Shoulder pain comes in many forms, among them is Adhesive Capsulitis, commonly known as frozen shoulder, a problem that causes the shoulder joint capsule to stiffen and causes a loss of movement throughout the shoulder joint. This condition is often confused with shoulder tendinitis or a rotator cuff injury, but it’s different because it affects the joint capsule rather than the tendons and muscles of the joint. To understand this concept better, it might help to look at the anatomy of the shoulder joint.

Shoulder Joint Anatomy

This particular joint is intricate and complex area of the body. While the shoulder is one of the most amazingly versatile parts of the body, it is also among the most fragile. With the number of tendons, bones and muscles involved with each movement, it’s easy for something to go wrong. The shoulder joint also has a large range of motion, but that means that it lacks the stability that other joints have. This makes it more susceptible to injury resulting in shoulder pain.

Three Bones in the Shoulder

• Scapula (shoulder blade)
• Humerus (upper arm bone)
• Clavicle (collarbone)

Four Muscles in the Shoulder

• Supraspinatus
• Infraspinatus
• Teres Minor
• Subscapularis

When we talk about frozen shoulder, we are talking about the point at which the humerus fits into the shoulder socket. The surrounding ligaments and capsule becomes inflamed and causes limited motion in the area and a great deal of shoulder pain.

Causes of Frozen Shoulder

Although the cause of frozen shoulder is a mystery, many cases of this condition occur following a shoulder injury, shoulder surgery or arthritis. Poor posture is also a cause of frozen shoulder, causing the ligaments that surround the shoulder joint to shorten and cause stiffness in the joint. Others believe that conditions like diabetes and hyperthyroidism can cause or at least contribute to stiffness in the shoulder.

Symptoms of Frozen Shoulder

You might not know what causes frozen shoulder, but you definitely know when you have it because of the extreme stiffness and shoulder pain you’ll feel in the joint. The pain is usually more like a constant aching and the stiffness prevents the joint from performing its full range of motion. In a typical case, you won’t be able to lift your arm above your head or rotate your shoulder at all. There are generally three stages involved with the condition:

Stage One

This is known as the “freezing phase.” The shoulder begins to have mild pain and stiffness. It can last for a few weeks or several months.

Stage Two

Known as the “frozen phase,” this stage sees the pain decline while the stiffness remains. This stage can last up to a year.

Stage Three

This “thawing phase” allows the shoulder joint to regain its full range of motion, but it could take up to a few months to fully recover.

Most cases of frozen shoulder clear up between four to six months after onset, but some extreme cases have been known to last a few years. Proper precautions and exercises can reduce your risk of getting this condition and any other type of shoulder pain.

Shoulder problems seem to be an ever-increasing problem with more and more people suffering from chronic pain that could often be prevented. It is also an injury commonly suffered by people who use poorly designed exercise programmes that put too much strain on the structures in the joint.

The shoulder is a complex joint with many different muscles and movements, which can easily become disrupted. In the case of an impingement tendons become trapped and inflamed, leading to pain and discomfort when the arm is raised to the side. If left untreated long enough it can eventually lead to a condition called ‘frozen shoulder’ when movement becomes very restricted and painful.

Shoulder impingement is often caused by poor posture and anyone who spends a lot of their time sat at a desk working on a computer is particularly at risk, as is anyone who spends a lot of time weight training their chest and shoulders without also using balanced movements for the back.

You can still go to the gym, but you should take care to avoid any movements that might overwork the tendon or cause pain. Stay away from pressing movements in particular, as they will stress the shoulder and likely make your problem worse. Like most chronic injuries, it won’t go away overnight and will take a patient approach to fully fix. Sitting at a desk all day will only make it worse, so try these simple exercises while sat at your desk.

• Sit tall with the arms out to each side and thumbs up to the ceiling. Pull the shoulder blades down and back until you feel the muscles between them working. Hold for 10 seconds and repeat 10 times.

• Next place one hand so it is resting on the opposite leg with the palm down. Raise the arm across the body as if you were drawing a sword. As you do this rotate the palm outwards with thumb pointing up and backwards. Make sure you don’t shrug up the shoulder as you do this. Repeat this 10 – 15 times on each side.

• Every fifteen minutes, try and stand up and take a walk around. Before you do this, while standing, make fists by your side with the thumbs sticking out. Slowly rotate your thumbs backward, lifting the breastbone and feeling the shoulders move backwards. As you do this, try and lengthen your neck and stand tall.

• Lastly, try to fidget. Change position regularly. Spending too long in any one position will lead to problems with posture and overworked muscles. Take regular breaks from your desk and move about frequently.

The condition generally effects people over the age of 40 and for some reason more women than men are effected.

