Frozen Shoulder

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[Mark Freeman]

Hi all.

I'm in the unfortunate position of having a 'frozen shoulder' (adhesive capsulitis). Probably brought on from an injury sustained last year :(

I doubt if I am the only one in the aikido community that has experienced this pain in the a$$ condition.

What did you find was helpful?

I know it will clear with time, but I am impatient and I hate not being able to make ukemi on both sides.

thanks in advance for any useful info.

regards,

Mark

[billybob]

http://www.aafp.org/afp/990401ap/1843.html

Never had it Mark. No reason you can't walk for exercise, and just let the shoulder swing. Taking it easy can be the hardest thing for any athlete.

david

[aikidoc]

Aka. Adhesive capsulitis. It generally goes through 3 phases: freezing, frozen, thawing. This can take several years but the range of motion normally returns. It can be very difficult to get back to normal. I usually start people out with stretching and Codman's exercises. You may need therapy to control pain or meds. I also use post isometric relaxation stretching. Also, Graston techniuqe (deep tissue instrument assisted myofascial release) or active release techniques may help as well. There are also exercises you should be doing-e.g., broom handle range of motion exercises, etc.

Hope that helps.

[Janet Rosen]

This probably corresponds to a named exercise on John's list, but I learned it as Pendulum Exercise, fdone first empty hand and then holding a can of food in the hand. Any PT should be able to show it to you and empty-handed it is often considered the first, gentlest range of motion for a postop or a frozen shoulder. And I agree that assisted or oh heck what is it called? proprioceptive or neurosomething facilitated stretching and/or myofascial release by a qualified person would be worth looking at.

[aikidoc]

Yes, the pendulum movement is part of the Codman series. Proprioceptive facilitation stretching (PFS). Myofascial release and also active release. Myofascial release in my experience works best with instrument assistance (Graston, Graston-Hall) since you can feel the scar tissue better with the instruments than you can your fingers. Exercise is also important. All these things work to a limited extent. If you e-mail me privately and give me your address, I can e-mail you a handout I give my frozen shoulder patients. I can also send you an attachment with the Codman exercises and capsule stretches on it.Patience is a virtue as these do not respond quickly at all.

The process can be sped up with manipulation under anesthesia-you are put under and the doc breaks down the adhesions. Sometimes a cortisone shot is also needed. Then you have to go through a lot of rehab to keep the adhesions from reforming (can be quite uncomfortable).

The key thing is to avoid the frozen part when it starts freezing-painful stretching and rehab. If it is already frozen then the challenge begins.

[aikidoc]

As a side note, a good massage therapist with a deep tissue background can also break down adhesions/scar tissue as well. It will not be a pleasant experience-you might want to down a cold one before a session. They can also break down scapular adhesions (shoulder blade) which can limit shoulder motion. They might also work the subscapularis but that is tricky due to the close proximity of nerves and blood vessels from the neurovascular bundle (brachial plexus and accompanying vessels).

[Aiki Teacher]

On the message therapist, and Graston. Sensei Riggs has used the graston technique on my shoulder it will work. A good theraputic message therapist is also great, but you may want to take a bullit! To bite down on! IT will help though!

[Just Jamey]

I know I am a broken record, but I'm an acupuncturist so here I go again.....

I would add Acupuncture treatments to the P.T. and other suggestions above. It will help speed up the recovery process and alleviate the pain.

Electro-stim to the needles can be really effective, as well as, a needle manipulation technique where the patient actively moves the shoulder while the acupuncturist (vigorously) stimulates a needle.

[Mark Freeman]

Exercise is also important. All these things work to a limited extent. If you e-mail me privately and give me your address, I can e-mail you a handout I give my frozen shoulder patients. I can also send you an attachment with the Codman exercises and capsule stretches on it.Patience is a virtue as these do not respond quickly at all.



Hi John,

thanks, I will PM you with my details, I appreciate your offer.

