Frozen Shoulder

Chances are you have heard of frozen shoulder, or know someone who had it. Even in our small town of San Luis Obispo I've seen quite a few cases come through my doors. I thought it would be a good time to shed some light on the issue.


Overview

Frozen shoulder, or adhesive capsulitis is a thickening, and tightening of connective tissue that make up the shoulder joint's capsule. The tightening restricts movement of the shoulder. In a classic capsular pattern the first movements to become restricted are abduction (moving your arm away from the side of your body), and external rotation (rotating your arm up as if to wave to somebody).


In general, symptoms begin gradually, worsen over time, and then resolve within one to three years.


Stages

1. Freezing stage: Any movement of your shoulder causes pain, and your shoulder's range of motion starts to become limited.

2. Frozen stage: Pain may begin to diminish during this stage but shoulder is stiffer and using it is often extremely difficult.

3. Thawing stage: Range of motion begins to make improvements.


Why

Risk of frozen shoulder increases when recovering from a medical condition, injury, or procedure that prevents you from moving your arm (stroke or mastectomy).


We know that it occurs most often in people 40 and older. Particularly in women. Systemic diseases seem to play a role: Those with diabetes, overactive or underactive thyroids, cardiovascular disease, tuberculosis, and Parkinson's.


One particularly hard case in my massage clinic coincided with Lyme disease. We discovered it after discussing a recent trip to Mexico. Referring out to another specialist proved to be helpful in resolving this case.


Treatment

Non-invasive treatment options are available. Physical therapy range of motion exercises can be very helpful to keep and gain motion of the shoulder.


More invasive treatments would include steroid injections, injecting sterile water into the capsule can help stretch the joint tissue, and shoulder manipulation where the patient is put under (unconscious) and the doctor moves the shoulder joint to loosen tissue. Surgery is rare but is an option when nothing else works.


Massage & Bodywork

Depending on the stage, and cause of the frozen shoulder massage seems to have varied results in my own experience. A quick search of Google Scholar yields few results for treating frozen shoulder with massage therapy. Working the tissue around the joint capsule and using passive / active stretching seems beneficial. However, if in the first two stages (freezing, and frozen) massage may have little impact besides pain relief.


Strategically, as range of motion begins to return I'll begin a more aggressive approach. All treatment is within the client's comfort levels. But we'll begin to push for much more range of motion in the thawing stage.


Below is a video of a case, shared with permission. Massage treatment was in conjunction with physical therapy. We took a conservative approach. When the shoulder began to show signs of entering the 'thawing stage' we performed Active Release Technique for the joint capsule of the shoulder. The technique involves a downward pressure towards the capsule of the joint with the practitioner's contact (thumb). Arm is place on the knee of the practitioner slowly inching the arm further into abduction (away from the body's midline) with a sustained pressure on the capsule of the joint. The results were amazing, see for yourself:





This case began in January. A full 10 months ago. Luckily it seems to be on the short end of the 1-3 year duration. It's possible to attribute these conservative approaches to shortening the time frame. It is absolutely attributable to these large improvements this week.


Keywords: Massage, Massage Therapy, Massage Therapist, Frozen Shoulder, Sports Massage, Lyme Disease, Active Release Technique, Personal Training, San Luis Obispo, SLO, Movement Assessment, Athletic Massage, Soft-Tissue, Injury.

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