Healing Thaw

Stretching can help free up a shoulder frozen by inflammation-related stiffness.

by Beverly Burmeier

April 2014

Like many people who develop shoulder pain, Sherry Paprocki, 55, of Naples, Florida, thought she had pulled a muscle while exercising. “I began protecting my arm because it was sore,” says Paprocki, president of RSRock Media, Inc. “I did not know that not moving my arm could make it worse.”

In many ways her experience was typical for people who suffer from adhesive capsulitis, the orthopedic name for a condition that causes pain followed by stiffness. Because it limits mobility of the shoulder joint this condition is often called “frozen shoulder.”

Scarring and Pain

Robert J. Neviaser, MD, chair of the Department of Orthopaedic Surgery at George Washington University Medical Center in Washington, DC, explains what happens. “As a result of an inflammatory process, the joint lining develops scarring which restrains movement like a tether. The person is usually uncomfortable, but they can function. If they suddenly reach beyond the limits of stiffness, they develop a sharp, severe pain, because what they’re effectively doing is microscopic tearing of the scar tissue.”

Houston-based writer Bridget Mintz Testa, 58, thinks lack of use may have contributed to her frozen shoulder. “My shoulder froze because it had been dislocated, and my arm was in a sling. I wasn’t told I needed physical therapy for the shoulder, so I just waited for it to get better. Meanwhile, the arm stayed in the sling, and my shoulder got stiffer,” she says.

Women between the ages of 40 and 60 are most likely to be affected. Unlike other shoulder conditions that result from overuse, the non-dominant shoulder is often the one that freezes.

Frozen shoulder isn’t always related to an injury or inactivity. Sometimes it just happens for no particular reason, says Catherine M. Robertson, MD, assistant clinical professor at UC San Diego Health System.

Diabetes, thyroid disease and other conditions have been linked to the risk of frozen shoulder. “There may also be a link with hormonal changes, such as those that happen around menopause, although the relationship hasn’t really been researched,” Robertson adds.

Frozen shoulder generally progresses through stages. The first, or “freezing” stage, happens over a period of weeks or months and is the most painful.

Early on, frozen shoulder may be confused with rotator cuff inflammation or tendinitis. “As the stiffness worsens, a diagnosis of frozen shoulder becomes apparent,” Robertson says. An X-ray can rule out other possible causes, and surgery is rarely indicated.

During the “frozen” state, overall achiness subsides, but stiffness can cause excruciating pain during activities like getting dressed, combing hair or reaching into a back pocket. Range of motion gradually improves, however, and discomfort eventually disappears on its own. “Most cases of frozen shoulder will get better in time although it may take years,” Robertson notes.

Slow Stretching

“A physical therapy program to stretch the capsule slowly and progressively usually helps,” Neviaser says. “Only stretching really helps, so it’s best to avoid strength training at this point.” Patients can do many exercises at home. Neviaser suggests elevating the affected arm a little more each day to the point of discomfort but not severe pain.

Applying heat before exercising can help limber the joint; cold may relieve soreness afterwards. If needed, anti-inflammatories can reduce pain and swelling. Natural agents include bromelain, a pineapple-based enzyme; the spices turmeric and ginger; and for topical use the herb arnica (available in gel form with other herbs, including comfrey, plantain, thyme, rosemary, white willow bark and peppermint).

Although a frozen shoulder may work loose without assistance some people feel different interventions are helpful, even though Robertson says studies haven’t proven the connections.

Paprocki claims chiropractic work helped release her shoulder. Physical therapy provided relief for Minz Testa. “The PTs got me back to normal; I consider them miracle workers,” she says.

Sally Abrahms, 60, a Boston writer specializing in baby boomer issues, made an all-out blitz against her frozen shoulder with both traditional and non-traditional techniques. “I’m very active, was in tremendous pain, and decided to attack this problem full force,” Abrahams says. In addition to her orthopedic doctor and physical therapist, she consulted an acupuncturist, chiropractor, neuromuscular therapist, Thai massage therapist and a personal trainer who specializes in rehabilitative training.

Throughout the healing process Robertson advises maintaining as much motion as possible. “In most people, frozen shoulder doesn’t recur, although it can happen on the other side. If it’s suspected, try to treat it proactively,” she suggests.

 

Exercising a Frozen Shoulder

Pendulum exercise: Support the unaffected arm on a table and lean over, letting the arm on the injured side hang straight down. Slowly swing that arm back and forth, then side to side. Move the arm in a circular motion; reverse direction.

Wall walk: Stand with the injured shoulder about two feet away from a wall. Raise your arm to shoulder level and gradually move your fingers up the wall as high as comfortable; hold for 10 seconds; then walk the fingers down the wall.

Overhead stretch: Lie on your back with arms at your sides. Lift one arm straight up and over your head. Grab the elbow with your other arm and push gently to stretch as far as possible.

Towel stretch: Place the back of the hand on the injured side flat against your lower back. Throw a towel over your shoulder, and grab the end behind your back. With your front arm, gently pull down on the towel. Let the arm in back slide up as far as comfortable.

Source: Shoulder Owner’s Manual by James D. Spiegel, MD
(The Staywell Company, www.krames.com)

 

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