Is Frozen Shoulder Permanent?
The purpose of this writing is to decipher what frozen shoulder really is and how to really return to normal functioning. Let’s start with a story.
I went to Starbucks the other day and saw my favorite lady in the drive thru. Last time I saw her a couple weeks ago she had just returned from a little time off due to a fall that dislocated her shoulder. At that time, she was still very, very bruised.
When I saw her most recently, she was out of the sling and had some range of motion though she said she had frozen shoulder. She has some pain and tingling in her wrist and hand. She is going to physical therapy and will be having a nerve test done soon to determine if there is damage.
Knowing how frustrating and scary that can all be, I asked if she wanted a couple tips. (Of course!) So, I spent a quick couple minutes explaining the importance of proper scapular movement and how a poorly positioned shoulder (such as can occur from the fall in her case) can affect that as well as then negatively affect the GH joint and the brachial plexus. A poorly positioned shoulder girdle can further limit the space nerves have to get through from above the shoulder to the arm, which can result in the symptoms in the lower arm, wrist and hand. I recommended she get a massage ball (trigger point ball) and talk to her physical therapist about the serratus anterior in particular to start with. Then move on to the pecs and rotator cuff muscles.
We have more time than I did in the drive thru that morning, so let’s break that down into something that makes sense, shall we?
“Frozen shoulder” is common after a shoulder injury, especially one where movement has been restricted for healing as well as a result of chonic shoulder pain that has not been accurately identified and treated wholly. The term “frozen shoulder” describes the lack of ability to move the shoulder and arm or the severe pain assiciated with moving it so that a person gradually moves it less and less until it becomes stiff and unwilling to move.
This problem can make daily life very challenging, frustrating and overwhelming. It can become nearly impossible to brush or wash hair, get dressed, carry or lift anything wiht the affected upper extremity. It can go further into restricting range of motion of the neck, making it difficult to even drive. From here, it can lead to headaches and even back or hip problems.
Talk about a domino effect!
After about three months, issues such as this become referred to as chronic conditions. What chronic means is that it has been upregulated into the nervous system-essentially your brain has accepted this as the new default. What chronic conditions imply is that they are permanent.
That implication is FALSE!
A better implication would be that we need to reset the programming so that the brain returns to believing that pain free is the default and again allows unrestricted movement.
Sadly, many doctors, surgeons and physical therapists miss a piece or two of the puzzle and leave patients with the impression or the explicit expectation that this is how they will just have to live and recommend measures to help keep them more comfortable as they stumble through life bearing this stress and limitation.
Not me. Not a chance.
Telling someone in pain or suffering with “a chronic condition” that they are essentially doomed to not get “better” just because I don’t have any more tools in my box or the knowledge necessary to help them is ridiculous. And extremely expensive to the patient in terms of productivity, satidfaction, quality of life, empowerment, and growth. Not to mention the stress it can cause financially and in relationships as well as other health issues.
Here’s how we will address frozen shoulder:
Questionairre (written or verbal) gathering information on a scale of 1-10 of stress level, sleep & energy levels. Talk about what is bothering you the most, what makes the shoulder better/worse.
What would success in treatment look like for you? How will you be able to tell if there has been improvement?
Assess shoulder range of motion, starting with lifting arm (overhead) in front of you, lifting arm (overhead) from the side, extending arm behind you, reaching arm behind the back (like to scratch your back and reach for your back pocket), raising arm like to take and oath, shoulder circles forward and backward.
Assess neck range of motion, starting with looking up & down, left & right, side flexion ear toward shoulder, looking toward armpits, and ear toward shoulder and rotating head toward ceiling.
With each of the previously listed movements, rate intensity of stretch, discomfort or pain.
The practitioner should be noting these numbers, locations, muscles affected when contracting and which ones when lengthening as well as referral patterns.
Use the information gathered to determine starting point, as it may actually be the neck instead of the shoulder.
**Default protocol outline: low/mid trap/pec major & minor (it’s very difficult to get to pec minor if pec major is really restricted as pec minor lives “underneath.”), serratus anterior/upper trap, lats/supraspinatus, infraspinatus/subscapularis
Protocol performance may be done with no equipment using a contract/relax method, with manual pressure/feedback, with a massage gun, roller or ball. It may be performed in conjunction with breathing exercises or visualization.
The pecs are notoriously known for being “tight” in many individuals and even more so involved in frozen shoulder. The serratus anterior, however, is very commonly overlooked and not addressed though it is often a reason that the pecs never seem able to loosen up.
The first step in frozen shoulder as well as in any shoulder pain, numbness or tingling in the lower arm, wrist or hand, or restricted movement is to make sure the scapula is moving properly. Not only should it be able to retract and protract (squeeze toward the spine and come around the side of the ribs) but it should be able to elevate (shrug), depress (oppostite of shrug-pull your shoulderblades down), tilt, and rotate upwards and downwards (like how your arms move for a jumping jack). Inability to perform all movements will affect the GH joint, which it the one at the front of the shoulder where your arm bone (humerus) and clavicle (collarbone) meet.
The scapula and GH joint work together to allow pain free, fluid movement of the shoulder. When the scapula is compromised it alters the space of the GH joint and puts more work on it. (Double whammy!) This inefficient functioning can result in numbness or tingling in the fingers, pain around the wrist, pain at the elbow and of course, pain in the shoulder.
Many of these symptoms beg consideration of nerve damage and scream “permanent limitations” like it should be a badge of honor to carry around as you struggle to get dressed without crying.
It’s not a badge of honor. It’s a sign that the problem has not been solved.
Stop putting on “Band-Aids” and let’s address it!
Frozen shoulder is only permanent IF YOU CHOOSE it to be!!!
If you are under the care of a practitioner (or practitioners) that continue to tell you what your limitations are and what you will “have to deal with” it may be time to consider another service provider.
**NOTE: There is a very important difference between your service provider telling you limitations of your condition and talking with you about “if, then” situations. “If you continue to think about pain and fear moving and avoid moving, then you will have less range of motion available and it will get more stiff” is very different than “You’re stuck dealing with this pain, there’s nothing else we can do.”
You are only stuck if YOU choose to be stuck. Nothing else that service provider can do is different than nothing else YOU or another provider can do!
If you feel stuck and need help, message me directly at Stephanie.meetthebody@gmail.com.
To experience related coaching live or on demand, join me on Ingomu https://play.google.com/store/apps/details?id=com.ingomu.ingomu (iOS coming soon!-stay tuned!)
Until next time,
Stephanie