Frozen shoulder (or as it is clinically called adhesive capsulitis) is a debilitating condition that severely limits movement around the shoulder joint. As the capsule around the joint thickens muscles can become weak and strained and we end up in a vicious cycle of moving less and less, which in turn makes the shoulder more and more immobile.
3 ways to treat frozen shoulder
Although this can be a stubborn issue to treat in clinic I find a 3 pronged approach to be very successful.
1) Soft tissue work
Massage and stretching is as old as the hills, and for good reason – it works! Focused hands on work along side sound clinical reasoning is always my first go to with any shoulder problem. Without movement, tissues around the shoulder joint lay down collagen in a haphazard pattern which leads to fibrosis and restricted motion. Using external pressure via massage and internal tension from muscle contraction (see the work of Andrea Spina and his Functional Range Release techniques) we can positively impact this collagen formation, begin to create space for movement and improve the flow of healing blood into the area. When we have worked on the muscles we can then begin to get deeper into the joint capsule itself using lovely distraction and rotational movements to work on the inner fascia of the capsule and gently encourage it to stretch. For a shoulder that has not moved in a while this gentle articulation can feel phenomenal.
I have written about Propriceptive deep tendon reflex therapy here, but in a nut shell this technique allows us to work on the nerve receptors that surround the shoulder joint and that feed information back to the brain. With frozen shoulders I find that the receptors which monitor stretch are incredibly important and working on these can often result in a staggering increase in range of motion nearly instantaneously. Although the exact cause of frozen shoulder is not entirely known, we often uncover a history of immobilisation of the joint or an incident of falling on an outstretched hand. In such cases we can stimulate the receptors that detect pain by putting a gentle thrust through the joint and seeing whether they are still causing an issue, resulting in the muscles locking down around the area or becoming inhibited and weak. Again this can be incredibly powerful when it comes to freeing up more motion.
Although I have put this last this is the most powerful tool of all and if I was only allowed one of my 3 go to s this would be my modality of choice. Assessing and treating with movement allows us to work on the soft tissue and the nervous system all at the same time and to start tying together the reasoning behind why the shoulder became compromised in the first place and where to start the process of unravelling it. Using Gary Wards Flow Motion model of gait we can see where the inner capsule of the shoulder should spiral and decompresses as we walk, which then allows us to use exercises as we would massage to work deep into that capsule as well as into the connecting structures of the neck spine and all the way down into the feet. A truly whole body solution.
Movement is also the glue that ties together all the work that we have done on the couch. Without movement ‘speaking’ to the structures we have worked on in clinic, it is highly likely that the new found range will shrink back to where it was. It is a real use it or loose it situation where tissues can now be restructured along the lines of force that exercise homework creates enabling the patient to become their own therapist. This is often where manual therapy on its own struggles to create lasting results.
A frozen shoulder can really start to affect a person’s quality of life, be it sleeping, exercising or even getting dressed in the morning. Unfortunately there is not always a quick fix to the problem but there are ways to gently offer back mobility and to empower the person suffering with movement strategies to help fast track their own recovery.