Are you struggling with pain and stiffness when moving your shoulder? Is stretching painful? Are you unable to achieve a full range of motion? If so, you might be just one of the thousands of people each year who struggle with a condition known as frozen shoulder. But what is frozen shoulder – and more importantly, how can we help!
Frozen shoulder syndrome (FSS), medically known as Adhesive Capsulitis, is defined as “a soft tissue capsular lesion which is accompanied by painful and restricted movements at the Glenohumeral joint of the shoulder” [1]. In simple terms, the connective tissue which supports the shoulder can become inflamed, which in turn restricts range of motion, and causes pain and discomfort.
Frozen shoulder syndrome isn’t as prevalent a condition as something like lower back pain, but it still affects 2-5% of the general population – a significant number! Since the symptoms of frozen shoulder are common to many shoulder disorders, it is frequently misdiagnosed as general shoulder pain, stiffness and other shoulder conditions such as Rotator Cuff muscle injuries, impingement and tendonitis.
Frozen shoulder is exactly how it sounds, over time the shoulder ‘freezes’ resulting in complete inability to move the joint. The development of the shoulder condition is a slow process taking months, sometimes years for it to finally freeze.. Because of this, its important to get a diagnosis from a practitioner who specializes in chiropractic, or sports therapy – a long term approach to the problem is often necessary to distinguish it from a short term shoulder problem.
Untreated, frozen shoulder can cause pain (sometimes severe!), stiffness and a loss of range of motion which can have a significant impact on quality of life, income potential and overall wellbeing. Thankfully, with the right support from our chiropractic and sports therapy teams, its possible to overcome frozen shoulder quicker than ever, and without resorting to steroid injections!
Why does Frozen Shoulder occur?
The shoulder is a very complex joint which has to perform a wide variety of movements as a part of day-to-day activity, therefore, it is no surprise that tissues. Our shoulders also tend to bear much of the load when we are lifting, working or playing sport – which makes injury and aggravation of the joint probable over the longer term. In fact, most people over 25 have experienced some kind of shoulder problem, and that’s not surprising! .
Unfortunately, it’s not yet clear why some people develop frozen shoulder, where others develop other issues, and some lucky individuals manage to sail through life pain free! What is known is the presence of some risk factors for frozen shoulder – these include; Diabetics (10-20% increased risk),[1] females typically between the age of 40-60[2] and pervious cases with FFS[3].
To help understand what a frozen shoulder is, it has been classified into two groups; Primary and Secondary.
Primary:
A frozen shoulder that has developed for no apparent reason. It is often associated with pre-existing medical conditions such as diabetes, COPD, heart disease and cervical disc degeneration. Posture and occupation; rounded shoulders and desk work with repetitive manual tasks can also cause a primary frozen shoulder.
Secondary: a frozen shoulder which is associated with a pre-existing condition, such as rotator cuff muscle tears or tendonitis. In some cases, a previous fracture, surgery or a fall on an outstretched arm can also contribute to the condition.
Do I have a frozen shoulder?
Diagnosing a frozen shoulder can be tricky, given that the freezing process has a number of different stages. This is why a visit to the GP might not be enough to get a correct diagnosis, as the different stages of a freezing shoulder can resemble other conditions – our sports therapists diagnose a frozen shoulder by looking at your history of shoulder pain and any associated conditions to build up an accurate picture. Broadly speaking, the phases are:
- Pre-Freezing Phase
- sign and symptoms of shoulder impingement syndrome- this is when most people visit the GP, hence the most common miss diagnosis!
- Range of movement is often unaffected but in certain positions tissues will feel as though they are ‘catching’.
Confirmation of a positive diagnosis will depend on the clinicians and how well they can palpate around the joint to identity inflammation and tenderness.
- Phase 1- Freezing
- Sharp pain when reaching for the back pocket of trousers or for a high shelf.
- Severe night pain and unable to sleep on the affected shoulder.
- Difficulty when combing hair or in women doing up the bra strap[4].
Patients typically describe the pain as “bad” to “horrendous” , with three main pain types being apparent:
- A constant dull burning within the shoulder joint.
- Pain down the outside of the upper arm.
- Sharp catching pain on certain movements lasting up to two minutes.
Along with the pain, rapid stiffness of the whole shoulder can also occur.
