Frozen Shoulder? Out With the Old, In With the New I disagree with much of the current information available about frozen shoulder. In all cases, in my opinion, there is either some underlying injury (sometimes more gradual than a fall or obvious trauma) and very often is related to a muscular imbalance or postural fault in the shoulder that either started the problem or keeps it alive by not being corrected (this is often why you can get this in both sides, because posture is often the same in both shoulders). As a result, the shoulder joint is exposed to chronic irritation of an area called the rotator cuff interval. There are several important and sensitive structures in this area of the shoulder. Chronic irritation either by compression (impingement) or stretch (by a loss of shoulder blade motion in a back and down direction) lead the shoulder to basically, FREAK OUT and start a self protective cascade of pain and stiffness. It basically starts to splint itself to stop you or your therapist from hurting it. The result is first, inflammation. After prolonged pain exposure, this area gets stuck in a stage of healing called the proliferative phase. This means you start lying down excessive scarring or thickening of tissue both in the rotator cuff interval and the lower/back joint capsule. These areas block rotation of the shoulder both in an outward and inward direction. Without rotation there is no elevation possible of the arm (without significant compensation). Muscular guarding sets in, notably in the subscapularis muscle which resists all attempts at outward rotation of the shoulder. Forcing the arm to move, particularly forcing it to move overhead is one of the worst things you can do to these shoulders as it causes the painful motions that started the process in the first place. These types of activities can keep your shoulder frozen for a really long time. It is counter intuitive, but to fix this problem, you must stop forcing your arm to elevate. The number one thing to start the recovery process that you can do, is to stop exposing the shoulder to pain. NOTHING should hurt the shoulder: therapy, exercise or day to day activity. Taking the pain out of the cycle will help the shoulder calm down and set the stage for getting unstuck in the healing process. Pain=scarring/freezing. Gentle rotation stretches (done below shoulder height and ahead of the body midline) are the priority motions, but again, they should not hurt. The sleeper stretch, shown in the pictures, will start opening the back shoulder (posterior inferior glenohumeral ligament) and a doorway stretch for the subscapularis muscle can also be done (elbow must stay forward of your midline). In about 1-2 weeks your pain should be at a 0/10 at rest. You will still be able to provoke pain but this will occur only as you raise the arm above your head, across your body or behind your midline. Painfree stretching can help you, but make sure your therapist is on board with this technique. Pain is not allowed. Pain when stretching the shoulder usually means there is a motion occurring in the joint (translation) that the therapist or you are inadequately controlling against. This allows compression or strain of the rotator cuff interval. With our approach, we can get people unfrozen in as little as three months. Much shorter than the stages that currently are used to describe this condition. For more information or phone/video consultation on how to get rid of your frozen shoulder, please contact Julie Warren, PT at (970) 963-6600.
Posted on: Thu, 14 Aug 2014 00:26:23 +0000
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