It's important for us to start with a huge DISCLAIMER here. Please see a physician before starting any kind of exercise regimen. What I am listing below is a very general outline of what usually works for patients after a thorough evaluation to confirm the cause of their symptoms. It may not work for everyone or every case and you should seek a formal evaluation and assessment of your concerns. In general, any time you feel numbness and/or tingling in your face, head or jaw, down your arms, or have an upset stomach, abnormal bowel/bladder movements, please discontinue the exercise and seek professional advice.
Shoulder pain has been rated as one of the worst pains because, not only does it hurt, but it also limits just about everything in daily life. Trying to avoid the use of your arm can be extremely frustrating and frightening.
There are many causes that contribute to shoulder pain, so getting the correct diagnosis is key. Today we are going to explore the "frozen shoulder." It seems to be a common complaint as aging progresses. You'll hear a friend speak about their shoulder "freezing up" and typically is accompanied by pain and lack of mobility. The truth is "frozen shoulder" is an over-generalized diagnosis, but the basic idea is that it is painful and your range of motion is limited.
The real diagnosis is called Adhesive Capsulitis. Simply put, if you suffer from Adhesive Capsulitis, your shoulder capsule, a fibrous pouch, has become stuck or rigid (hence the word frozen) and is usually irritated or swollen.
Where does frozen shoulder come from?
Disuse/Misuse- Use It Rr Lose It:
If you choose not to use your arm in its full range, it can get tight. Normal everyday full-range movement lubricates the shoulder joint and keeps the capsule healthy. If you've ever fractured your wrist or elbow, you can compare it to casting it for months. When the cast comes off, it is very difficult to move and the muscles around it have often atrophied.
Possible Infection:
Infection is sometimes suspected when patients complain of frozen shoulder. There may have been a "bug" that got into the shoulder capsule to make it inflamed, angry and painful.
Poor Posture:
This is a wake-up call for all you desk jockeys. Often, poor posture can set you up for a forward shoulder and forward head position. This will create problems as you lift the arm above your shoulder height and cause impingements.
Repetitive Impingement Or Injury Perpetuating A Lock Up:
Impingement is when your shoulder bone bumps into the top part of your shoulder (near your collarbone).
Or Something Else Like Arthritis:
There's no way to just quickly diagnose arthritis unless you have it checked out by an orthopedic doctor. A simple x-ray will tell you this. Arthritis can cause inflammation and cause quite a bit of pain. So this may explain the frozen shoulder symptoms.
So what are the common symptoms of frozen shoulder?
Pain lifting your arm to the side or in the front overhead
Limited range of motion in the shoulder
Stiff neck
Inability to rotate (as a pitcher would move)
Inability to hook your bra strap
What would we do about it in-office?
Here at Rehab and Revive, we like to work on the whole chain of movement beginning with proper ribcage alignment. Addressing the hip and pelvis' ability to extend and rotate during repetitive motions like walking also play a key role in the body's mechanics. There are times when the shoulder is off-axis and causing compensations, so that will have to be addressed with manual therapy.
Taping the shoulder to give it a little support doesn't hurt either.
In some cases, if we catch it before the freezing process worsens, myofascial work can speed up the healing and recovery.
Although quite popular, try to avoid Codman's pendulum exercises (holding a weight and dangling your shoulder, in theory, to help stretch the tight capsule). We have rarely found it to be beneficial for those suffering from Adhesive Capsulitis.
We also like to work the muscles that surround the shoulder blade, such as your rhomboids, to help ease the pain symptoms and redistribute the stress when trying to use the arm.
Below are three of my favorite exercises for patients with frozen shoulder!
Scapular or shoulder blade clocks is one of my all-time favorite shoulder exercises. This exercise keeps the rhomboid muscles healthy for shoulder movement which is oh so important because it comprises 1/3 of your shoulder's motion.
Gently and lightly freeing up your shoulder capsule, specifically, your superior capsule (pictured below), is a great way to get motion. I'd recommend doing this one gently, but if you can get it decompressed, then this could be one of the pivotal exercises to unfreeze your shoulder.
Working on strength, stability and keeping the rotator cuff muscles healthy is one way to help provide solid, safe and stable motion. The cuff's job is often confused with helping rotation. We believe at Rehab and Revie that it is meant to pull the shoulder head closer to allow for an efficient motion and, essentially, become a hammock to keep the shoulder head in place. So work this out carefully and fuel the fire to a clean shoulder motion.
Finally, there is always rest. You can try resting the affected shoulder. But if you've rested it for more than a week and you feel it getting worse, then it's probably in need of something more. I always recommend going to schedule with your trusted physical therapist to get evaluated. If you find your shoulder is getting worse and you are losing more and more range, you may have yourself an angry shoulder capsule.
Also, these are just a few of my favorite exercises for my patients suffering from frozen shoulder pain. No single program works for everyone, so even if these don't work for you, there may be many others that do!
Remember, we can and we will get better together!
Dr. Justin C. Lin
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