08 Feb Frozen Shoulder
Do you, or someone you know, live with frozen shoulder syndrome?
This condition, scientifically referred to or diagnosed as adhesive capsulitis, is unfortunately a fairly common problem for individuals who have had traumatic shoulder injuries or are put in a situation where the shoulder is immobilized for an extended period of time (i.e. post-surgery). There is also a significant bias towards those in their late 40s to early 60s, as this is when the body typically begins to degrade and break down. Frozen shoulder is predominantly characterized by severely limited range of motion as well as pain within the shoulder and sometimes radiating further down the arm or up the neck. An important part of the diagnosis of this syndrome is that not only is the active range of motion impacted, but so is the passive range of motion because there have been biological changes to the tissue in the joint. As the joint initially becomes very angry and inflamed the body responds by reducing everyday shoulder movements, and then the joint capsule itself becomes fibrotic in nature meaning that the tissue stiffens as the body tries to reinforce the capsule, tendons, and ligaments with additional cells and scar tissue. Because of the intricacy of the shoulder joint and the surrounding musculature, as well as the biological changes occurring in the tissue, this syndrome can be extremely difficult and painful to reverse depending on how far along the condition has progressed. The two most common strategies for this reversal process are surgery and/or physical therapy. We’ll talk about what these options are, and our other favorite strategies we can take to reverse the biological changes in the tissue and optimize shoulder function.
As I mentioned above, the two most common modalities to overcome adhesive capsulitis are surgery and physical therapy. A general rule to follow for any injury or pathology which is not immediately time sensitive is that surgery should be a last resort. Invasive procedures like this may be able to clean up some of the fibrotic tissue in the rotator cuff, but we’re talking surgery here which means that there will be a fairly long recovery process involving, yet again, immobilization of the shoulder to allow for the body to heal. In older populations, recovering from surgery is already a tremendous task since the body’s natural processes have begun to slow down and tissue health is on the decline. As I said earlier, the most common demographic for frozen shoulder syndrome is those in their mid to late 40s up to early 60s, so surgery is typically setting these individuals up for a brutal recovery process that may not even work.
Physical therapy is a great tactic for a number of pathologies and injury rehabilitation scenarios, and many people have had success taking this route for frozen shoulder. In our experience at Kinetik, we have seen individuals who become frustrated bouncing around to many different treatment facilities trying to find a form of therapy that their body responds well to. We pride ourselves on having the confidence to know we will be able to help whoever walks through our door, whether that is by hands on treatment, other modalities, or referring to a trusted practitioner who is suited to that specific task. That word “specific” is a keyword for us at Kinetik and is synonymous with individualized. Every form of treatment we provide is tailored to the individual we are working with. This is extremely important for someone with a pathology like frozen shoulder syndrome because the diagnosis is so general. It is necessary to dive deep into their history and the specifics of what is going on with their body to fully understand the whole picture of their condition and what the root cause is.
This brings us to an important question: what should I do then? There are a lot of great options when it comes to treating this pathology. A safe place to start is with a skilled manual therapist who has a comprehensive understanding of the shoulder capsule, the muscles of the rotator cuff, and it’s proper functions. This way a more in depth evaluation of the initial overarching diagnoses can be performed which will give more insight into what actually needs to be done to restore proper mechanics and tissue health to the shoulder. Typically a combination of soft tissue manipulation, to break up scar tissue and realign structures that have been pulled out of place, mixed with very specific corrective exercises, to strengthen the appropriate posterior cuff muscles while the humerus and scapula are in their correct anatomical position, is going to be a winning formula. Another modality, acupuncture, is a useful tool for especially tricky cases or those that have progressed to an extremely limited range of motion ( >15°). Needling has the unique ability to encourage a person to relax into a parasympathetic state, and mixed with the benefits of the actual needle placement, can produce some incredible results. For those who are itching to push through the recovery process as fast as possible, whether it is due to sports performance goals or simply being tired of dealing with this syndrome for an extended period of time, deep tissue laser therapy has been shown to reduce pain, increase range of motion, and improve ability to complete activities of daily living. The last “fast tracking” modality is a unique stim device called the ATOM.
This device can help find the root problems by showing where the electrical current meets the most resistance while traveling through a person’s rotator cuff because of its unique electrical waveform. It can also improve muscular motor unit recruitment and the speed of the hypertrophic response to corrective exercise which will improve shoulder function and range of motion quicker than corrective exercise by itself.
While all of these modalities are great options and we have seen positive results with them at our facility, the first step for anyone with adhesive capsulitis should be figuring out the specifics of their own general diagnosis. Like I mentioned above, this is best done by a skilled manual therapist who can point the individual in the right direction to ensure they are doing the correct steps to reverse this debilitating syndrome and return normal shoulder function, and consequently improve their overall quality of life.
– By David Barnet