8 April 2020
Frozen Shoulder-what is it and can Osteopathy help?
The term Frozen Shoulder was first used in 1934 by Dr Codman. He stated that ‘the entity is difficult to define, difficult to treat and difficult to explain from the point of view of pathology. Even in the 86 years since he said that it is still to fully understood.
Frozen shoulder is now more commonly known as Adhesive Capsulitis (AC). It refers to Fibrosis and contracture of the tendons and joint capsule around the shoulder (see below).
AC affects an estimated 2-5% of the population. It has always been said that women are affected around 3 times more than men. But these figures vary from paper to paper. The most common ages are between 40- 60 years old. But in Japan they call it the ’50 year old shoulder’. There is a strong relationship with Diabetes. 30% of those with AC also have Diabetes. People with Thyroid problems are also at increased risk. Smoking increases the risk too.
Once you’ve had AC in one shoulder, there is a 50% chance of then having it in the opposite shoulder. However, some good news is that rarely does the same shoulder become affected a second time. Also, it is very rare for both shoulders to be affected at once.
In one word… Suddenly! One day you can be fine and the next you’re in extreme pain. Most people mention that it develops overnight. Then certain movements of the shoulder become limited and painful. Movements such as putting on jumpers, hanging out washing, brushing your hair or scratching your back become almost impossible. Sudden or jolting movements can become excruciating. Pain can be worse at night.
You may have heard of overuse injuries. Well, AC could be a cause of UNDERUSE. For example, sitting at a computer for long periods, being bedridden/ hospitalised, or if your arm has been in a sling.
The pain usually begins 1/3 of the way down your arm. This is called the deltoid insertion. After that it can be painful on the front of the shoulder (bicep tendon). And on the top of the shoulder (supraspinatus). Bringing your arm up in front of you or to the side are usually the worst movements. As time goes on, external rotation of the shoulder is reduced.
A number of these signs can be similar to what you would see in someone with a rotator cuff injury, which is why AC can often be misdiagnosed.
There are 3 stages associated with AC. As with a lot of injuries Osteopathy or manual therapy should be tried first before any surgical intervention.
Again, different papers report different timings but typically this stage lasts from 6 weeks to 9 months. It begins with diffuse pain then progresses to severe. This is the time when it is good to keep movement in the shoulder. This will be done through treatment and home exercises. Both should be within the ‘tolerable range of movement’. Heat and cool packs can be used.
This lasts between 4 to 12 months. Often the pain is much reduced. The shoulder is very restricted during this time. Osteopathy can continue with particular focus to the chest muscles, rotator cuff, upper shoulder and bicep. The mobility exercises can continue in this stage. Also, some strengthening exercises can begin. Hot and cool can still be used.
The best part of the process!! The shoulder begins to return to normal. Strengthening is required during this phase. Your Osteopath will need to work with you on your shoulder blade movement to break the ‘bad patterns’ that your body will have picked up over the course of this injury. Compensating for the AC will have affected your upper back, ribs and neck and will also need treatment.
In total the process can take between 18 months to 3 years. But with the correct treatment and exercises can often be reduced. A healthy shoulder awaits you! For further information click here