I would like to go down the 'self help' exercise route as much as possible, as I don't like the idea of cortisone injections or any other invasive surgery. As it is a condition I know will improve with time, I'm happy to be patient, but I know taking the right pro active approach, I can minimize the time scale, and hopefully the pain.

regards,

Mark

[Mark Freeman]

On the message therapist, and Graston. Sensei Riggs has used the graston technique on my shoulder it will work. A good theraputic message therapist is also great, but you may want to take a bullit! To bite down on! IT will help though!

Bullets are hard to come by over here, I maybe asking for someone to send one to me ( preferably one un-bitten on ;) )

regards,

Mark

[aikidoc]

Sorry Jamey, I forgot about acupunture-had it done on mine for a shoulder impingement and it was the only thing that helped.

[aikidoc]

Also, kinesio taping can sometimes help support the shoulder while you are working on getting it back to normal.

[Mark Freeman]

Also, kinesio taping can sometimes help support the shoulder while you are working on getting it back to normal.

Kinesio taping??? what is that John?

I'm aware that I still have a fair range of movement in my shoulder, but certain movements are very restricted/painful ( hand behind my back - doing my hakama up is very difficult :( ) Shihonage and Immobilisations are definitely out on that side for the meantime :uch:

thanks again to all contributors

regards,

Mark

[aikidoc]

Kinesio taping??? what is that John?

I'm aware that I still have a fair range of movement in my shoulder, but certain movements are very restricted/painful ( hand behind my back - doing my hakama up is very difficult :( ) Shihonage and Immobilisations are definitely out on that side for the meantime :uch:

thanks again to all contributors

regards,

Mark


It is the use of flexible tape called kinesiotape for either support or edema reduction. If you have good range of motion but certain movements are bad, you might not have a frozen shoulder but one that is in the process or you might also have a rotator cuff impingement. If it hurts to bring your arm into abduction or flexion that may be part of the problem. There could be a spur catching and inflaming the tendons, especially if you have had prior injuries.

[Mark Freeman]

It is the use of flexible tape called kinesiotape for either support or edema reduction. If you have good range of motion but certain movements are bad, you might not have a frozen shoulder but one that is in the process or you might also have a rotator cuff impingement. If it hurts to bring your arm into abduction or flexion that may be part of the problem. There could be a spur catching and inflaming the tendons, especially if you have had prior injuries.

If it is a FS I'm probably still in phase 1 ( freezing). If it is as you suggest, a spur, what is the best way ahead, X ray?

Thanks again,

Mark

[aikidoc]

Shoulder spurs are sometimes hard to see but can be picked up on an x-ray. A common one is located at the acromio-clavicular joint-especially if you have separated it in the past. MRI is next step. I'd probably at least get an x-ray to see what is going on.

[Carol Shifflett]

I'm in the unfortunate position of having a 'frozen shoulder' (adhesive capsulitis). Probably brought on from an injury sustained last year :( Has it been hurting (and "freezing") since last year?
Extremely painful? -- or more stiff than painful?
What can you not do? Inability to reach back to tie your hakama suggests a couple of possibilities, but for more detail . . .

There are some specific muscle tests and a bit of information on "frozen shoulder" (a nice, general non-specific term), vs. "adhesive capsulitis" vs. myofascial trigger points at:
http://round-earth.com/RotatorCuffTests.html.

If it is truly adhesive capsulitis, then low-level steroids may be very appropriate. OTOH, you may be living with some unresolved trigger points laid down last year and a combination of myofascial therapy, accupuncture and exercise should produce excellent results.

Cheers!
Carol Shifflett

[Mark Freeman]

Has it been hurting (and "freezing") since last year?
Extremely painful? -- or more stiff than painful?
What can you not do? Inability to reach back to tie your hakama suggests a couple of possibilities, but for more detail . . .

There are some specific muscle tests and a bit of information on "frozen shoulder" (a nice, general non-specific term), vs. "adhesive capsulitis" vs. myofascial trigger points at:
http://round-earth.com/RotatorCuffTests.html.

If it is truly adhesive capsulitis, then low-level steroids may be very appropriate. OTOH, you may be living with some unresolved trigger points laid down last year and a combination of myofascial therapy, accupuncture and exercise should produce excellent results.