- Phase 2- Frozen
- Shoulder has stiffened
- Range of motion is very limited
- Daily chores are extremely difficult
- Sleeping on the affected shoulder has become easier
- Pain had traveled down into the palm of the hand or forearm (in severe cases swelling is present)
- Pain at the back of shoulder; around the triceps muscles.
Treatment
Frozen shoulder is somewhat unusual in that over time, it does tend to resolve itself – recovery of movement generally takes between 4 to 12 months without treatment. While rapid spontaneous recoveries do take place, its more typical for cases of frozen shoulder to continue to cause restricted movement and pain for about 2 years.
In terms of proactive treatment, there are, as usual, two approaches – the first is drug based, generally focusing on the administration of steroids.
As an alternative, at Complete Chiropractic our sports therapists are qualified in the Niel-Asher Technique (NAT), NAT is a natural hands-on approach, designed to treat any stage of frozen shoulder. The technique is designed in a series of mobilisations & manipulations that help the movement of the shoulder and its surrounding tissues.
The treatment pattern is the same for all cases, it can however, vary due to stage of FSS and the response to treatment. Even better, along with frozen shoulder syndrome, these specific sequences can also help improve a range of conditions such as rotator cuff problems, biceps tendonitis and bursitis.
NAT uses a more natural method and it is a combination of sustained pressure and working on other tissue structures around the shoulder.
The first sessions of treatment aim to address the inflammation around the shoulder, after this, the primary focus is on revering range of motion. Whereas cases left untreated typically take 2 years to resolve, and drug based approaches vary in their effectiveness, NAT research shows that, positive results are usually seen in 4-13 sessions! Depending on session frequency, this means a sufferer can be well on the road to recovery in just a few weeks.[5]
Does NAT treatment prevent frozen shoulder?
Unfortunately, NAT treatment does not stop frozen shoulder from occurring, once the process has started little can be done to stop the development, NAT treatment can however, accelerate the condition through its phases – greatly reducing the impact of the issue in terms of time, pain and inconvenience.
At complete chiropractic our Sports therapist will diagnose, treat and prevent shoulder conditions from developing ensuring you remain healthy and active!
How can I avoid frozen shoulder?
Since we don’t understand the exact mechanism which causes frozen shoulder, its difficult to say exactly what the best method for preventing one would be. As we mentioned above however, preexisting injuries and shoulder conditions can be a contributory factor. This means that taking a proactive approach to shoulder care is a good way to reduce your risk of developing a frozen shoulder. At Complete Chiropractic, we can take a blended approach to patient care, taking both chiropractic and sports therapy based methodologies into account when working to optimise our clients health and well being – thus helping to prevent injury or strain, and reducing the risk of frozen shoulder.
[1] Pal B, Anderson J, Dick WC, Grifiths ID Limitation of joint mobility and shoulder capsulitis in insulin and Non-insulin dependent diabetes mellitus. Br J Rheumatol. 25ǿ 147-151, 1986
[2] Grubbs No Frozen shoulder syndrome – a review of literature. JOSPT Volume 18, Number 3, Sept 1993. Hannafn JA, Chiaia TA. Adhesive capsulitis, a treatment approach. Clin Orthop 2000Ȁ3720 95–109. Hendry F 1995. NMS Course Notes. British School of Osteopathy. Hertel R. Die steife Schulter. Orthopade. 2000 OctȀ29(10)0845-51.
[3] Fareed DO, Gallivan WRO Office management of frozen shoulder syndrome treatment with hydraulic distension under local anaesthesia. Clin Orthop 242ǿ177-183, 1989
[4] Kesler RMo The shoulder. Inǿ Kesler RM, Hertling D (Eds.), Management of Common Musculo-Skeletal Disorders, 274-310. Philadelphiao Harper and Row, 1983.
[5] Weis J, Niel-Asher S, Latham M, Hazleman B, Speed C, A randomised placebo controlled trial of physiotherapy and osteopathic treatment for frozen shoulder – Rheumatology (UK) Vol. 42 supplement 1 146. article 418 BHPR 2003, Murnaghan JPǿ Frozen shoulder. Ino Rockwood CA, Matsen FA (Eds.) The shoulder pp. 837-862. Philadelphiao W B Saunders & Co., 1990.
