasts an average of 30 months. Some say longer).

1.    Freezing (1 – 8 months) You notice some things you normally do are starting to hurt.
2.    Frozen (9 – 16 months) It’s full on! Any movement using the arm is incredibly painful.
3.    Thawing (12 – 24 months) Slowly gets back to normal and pain free use of the arm.

Not much to look forward to, is it.

The pain and loss of function associated with this condition can become so severe that it can significantly affect the quality of life, and prevent some people from sleeping well or working.

What causes a Frozen Shoulder?

There’s no explanation for the development of Frozen Shoulder in most patients. The majority of cases seem to be more prevalent in women. Some who develop Frozen Shoulder have sustained an injury and developed stiffness as a result. The trauma can be quite mild or severe, and the body’s response to the event is probably more important than the event itself.

What is happens inside a Frozen Shoulder?

The shoulder joint is a ball and socket (Gleno-humeral) joint. The ball is at the top of the Humerus (arm bone), and the socket is a shallow cup on the end of the Scapula (shoulder blade).

Surrounding the Gleno-Humeral joint (shoulder joint) is a bag called the Capsule. When the arm is raised above the head, this Capsule is fully stretched. When the arm is lowered to the side, the capsule hangs down like a small pouch.

To improve the stability of the shoulder a group of four muscles called the Rotator Cuff braces the joint as well as an elaborate bunch internal ligaments.

Inflammation.
In a Frozen Shoulder Syndrome the Lax Capsular Sack and the Synovial Fluid it contains becomes sticky and thick and can sometimes form adhesions. The stickiness is brought on through inflammation. This can occur after a small injury, but often you may not remember anything about it. Once established, this inflammation spreads into other shoulder soft-tissues and can cause swelling in other shoulder sacks (bursae).
Stiffness.
The stiffness is an ‘overreaction’, or the shoulders attempt to counteract the inflammation within the Biceps groove. The body seems to ‘switch off’ muscles in a coordinated sequence. This sequence is the same for everyone.  Arm movements start to diminish, and within a few weeks the arm literally becomes frozen and for many, cannot be raised more than 40° in any direction. The muscles of the Rotator Cuff become weak and start slowly to waste away, leaving the arm to hang stiff and immobile.

The shoulder may not be completely stiff for several months and both active and passive movements are stiff and neither you nor anyone else can lift it because it’s too painful!

At this point, you’re probably saying “He’s talking about me!”

Traditional treatments may include:

Cortisone Injections:
Cortisone injections are often tried during both the freezing and frozen phases. It is usual to have up to four injections. Cortisone injections may give brief periods of pain relief, but mostly, they seem to give only a few days or weeks of symbolic respite. Cortisone, which is a steroid, is a crystalline substance and is injected into the joint capsule.

Suprascapular Nerve Block:
The suprascapular nerve is the major sensory supply to the shoulder joint and motor supply to the Supraspinatus and infraspinatus muscles.

A Suprascapular Nerve Block has been used in patients with severe pain associated with Frozen Shoulder syndrome. This injection technique is usually performed 3 times over as many weeks. It has given some relief for pain, but has no effect on the stiffness in the shoulder.  This injection consists of a local anesthetic and steroid, and is done with x-ray guidance and involves inserting a needle through skin and deeper tissues.

The procedure is not without pain.  However, the skin and deeper tissues are numbed with a local anesthetic. Most of the patients also receive intravenous sedation which makes the procedure easier to tolerate.

Manipulation:
Under anesthetic, manipulation can be performed in the freezing phase (after about 6 months).  It is performed under general anaesthetic and followed up by several months of physiotherapy. Complications arising from this include fractures and dislocations of the Humerus, Rotator Cuff tears, increased inflammation and scarring. Nerve damage can also occur, especially to the Radial Nerve.

Physiotherapy:
Physiotherapy is commonly advised  by doctors during the ‘Frozen’ stage and is mainly aimed at keeping the shoulder mobile through stretching and pushing the joint.  However, it rarely seems to hasten the recovery of the condition.

Halleujah.
The good news is that even very severe types of Frozen Shoulder syndrome can be treated effectively. Treating Frozen Shoulders is massage based and naturally utilises the body’s own healing mechanisms. No drugs, no surgery. It utilises a specific sequence of manipulations to the shoulder joints and soft-tissues.

In a Frozen Shoulder there are masses of inflammation and on top of this the brain starts to recruit the ‘wrong’ muscles to move the shoulder.

The body and the brain is tricked into healing itself by addressing the two main components of the problem … pain and stiffness. Initially the aim is to significantly reduce the pain by treating the swelling around various shoulder tendons, especially the biceps tendon.

Following this, the technique moves on to rapidly ‘thaw’ and improve the range of shoulder motion by stimulating a unique sequence of reflexes hidden within the muscles. One reflex is triggered against another in sequence and the arm is not forced. Instead it’s kept still whilst applying the pressure.

Patients treated in this massage based technique will notice a definite improvement with each treatment session. These should be twice a week for twenty to thirty minutes a session and complete relief should be within twelve weeks.

There is a couple of testimonials regarding Frozen Shoulders you might care to visit, and if you believe you might be displaying the symptoms of this condition… call me to talk about it.

Frozen Shoulders CAN be fixed… but it won’t happen with medication.

The Rotator Cuff is an amazing piece of kit that allows the arm to raise and rotate at the shoulder and helps to stabilise the shoulder joint during movement.  Although each Rotator Cuff muscle moves the arm from the shoulder joint in a specific direction, they all work together to stabilise the shoulder joint.