Cheers!
Carol Shifflett

Hi Carol, thanks for the info and the link, lots there to confuse me ;)

I think the freezing has only been happening for the past 2/3 months, virtually all the pain is at the front of the shoulder, and then only when I try to put my hand in certain places i.e. behind my back. Also if I put both hands above my head, the bad side reaches about 6"lower.

I obviously need to do a little more reserch to discover the actual prognosis, my local GP didn't seem to have much of an understanding. I think I need to go back armed with the info that I have received from you helpfull folk.

thanks again,

Mark,
p.s. interestingly I have had to adapt some of my aikido on the 'duff' side, and this has proven to be no less effective, hooray!

[Carol Shifflett]

I think the freezing has only been happening for the past 2/3 months, virtually all the pain is at the front of the shoulder, and then only when I try to put my hand in certain places i.e. behind my back. Where behind your back? Reaching up behind your back as in combing hair? -- or down behind your back as in tying hakama strings?
If reaching down and back, that pain pattern sounds remarkably like infraspinatus (the muscle that covers the lower 3/4 of the back of the shoulder blade) rather than pain from the capsule itself. When unhappy, it produces an aching pain deep in the FRONT of the shoulder joint. Also if I put both hands above my head, the bad side reaches about 6"lower. That is the test for triceps, teres major, and latissimus dorsi. Neither triceps nor teres produce pain in the front of the shoulder. Latissimus does. I obviously need to do a little more reserch to discover the actual prognosis, my local GP didn't seem to have much of an understanding. I think I need to go back armed with the info that I have received from you helpfull folk.Go back with a copy of "The Trigger Point Therapy Workbook" by Clair Davies. It has pain pattern pictures and is oriented towards self-treatment (rather than clinical techniques) -- i.e., nothing that can't be done on the mat. For GP, look for Travell & Simons "Myofascial Pain and Dysfunction" (Volume I). Can be found in most medical libraries, interlibrary loan, etc. or used online.

GPs trained in heart muscles of course, but ignore the rest. I have an anatomy book for surgeons that recommends being more familiar with muscles so's to be able to slice through them more efficiently on the way to the "real" organic problem. Of course muscle (and its fascia) is the biggest organ system we have and its no slouch at symptoms, either. There's a trigger point that can cause cardiac arrhythmia, several muscles that do an excellent imitation of appendicitis, and a calf muscle that will give you low back pain and jaw pain. Not to be ignored.

National Association of Myofascial Trigger Point Therapists (NAMTPT) has a locator map at:
http://www.myofascialtherapy.org

In Europe, Society for Myofascial Trigger Point Therapy (IMTT) is in Switzerland. Telefon / Telefax: 052 242 60 74

Anyway, sounds like as good a time as any to post the shoulder pain patterns that were supposed to go with the ROM tests. Will try to get those up today and hope they're helpful.

Cheers!
Carol Shifflett

[Mark Freeman]

Where behind your back? Reaching up behind your back as in combing hair? -- or down behind your back as in tying hakama strings?
If reaching down and back, that pain pattern sounds remarkably like infraspinatus (the muscle that covers the lower 3/4 of the back of the shoulder blade) rather than pain from the capsule itself. When unhappy, it produces an aching pain deep in the FRONT of the shoulder joint.

Both, but much worse when reaching back to tie my hakama, that particular movement makes nikkyo seem tame :uch:

I appreciate the links and info that you have provided and for taking the trouble to do so, thanks.

At the end of the day, it's not that bad, it only 'really' hurts when I attempt to put my right hand in particular areas, so I spend my time making sure that I don't go beyond where pain free movement allows. I can still teach my classes without a problem, and I can practice if I am super aware of what is possible, so I just miss out on one side of the technique.

I will read all the info provided, I think between you and John, I have been given plenty of good reading to do. I will attempt to live through it with suggested exercise, and the occasional ibuprofen. I may explore some accupuncture, if I feel it is getting too uncomfortable.

