Louise is an Advanced Clinical and Sports massage therapist with 20 years’ experience. She holds flexibility training workshops and also holds the UK’s highest qualification in massage therapy (BTEC level 6) she only holder of this level in Wales.
If you ask anyone with a frozen shoulder to describe their symptoms, I’m sure the adjectives “horrendous”, “debilitating”, “frustrating” would be used. The condition can start simply enough with just a feeling that you’ve slept awkwardly or an injury in the shoulder that hasn’t healed. Gradually, you’ll find the stiffness doesn’t ease but gets increasingly worse until you can’t lift your arm. Basic chores become unmanageable and can sometimes lead to long periods off work. However, as the NHS prognosis of frozen shoulder is 18-24 months, the symptoms of this condition are not just devastating physically, but psychologically too.
The term frozen shoulder (adhesive capsulitis as it’s also known) is an apt description of the symptoms as the condition is characterised by a severely reduced range of motion. Inflammation in the shoulder leads to eventual thickening or scarring of the joint capsule. This inflammation often starts in the groove behind the biceps tendon. (This can occur after a small injury, like reaching for the back seat of the car). Once established this inflammation spreads into other shoulder soft-tissues and can cause swelling in other shoulder sacks (bursae).
You first port of call should be your GP if you have shoulder pain that limits your range of movement. A diagnosis of frozen shoulder needs to be made early so treatment for the condition can be started quickly to help prevent long-term pain and stiffness developing in your joint.
Painkillers, steroid injection and physiotherapy are among the gentler treatments. If these fail, manipulation under anaesthetic to break up the adhesions might be advised, but some studies have shown that this traumatic approach can cause complications such as fractures, increased inflammation and dislocation.
Although the causes are poorly understood, there are certain groups that are of higher risk of suffering this condition such as people who are diabetic, have had surgery (e.g. mastectomy), aged between 40-70 and people who are involved in a shoulder intensive sport.
So, what can you do to speed up the recovery process?
- It is important to keep the shoulder moving in a pain free range of motion, as much as possible. In later stages of treatment gentle stretching and strengthening exercises can be effective.
*Figure 1* (Pendulum exercise) Bend at the waist and rest one arm on a table. Allow the affected arm to hang straight down and move this arm in circles and then backward and forward. Allow gravity to weight your arm initially and just swing in a pain free range of motion.
- It also may be worth considering the possibility that the problem could be coming from “trigger points” in one of the rotator cuff muscles called Subscapularis.
*Figure 2*(Subscapularis diagram) Subscapularis is sandwiched between the ribs and the shoulder blade.
A consistent finding is that subscapularis muscle trigger points play a key role in the development of the frozen shoulder syndrome. These points can produce all the symptoms of frozen shoulder and self-manipulation can ease the symptoms.
It has been shown in clinical trial that subscapularis trigger points infiltration have both a diagnostic and therapeutic value for the treatment of the frozen shoulder.
*Figure 3* (self-manipulation of Subscapularis) Sit with the affected arm hanging between your legs. With the flats of your fingers firmly against your ribs, push deep into the slot between the ribs and the roll of muscle that defines the back of the armpit. Search for tender points along the outer edge of the shoulder blade. When you find a trigger point keep the pressure on for around 12 seconds. Daily manipulation is advised.
Although there are almost always other muscles involved the Subscapularis on its own can cause reduced range of motion, constant aching in the shoulder, sleeplessness, sharp pain on sudden movement and so on.
When stretching, strengthening and self-manipulation the emphasis is gentle. “Listen” to your body and move regularly.
Remember that each one of us is unique with our own comfort levels and if we learn about our bodies and its needs we have the potential to gradually build a foundation of fitness that lasts a lifetime.
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