Your shoulder joint (Glenohumeral joint) is a ball and socket joint. The end of your upper arm (humerus), or the ball, unites with the socket (glenoid fossa) of the shoulder blade (scapula) to form this ball and socket. This joint is surrounded by a capsule made of ligaments which is full of synovial fluid. This fluid lubricates the joint and allows for easy motion. The capsule itself is designed for optimal motion, consequently it has numerous folds that allow for movement. The capsule, which itself is not very strong, is surrounded by the rotator cuff muscles which act as active ligaments providing stability for the shoulder.
In the case of frozen shoulder the capsule which surrounds your shoulder joint becomes inflamed and extremely rigid. Commonly there will also be a decrease in synovial fluid in the joint. Synovial fluid is a viscid lubricating fluid secreted by the membrane lining the joints and tendon sheaths.
This often-stubborn condition is characterized by severe pain and a progressive stiffness in the shoulder joint. With advancement of this condition your shoulder’s range of motion decreases substantially. This condition usually only affects on shoulder at a time, but in some cases it can affect both shoulders.
The exact cause of Frozen shoulder is unknown by the medical community. Frozen shoulder can occur after a long periods of immobilization, or after an injury. Also persons who have the following conditions have an increased chance of developing frozen shoulder: diabetes, lung disease, heart disease, hyperthyroidism, and Parkinson’s.
Classically frozen shoulder is divided into three stages, each stage can last for several months before any change is seen. The three stages are:
- Painful stage (2-9 months): This stage is characterized by pain with any movement. This is also the stage where the patient’s range of motion starts to decrease.
- Frozen stage (4-12 months): During this stage the shoulder’s range of motion will decrease considerably. The level of pain may begin to decrease All activities of daily living are extremely difficult to perform.
- Thawing stage or recovery stage (5-26 months): In this stage the range of motion will increase and the patient’s pain will diminish.
The good news is that 90 percent of frozen shoulder patients will have a complete recovery. The bad new is that this recovery with conventional therapy may take a very long time. Fortunately there are alternatives to these conventional therapies.
There is no doubt that this is one of the tougher conditions to treat but with the right therapy treatment time can usually be reduced to about 4-6 weeks. Severa forms of therapy have designed specific protocols for this condition (Active Release, Graston Technique, Massage Therapy, Fascial Manipulation). With these techniques and the right exercises I have consistently seen results in about 80% of cases.
In our clinic we heat the involved shoulder prior to treatment to increase blood circulation and to make the tissue more malleable. Manual therapy treatments for this condition are then administered. Initially, gentle shoulder exercises are also prescribed (such as pendulum exercises). More advanced exercise, including range of motion and strengthening exercises, are implemented as the patient improves.
During treatment we also tell our patients that it is extremely important to avoid shoulder positions that cause pain. If patients force themselves to push through positions of pain, treatment time will be extended and results could be compromised.
This also applies to the pain that patients may experience while exercising. There is a difference between pain experienced while exercising that causes damage to your tissues in comparison to pain that you experience while exercising that does not cause damage. Tissue damage pain that is described as: extremely intense, sharp, a tearing sensation, or a nerve type pain. This is not what you should be feeling while performing the exercises. In comparison, the non-damaging pain will be described as: dull, achy, or as a compressive feeling. When performing the following exercises you will feel some discomfort, but you should not feel the intense pain that causes tissue damage.
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