A strain or tear in the Rotator Cuff may occur suddenly from trauma like a fall or happen gradually from overuse.

Strengthening exercises for the muscles that control the Shoulder Blade is also important, as the Shoulder Blade (Scapula) helps the Rotator Cuff to dynamically stabilise the shoulder.

The Importance of Strengthening the Rotator Cuff

Many muscles are involved in shoulder movement and all work together, but strengthening the Rotator Cuff is especially important. The Rotator Cuff is the main stabiliser of the shoulder joint during movement of the shoulder.

If the ball of the upper arm is not kept centered, abnormal stress is placed on surrounding tissue and may cause gradual injury. Strengthening the Rotator Cuff helps prevents common Rotator Cuff injuries including Tendonitis, Rotator Cuff tears, and Shoulder Impingement Syndrome.

As we get older, Rotator Cuff tendons reduce in elasticity and become more susceptible to injury. There is also a gradual loss of muscle mass that occurs, but this can be counteracted with strengthening exercises.

Rotator Cuff Muscles

The Supraspinatus is located at the top of the shoulder and abducts the shoulder – it raises the upper arm and moves it away from the body.

The Subscapularis is at the front of the shoulder… same side as your face.  It internally rotates the shoulder.
The Infraspinatus and Teres Minor are in the back of the shoulder – they externally rotate the shoulder.

Though each Rotator Cuff muscle moves the shoulder in a separate direction, though they all work together to stabilise the shoulder joint.

Strengthening the muscles of the Rotator Cuff is important.
The two small external Rotator Cuff muscles are often weaker than the larger internal Rotator Cuff muscle.

The Rotator Cuff muscle involved in abduction (taking the arm away from the body) is the Supraspinatus, and is the one most often injured of the Cuff muscles due to its position between two bones which often squeeze this tendon during overhead movement.

Other Shoulder Stabilisers:
The Scapula or Shoulder Blade helps the Rotator Cuff to stabilise the shoulder joint as it moves. The Rotator Cuff muscles rise from the Scapula and attach to the head of the upper arm bone or Humerus.

If the Shoulder Blade isn’t stable, pressure may be placed on the Rotator Cuff, so strengthening the muscles that support the Scapula are important.

The Bicep Tendon is the one that runs over the top of the Humerus and connects at the top of the shoulder joint helping stabilise it. Overloading the Biceps by lifting something too heavy can result in Biceps Tendonitis (also known as Shoulder Tendonitis).

Strengthening the Biceps helps prevent injury.

Exercise after Shoulder Injury

The question is… how long should the shoulder be rested?
The amount of time to rest an injured shoulder before starting rehabilitative exercises hinges upon how quickly one heals, as well as the type and the severity of the injury.  Working it too soon may cause further damage.

On the other hand, if the shoulder is not used enough, the shoulder muscles weaken, so strengthening exercises are an important part of rehabilitation. Stretching exercises increase the range of motion of the shoulder.

Stretching exercises may… may… help prevent Frozen Shoulder from occurring after an injury that causes one to restrict shoulder movement due to excruciating pain.
Stretching exercises are often started after a few days of rest, but it’s best not to overdo it.

Building up Strength:
Warming up with five minutes of ‘a mini version’ of the exercise you are about to do prepares the body by increasing heart and breathing rates, and increasing blood flow to the muscles, and raising body temperature. Warming muscles and tendons improve range of motion and reduces the risk of injury and warm muscles are more flexible than cold muscles.

Have Patience. Too much too soon can cause overuse injuries. Strengthening a group of muscles should only be done every second day to give the muscles a chance to heal. Strengthening exercises load the muscles slightly beyond their limits and cause micro tears. If given a proper chance to heal, muscles become stronger. If not given a chance to heal, chronic inflammation and problems may develop.

You should feel a bit fatigued by the end of a dozen reps. If you feel fatigued after just a few reps, reduce the difficulty of the exercise by lowering resistance (e.g. use lighter weights or no weights). If you do not feel fatigued after a set, increase the difficulty of the exercise by increasing resistance, but again… not too much.

Don’t “lock” the elbows. Your elbows should be slightly bent. This makes the muscles work harder to increase the effectiveness of the exercise. Locking a joint while exercising also increases the chances of injuring the joint.

Posture: The shoulders should be kept back and down during exercise.  The same goes for when you are standing or sitting.  Slouching reduces the space the Rotator Cuff tendon passes through and puts unnecessary strain on the shoulder joint.

Take it easy and don’t  jerk. Proceed slowly and steadily to use the muscles, not momentum, to complete the exercises. For exercises involving lifting or pulling, slowly lift or pull, hold for a second, and slowly lower or return.

Stretching:
Stretch Gently:  No bouncing. Stretch until you feel a tug but don’t go past. Always hold a stretch for about 30 seconds. Do not stretch to the point of pain. Over-stretching can tear muscles.

Breathe normally during stretching exercises.

Dumbbells or resistance bands are often used to provide resistance in strengthening exercises. Handheld weights come in a variety of weights, so you can gradually increase difficulty of exercises.
Resistance bands provide resistance when stretched. They come in a variety of thicknesses to provide different levels of resistance and are usually color-coded. When using resistance bands, increasing the distance you stand from whatever you have them attached to increases the resistance.

Part of your Shoulder Stabilising should incorporate Remedial Massage and its wise to see a qualified therapist.  If you’re experiencing shoulder problems, call me and book a massage today and see what a difference it can make.