Frozen Shoulder Part III: Treatment
The Challenges of Frozen shoulder: Severe pain and restricted range of motion that doesn’t resolve itself as one would expectThe pain of Frozen shoulder aka adhesive capsulitis drives patients to get treatment. The shoulder pain is commonly severe and interferes with routine daily activities such as brushing teeth, washing dishes, even using the restroom. It also consistently interrupts a patient’s sleep.As a Chiropractor and Myofascial Therapist we prioritize pain first. This isn’t because the restriction is unimportant but rather because it’s necessary to improve the patient’s level of pain before you can deal effectively with restricted motion. Repeatedly moving a patient into a painful position will actually make the body protect itself by restricting motion even further.As the pain improves we work towards greater ranges of motion without producing additional longer-lasting pain. There are important milestones to achieve that let us know it’s time to push harder. One is that pain becomes intermittent, and based on offending activities, rather than a constant factor limiting activity. Another is the patient’s ability to get comfortable while going to sleep and rest for longer periods without being awoken by pain.We use a multi-part approach to tackle the complicated condition Frozen shoulder. Active Release Technique (Myofascial Release) is our primary tool. We also recognize that helping patients help themselves is important in creating patient satisfaction and shortening treatment times. Thus, we use the acronym DREAM to guide patients through the process. DREAM stands for Diet, Rest, Exercise, Alignment and Mindfulness.
Inflammation is an essential element of Frozen shoulder and it’s believed that a person’s overall level of inflammation plays a role in its onset. This is a topic that should have its own post as it’s so important. A Frozen shoulder patient should modify their diet to eliminate or greatly reduce the inflammation and include anti-inflammatory foods and nutrients. In the most general terms this would be to reduce or eliminate saturated fat and foods that have a high glycemic index (sugary foods). Greatly reduce saturated fat. Additionally, Frozen Shoulder sufferers should add sources of Omega 3 Fatty acids, Fiber, Magnesium and anti-inflammatory nutrients such as Turmeric, Boswellia, and Ginger.
Better rest equates to better healing, period. Focusing on reducing the pain first allows us to improve the quality of sleep and tap back into healing processes that may be operating sub-optimally. We must also consider what rest means. In the case of Frozen shoulder, it can often be brought on by too much of the wrong kind of rest (see Frozen Shoulder part I – Immobilization).
Therapeutic exercise is a requirement for the full recovery of Frozen shoulder. There are three types that are recommended: isometric, stretching, and strengthening exercises. Exercise, in combination with the other elements of the treatment plan help the body to remodel the restricted tissues. Additionally, because they are done daily these exercises contribute to minimizing pain and restoring range of motion. Using the arm as much as tolerable while healing, this helps to maintain the gains made with Active Release Technique (A.R.T.). The key reason daily exercise is so important is that if the Frozen shoulder is not used or is ‘babied’ as might be a patient’s tendency, the condition will actually take longer to resolve.
Standing tall raising the top of your head and allowing the muscles in your shoulders, chest, stomach and your neck to relax. Poor posture and shoulder position in particular is often a factor in Frozen Shoulder onset. It sounds simple, but this is an important part of the recovery process.
… Mindfulness? Yep. One of the hallmarks of this condition is that it starts in a very unfamiliar way. This can cause quite a bit of anxiety, which in itself can magnify the pain of Frozen shoulder. (for more on understanding pain see the book “Explain Pain” by Lorimer Moseley and David Butler) Understanding what is happening helps limit this effect, allowing the patient to heal faster. Healing a Frozen shoulder does take time, and in some cases longer than others. However, early detection and treatment help markedly, which is why mindfulness is a real boon to one’s overall health.
Frozen Shoulder is one of the toughest Musculoskeletal conditions there is. Unfortunately it is often not identified in the early stages. There is much that can be done. The multi-factoral approach outlined out above resolution is highly effective in resolving Frozen shoulder.