I think that although the symptoms I have are probably the result of an injury sustained practicing aikido, I am pleased to know through past experience, that aikido is a great practice to keep a body in good shape, I know that the healing process will be helped rather than hindered. I understand much more now, through aikido about how to move efficiently and how the body works. Also I know that a positive mental attitude can be the best medicine available, and at not cost! :D

Cheers,

Mark

[Carol Shifflett]

it only 'really' hurts when I attempt to put my right hand in particular areas, so I spend my time making sure that I don't go beyond where pain free movement allows. I may explore some accupuncture, if I feel it is getting too uncomfortable. Careful! Too much caution is where the "freeze" starts!. Per accupuncture, I come from the myotherapy end of things, but seems clear to me that it's all related and that "meridians" aren't just ancient Chinese philosophy but specific references to fascial lines. You can produce a passable "meridian" map simply by tracing the lines of muscle boundaries. What's there? Fascia. Strong stuff (tensile strength of 2,000-4,000 psi), contractile (contains smooth muscle fibers), and piezoelectric (perhaps explaining pain referral patterns that travel from head to foot -- no individual muscle or nerve travels all that way, but the fascial net does). Mess that up and you're going to hurt. Bad.

Per trigger points, muscle relaxants and ibuprofen don't affect them. They can be broken up with pressure techniques, and very effectively with dry needles. Apparently needles disrupt (an accupuncturist would say "balance") the muscle electrical potentials. One caveat: I tried this on a subject with a trapezius full of trigger points. The very fine accupuncture needles accomplished nothing. His dad's insulin needles worked great, instantly melting the trigger points; the little devils fired off their textbook pain patterns then just vanished. Quite fascinating!

I just posted some typical shoulder pain patterns at
http://round-earth.com/ShoulderPainIntro.html and added a couple additional ROM tests on the Test page (the Overhead Reach which you described and a Triceps test). If you see familiar pain patterns especially if they appear when doing the ROM tests (and MRI / Xray are normal) consider the possibility of trigger points. Consider tracking down a myofascial therapist or accupuncturist who can actually find a trigger point (not just talk about them!) and and eliminate it -- not as a Last Resort, but as a useful step towards resolving the problem now rather than a year or two from now. (Owww!!) Good luck!

Cheers,
Carol Shifflett

[Mark Freeman]

Hi Carol,

Thanks again for all your helpfull info :cool:

regards,

Mark

[Just Jamey]

I will read all the info provided, I think between you and John, I have been given plenty of good reading to do. I will attempt to live through it with suggested exercise, and the occasional ibuprofen. I may explore some acupuncture, if I feel it is getting too uncomfortable.


Mark, keep being proactive about this injury. The exercises are a great way to be engaged in your own recovery, but follow up with the appropriate professional/treatment option for you. Carol hit on it in the first sentence of her response, reply #21, "Careful! Too much caution is where the "freeze" starts!".

Treatment, no matter which modality, works better/faster/more completely on injuries/disease/imbalance the earlier you catch it. It's much like Aikido technique; move too late and the timing degrades so that the technique becomes very hard to accomplish. Wait too long with an injury and the condition degrades until it is less than optimal for treatment.

You already admitted by starting this thread that it is too uncomfortable for your lifestyle (if I may summarize your initial post). You have better options than to just tough it out.

Marrrrk.... Marrrrrrrk.... It's Obi-Your-Body-Kenobi.... Use the forc...er...*cough**cough*.... get the shoulder help now...

[Just Jamey]

Sorry Jamey, I forgot about acupunture-had it done on mine for a shoulder impingement and it was the only thing that helped.

John, I appreciate this. Thank you very much.

[Mark Freeman]

Jamey,

thanksfor your advice, it will be heeded! :)

regards,

Mark

[Dennis Hooker]

Hi all.

What did you find was helpful?

regards,

Mark


I had the shoulders rebuilt and they work better than they have in years. However I do snap parts every now and again but I can still lift my arms over my head and that helps when doing sword work. For a long time I just did short sword technique which doesn't require much overhead work.

I wish I had had the surgery done years ago and avoided so much pain.


Dennis Hooker

[shodan 83]

Ah so it’s the bionic sensei, you never had any trouble whipping my ass.