If you have a frozen shoulder the following symptoms are likely:

1. Pain in the shoulder
2. Difficulty sleeping because of the pain
3. Restricted movement at the shoulder joint
4. Normal daily activities become difficult

Frozen Shoulder Therapies

1. Stretching can help if done under medical supervision
2. Heat applied to the shoulder
3. Visiting a Physiotherapist
4. Anti Inflammatory drugs
5. Cortisone Injections
6. Surgery

The most important thing is to get the frozen shoulder properly diagnosed by a health professional before attempting any self medication or stretching / exercise.

All the best,

Carol J Pearson

The most frustrating problem I encounter when treating a patient with frozen shoulder is apathy. When the patient arrives for their first therapy session they are usually in desperation mode because of the sleepless nights they have encountered over the past 6 months due to shoulder stiffness and pain. They are willing to do just about anything short of cutting off their arm to get rid of the pain and return function… at least that’s what they say to my face during this all important first visit. “What’s the best frozen shoulder exercise?” is usually one of the first questions I get, and the patient’s apathetic expressions begins when I begin explaining that frozen shoulder treatment consists of a combination of exercise and rest, performed in multiple but brief sessions throughout the day. “Do you think going to a chiropractor would help me more?” has been another question on more than one occasion. “Not necessarily, sir” is the reply followed by “their are many techniques to treating your stiff shoulder, most of which are pretty good, but the important thing is that you are somewhere taking action”.

Now I’m not trying to sound like a “self-help” guru, but taking daily action is the absolute crucial first step someone with frozen shoulder can do to help speed recovery. Despite popular belief, just resting the shoulder only makes it more stiff and painful when you have to move it.

Now the next most important step is to avoid making it worse. Now as I just wrote the previous line, I can almost here the sarcasm laden reply of thousands of web surfers as they say “ya think?” However this is not as obviously simple as it seems. You see, in the world of injuries and recovery, my wife is known as a “tester”. If she happens to have an injury such as a painful shoulder, neck, etc… then everyday, no, several times a day she “tests” that injury to see if it still hurts. For instance if reaching overhead pinches or hurts her shoulder, she will repeat this movement throughout the day to see if “it’s getting any better”. The point of all of this is to emphasize that if you happen to be a type “A” personality, then bulling your way through the day using your painful shoulder is not the answer.

This is not to say that you will not feel pain throughout the day during specific frozen shoulder exercise, because you definitely will. The important concept here is to realize the difference between “damaging” pain and “non-damaging” pain. Now I can go into a whole section on the difference between the two (which is out of the scope of this article), but basically “damaging” pain is pain you feel when, obviously, damage is being done to soft tissue, ligament, or bone. Damaging pain is often described with words such as “sharp”, “tearing”, “nerve pain”, and “shooting”. Most people automatically stop when encountering damaging pain (although some low-pain-threshhold people will push through damaging pain).

By contrast, non-damaging pain is is pain felt due to shortened muscles, ligaments, soft tissue, connective tissue, or tendons and is often described with words such as “achy”, “dull”, “pulling”, and “pressure”. Certainly there are many more words to describe these two types of pain, but these are the ones I have encountered over thousands of patient visits over the years. The point of all of this is that if you do exercise and do not push through non-damaging pain with frozen shoulder exercise, you WILL NOT improve your chances of recovery. A trained physical therapist can help give you the best combination of frozen shoulder exercise to maximize your recovery.

Are you experiencing shoulder pain? Maybe you’ve been diagnosed with a rotator cuff injury and possibly even a tear. Or maybe you’ve just been experiencing a pain in your shoulder that you were hoping would just go away but it hasn’t yet. What are your options? Is there a way to naturally heal your rotator cuff? Here are some shoulder injury exercises and tips that, when performed a certain way, can help you heal your shoulder… hopefully without surgery or other intrusive methods.

Improve circulation

Because the shoulder/rotator cuff is a series of small muscles and tendons it receives very little blood supply. Strengthening and stretching exercises increase circulation which promotes healing. Other ways to improve blood flow are through applying heat and massage.

Dealing with pain

Icing will help with the pain, especially right before bedtime. 20-30 minute sessions, as many times per day as needed.

Strengthening exercises

The rotator cuff is a complex series of small muscles, tendons and bones. These muscles respond best to higher reps and lower weight. Reps should be higher… in the 12-15 rep range to start. As your shoulder gets stronger, eventually the reps can reach the 20-25 rep range.

Instead of trying to explain these exercises, I suggest visiting this web site that has many clear pictures and good descriptions of each exercise. You can find them at http://familydoctor.org/handouts/265.html

Get on a proper healing program

The good news is yes, you can heal your shoulder if you follow the proper shoulder injury exercises. But randomly performing a set of exercises from the internet without the detailed instruction of an expert in shoulder rehabilitation will probably make your injury worse. It’s important that these exercises are performed in a specific way and a specific order depending on the extent of your injury.