Resolving Frozen Shoulder

The Glenohumeral (Shoulder) Joint

Your shoulder joint (glenohumeral joint) is a ball and socket joint in which the end of your upper arm (humerus) forms the ball and unites with the socket (glenoid fossa) of the shoulder blade (scapula).

This joint is surrounded by a ligamentous capsule which is full of synovial fluid that lubricates the joint and allows for easy motion. Synovial fluid is a viscous, lubricating fluid which is secreted by the membrane lining the joints and tendon sheaths. The capsule is designed for optimal motion, with numerous folds that allow for movement. The capsule, by itself, is not very strong. However, it is surrounded by the rotator cuff muscles which act as active ligaments and provide stability for the structures of the shoulder.

Causes of Frozen Shoulder

The actual cause of this condition is unknown, but Frozen Shoulder commonly occurs after:

• Extended periods of immobilization. 
• Trauma, injury, or a previous surgery to the shoulder. 
• Experiencing conditions such as diabetes, lung disease, heart 
disease, hyperthyroidism, and Parkinson’s.

Effects of Frozen Shoulder

With Frozen Shoulder, the capsule surrounding the shoulder joint becomes inflamed, thickened, and extremely rigid. This is often accompanied by a decrease in the levels of synovial fluid within the capsule, followed by contraction of the joint capsule.This combination of inflammation and contraction leaves less space for the upper arm bone (humerus) to move around.

The development of Frozen Shoulder is typically divided into three phases, with each phase lasting for several months before change is noticed:

Painful Phase (2-9 months): This phase is characterized by pain with any movement and is accompanied by a decrease in the patient’s range of motion.

Frozen Phase (4-12 months): The level of pain decreases, and is accompanied by a substantial decrease in the shoulder’s range of motion. All the activities of daily living become extremely difficult to perform.

Thawing or Recovery Phase (5-26 months): The range of motion will begin to increase and the patient’s pain diminishes.

Treating Frozen Shoulder

There is no doubt that Frozen Shoulder is one of the tougher conditions to treat. The good news is that 80 – 90% of patients suffering from Frozen Shoulder will eventually experience a complete recovery. The bad news, recovery that is based on conventional therapy (muscle relaxants, corticosteroid injections), can take a very long time (twelve to forty-two weeks).

A solution that works!

Fortunately there are alternatives to these traditional therapies, and that with the right therapy, treatment time can be reduced to between 4 to 10 weeks. I have consistently seen positive results in over 80% of cases treated with a combination of specifically designed Active Release protocols and the correct combination of rehabilitative exercise routines.

At our clinic, we use a treatment protocol that involves:

• Heating the involved shoulder prior to treatment to increase blood circulation and to make the tissue more malleable. 
• Administering appropriate ART protocols for Frozen Shoulder. 
• Initiating a gentle shoulder exercise routine to mobilize and 
activate the joint (such as pendulum exercises).  See Release Your Pain for examples of some of these exercises.
• Following up with more advanced exercise routines that address range-of-motion, strength, and flexibility as the patient improves. See Release Your Kinetic Chain: Exercises for the Shoulder to Hand for examples of exercises that activate and work the full kinetic chain of the shoulder.

How ART Helps

As we have shown, the shoulder is composed of numerous layers of muscles, tendons, nerves, and other soft tissues. Effective treatment of shoulder problems, or of any soft-tissue injury (ligaments, muscles, blood vessels, fascia, and nerves) requires altering this tissue structure to:

• Break up the restrictive cross-fibre adhesions. 
• Restore normal tissue translation and movement. 
• Restore strength, flexibility, balance, and stability to the affected soft tissues.

Recommendations during treatment

During the treatment process, we encourage our patients to avoid positions or activities that cause pain. Pushing through the pain can advance the injury, diminish the benefits of the treatment, and result in an increase in treatment time. This caution also applies to the pain that you may experience during exercise.

Note: Pain that is extremely intense, sharp, tearing, or a nerve-type pain is an indication that you are damaging your tissues. You should NOT be feeling this type of pain when exercising. Dull, achy, or compressive pain can occur during light exercise, and is to be expected as you activate and use dormant muscles and structures.