Frozen Shoulder (Adhesive Capsulitis), is when the shoulder is so tight and painful it becomes difficult to move. As the name suggests, the shoulder joint or capsule is immobile or frozen.

 

Frozen Shoulder occurs for three reasons:

1. Traumatic injury

2. Repetitive motion over use (throwing a baseball for example)

3. The accumulation of stress and tension over time

 

The common thread in all three of the above are contractions 

A contraction is when soft tissue; muscle, fascia or tendon becomes shortened, tight and ischemic (dehydrated).  When enough stress and tension accumulate in soft tissue, either over time or all at once from a traumatic injury, contractions occur. 

 

A cycle forms in which contractions create an imbalance in the function of a joint. Imagine the musculoskeletal system as an elaborate system of levers and pulleys. In the case of Frozen Shoulder several muscles in the shoulder assembly have gone into contraction becoming shortened and ischemic. These shortened tight muscles are pulling in various directions putting great strain on the joint as smooth movement is interrupted. When enough strain is put on the joint the brain will act to protect it by locking the area down or freezing it.

 

Frozen shoulder occurs when contractions and imbalance become severe enough that the brain decides to immobilize the area to protect the vulnerable joint from damage.

 

To mobilize a frozen shoulder, contractions and often nerve impingements must be identified and released in the shoulder assembly which include the 4 rotator cuff muscles and a few supporting muscles.  

 

There are 4 main causes of musculoskeletal pain; contractions, slackening, adhesions, nerve impingements - you can learn more about those HERE.

 

I start by identifying which exact muscles are in contraction. We perform PNF stretches that isolate those specific muscles. A PNF stretch is when the client provides a counter force to my pressure.

Even though a frozen shoulder is mostly immobile a little bit of movement is available which is enough to get the desired effect. The client is offering resistance to my pressure so not a lot of movement is necessary.

 

The stretches are simple yet essential steps in the process. They increase blood flow into the area by activating the muscle belly as well as pulling the tendon gently away from the bone.

 

This is essential because without the increase of blood flow the deep tissue work that comes next would be too painful. It would create resistance. Real change cannot occur if the client is in a state of physical or emotional resistance.

 

When the targeted muscle has enough increased blood flow from the PNF stretching then very specific and very deep pressure is applied. When contracted tissue is properly prepared and the correct pressure is put in the right place, the tissue begins to release. The client will feel the release occurring as it begins to twitch and carry a significant sensation that can be described as a tolerable "productive pain". 

 

When chronic soreness, tightness and pain occur we learn to use alternative movements to compensate for the discomfort. No one wants to feel pain all the time so not only do we learn to use our bodies incorrectly but we also learn to block the area out of our conscious awareness.

 

When we block out our awareness long enough an amnesic barrier forms. We literally lose conscious control of muscles in which amnesic barriers occur. 

 

The manual work and coaching reestablishes connection and control of our bodies in essential ways.

Clients must learn to form new habits using these muscles. This is easier said then done as our subconscious muscle memory will automatically bring us back to where we were instead of where we want to go.

 

First release the contractions (and potential adhesions and nerve impingements) then form new habits by improving awareness of how muscles are being used.

 

It is really that simple, but requires focused persistent effort. This is not traditional massage in which the client passively receives. You work and participate during the session and are given awareness building techniques to practice in between sessions and to carry forward in life.

 

Our subconscious minds are powerful in creating ways to avoid pain. Compensatory movements and amnesic barriers mask pain for a while but eventually fail. Then chronic soreness, tightness, pain and Frozen Shoulder become a reality.

 

Frozen Shoulder is very treatable - in most cases 5 sessions can get mobility all the way back. It is never too late.

 

Soreness, tightness and pain are the single greatest drain on our daily energy. Regain vitality by getting your soft tissue in good shape. There is little in life more worthwhile than getting our body flexible and free of pain.

 

 

Tom Fabish is a manual therapist bodyworker in Denver, Colorado. Book your treatment sessions here.