Shoulder Pain and Frozen Shoulder, By: Brad Walker

Prevention & Treatment Strategies for Frozen Shoulder (Adhesive Capsulitis).

Frozen shoulder, also known as Adhesive Capsulitis, is a condition that affects the shoulder joint capsule and results in stiffness and loss of movement in the shoulder joint. It is different to rotator cuff injury or shoulder tendonitis in that frozen shoulder affects the joint capsule, where as the other two conditions affect the muscles and tendons of the shoulder joint.

Anatomy of the Shoulder Joint
The shoulder joint is a truly remarkable creation. It's quite a complex formation of bones, muscles and tendons and provides a great range of motion for your arm. The only downside to this extensive range of motion is a lack of stability, which can make the shoulder joint vulnerable to injury.

The shoulder is made up of three bones, and the tendons of four muscles. (Remember, tendons attach muscle to bone.) The bones are called the "Scapula," the "Humerus" and the "Clavicle." Or, in layman's terms, the shoulder blade, the upper arm bone and the collarbone, respectively.

The four muscles which make up the shoulder joint are called, "Supraspinatus," "Infraspinatus," "Teres Minor" and "Subscapularis." It is the tendons of these muscles, which connect to the bones that help to move your arm.

Frozen shoulder occurs in the shoulder joint at the point where the humerus bone fits into the socket of the shoulder, (the glenohumeral joint). The supporting ligaments and surrounding capsule become inflamed causing stiffness and limited motion.

Causes
The exact cause of frozen shoulder is unknown, however in a number of cases, frozen shoulder occurs after another shoulder injury like rotator cuff tear, arthritis or shoulder surgery.

Also, poor posture can cause a shortening of the ligaments around the shoulder joint, which can lead to frozen shoulder. Other theories have suggested that hormonal and genetic conditions like diabetes and hyperthyroidism can also contribute to frozen shoulder.

Symptoms
The most common symptoms of frozen shoulder are pain and stiffness. Pain usually takes the form of a persistent dull ache and stiffness prevents the full range of motion of the shoulder and upper arm. Patients are often unable to lift the arm above their head or rotate their arm inward.

The normal progression of frozen shoulder has been described as having three stages.

• In stage one, (the freezing phase) the patient begins to develop mild pain and stiffness in the shoulder joint. This stage can last from a few weeks to a few months.

• In stage two, (the frozen phase) the stiffness remains but the pain begins to decline. This stage can last from a few months to nearly a year.

• In stage three, (the thawing phase) the full range of movement begins to return to the shoulder joint. This stage can also last a few months.

Most sufferers of frozen shoulder will be fully recovered within 4 to 6 months but some cases have lasted for up to three year, although these are extremely rare.

Treatment
Frozen shoulder treatment primarily consists of pain relief and physical therapy techniques. Pain relief usually takes the form of anti-inflammatory medication and the aim here is to reduce the pain enough so that physical therapy can be initiated.

Two other forms of therapy should also be considered; heat and massage.

• Heat is extremely good for increasing blood flow to a particular area. Heat lamps and hot water bottles are the most effective way to increase blood flow; while heat based creams are distant second choices.

• Massage is one of the best ways to increase blood flow to an injured area, and of course the oxygen and nutrients that go with it. The other benefit of massage is that it helps to reduce the amount of scar tissue which is associated with all muscle, tendon and joint injuries.

During this period of pain relief treatments physical therapy should also be initiated. This is an extremely important part of the treatment process and full recovery will not occur without a dedicated approach to physical therapy treatments.

Firstly, don't stop moving. Some doctors will often tell patients to keep the injured area still, and this is not always the best advice. Gentle movement will help to keep the blood flowing to the injured area. Of course, if pain is present, limit the amount of moving you do, but don't stop moving all together.

Next, specific stretching and strengthening exercises should be started to help loosen up the shoulder joint and speed up the recovery process. A full description of appropriate stretching and strengthening exercises are included in the next section.

Prevention
Mark my words, "Prevention is much better than Cure." Anything you can do to prevent an injury from occurring is worth it. The prevention of frozen shoulder and other shoulder injuries comes down the conditioning of the shoulder muscles, tendons and ligaments, which ultimately involves both stretching and strengthening of the shoulder joint.

Also, don't forget the common injury prevention techniques like, warming up properly and using a bit of old-fashioned common-sense. However, for the most part, stretching and strengthening are going to be your best defense against frozen shoulder. Even if you don't have a shoulder problem now, the following stretching and strengthening exercises could save you from a major headache in the future.

Firstly, below you'll find two good stretches for the shoulder area. Although both are quite basic stretches, please be careful. If you haven't been stretching your shoulder joint, or your shoulders are normally very stiff, these stretches will put quite a lot of stress on the muscles and tendons. Be sure to warm-up first, then gently and slowly is the best way to proceed.

·          In this stretch, simply stand upright and clasp you hands behind your back. Keep your arms straight and slowly lift your hands upwards. Hold this stretch for about 15 to 20 seconds and then repeat it 3 to 4 times.

·          In this stretch, place one arm across your body, keeping it parallel to the ground. Then slowly pull your elbow towards your body. As above hold this stretch for about 15 to 20 seconds and then repeat it 3 to 4 times.

Stretching is one of the most under-utilized techniques for improving athletic performance, preventing sports injury and properly rehabilitating sprain and strain injury. Don't make the mistake of thinking that something as simple as stretching won't be effective.