Help with Shoulder Capsulitis (Frozen Shoulder)

[dmiksisu]

Hello,

I was diagnosed with Shoulder Capsulitis earlier this week and was curious to see if anyone has dealt with this particular issue through Warrior Wellness and Club Bells. Are there exercises I should be specifically concentrating on to help this situation?

I have been doing Warrior Wellness for the past several months which have helped my right shoulder. My range of motion has improved and reduced the pain. In addition, I have been doing light Club Bell work and have been diligent in keeping my hands below my shoulder height when working the club bells.

Next week I plan to attend a Physical Therapy session the doctor recommends. I plan to show the therapists the Warrior Wellness exercises.

Thanks,

Dave Miklasevich

[James Boelter]

There is a classic manual therapy move for 'frozen shoulder' which can be adapted for self treatment. Use caution and be conservative about this. My massage therapy teacher demoed the manual therapy version on me, and I can attest that it is VERY effective for releasing the shoulder capsule. At the risk of being a pretentious twit, (I am not yet certified as any kind of therapist, let along experienced) I'll describe it in the hopes that you can adapt it to your needs.

There is an excellent picture of the drill in the new book, 'The Ultimate BodyRolling Workout' by Zake and Golden. I would recommend you see that picture before you try this, but I will supply the description of the exercise and perhaps that will make it clear:

(You should ideally have an 8-to-10 inch ball made of a soft vinyl surface - not surprisingly, Zake sells a version of the ball which she claims has the ideal combo of 'give' and firmness to avoid injuring the softer potions of the maxillary area). The following procedure is for the right arm.

1. Raise your right arm out to the side and use your left hand to push the ball up into your armpit as firmly as you can. Relax your right arm down over the ball. Reach in front of your body with your left hand, grab your right wrist of forearm, and pull it to the left. This action locks the ball into your armpit. Pull your right shoulder down away from your head and neck and stretch your left ear toward your left shoulder. (Be sure not to rotate your right elbow in front of your body - your elbow should remain directly out to the side, while you grasp your wrist in front of you about waist high. The ball is effectively wedged into your armpit).
2. As you inhale, your ribs will expand out against the ball; as you exhale and the ribs move inward, pull your right arm more strongly against the ball with your left hand. The ball acts as a fulcrum over which the shoulder capsule is gently stretched. (Zake doesn't mention this, but I think this would be an excellent place to use Pavel Tsatsouline's 'Relax Into Stretch' breathing protocols. Alternatively, simply keep telling the shoulder 'Relax....relax....relax'.)
3. Even if you are only treating stiffness on one side, be sure to do this routine on the other side for balance. (Also, contra-lateral effects of limb work)

This stretch is sort of a self-applied traction to the shoulder capsule. I've tried it myself for general stiffness in the area stemming from an improperly healed shoulder injury from my childhood, and it does a great job of loosening up the area. Again, be very conservative and cautious with this. If you get numbness and tingling in your hands and forearms afterward, you are being too aggressive. If even a gentle pull still causes pain anywhere in the arm, discontinue and talk to your doctor, or a PT who can show you how you are misapplying the stretch, or who can give you a better exercise.

Another shoulder release using the ball which can supplement the first one nicely, is to lie in an elevated surface with the arm hanging off the edge and the ball wedged between the edge and your armpit. (Not your upper ribs, but your armpit). Then reach with the other hand and cup it around the supported shoulder and rest your hand on the back of the cupping hand (this supports the neck and makes it easier to relax and hold the position). Stay in the position 30-60 seconds (or longer), moving the ball slightly to the front and then the back of the armpit. Again, be sure to repeat on the other side.

The 'specially made' balls are certainly reasonably priced, but I suppose you could use a playground style vinyl ball, especially if you put a foam surface between the ball and your armpit to avoid putting too much pressure on the soft tissues and vessels in the maxillary area.

The balls (and the book, and some demo videos) are available at
www.yamunabodyrolling.com


Hope this is of some help to you. If Bob or Jarlo or Arthur or Vince give you conflicting advice, I would go with them, as I am far behind them on the learning curve.

[Jarlo Ilano]

Dave,

True adhesive capsulitis can be a very difficult condition to manage. I have done both well and very poorly with patients with this problem. At times it seems so variable as to have no pattern! I have considered the bane of my existence some days!

Some random information, that is fairly standard, but also comes with its own controversies. The natural course of frozen shoulder is said to follow three stages. Stage I of initial stiffness with minimal pain. Stage II with significant decreased range of motion and significant pain (pain especially at night when sleeping), and Stage III, in which the resolution occurs. Theoretically, if you catch the condition in Stage I the treatment is most effective and therapy seems to go nicely in a smooth progression. Stage II is allegedly near unresponsive to therapy and some think its best just to wait therapy out and do a comprehensive home exercise program, and perhaps come back to therapy at some later point.

Also, early research has said that this condition resolves itself without any treatment in 6 months to 2 years. The 2 year range seems unacceptable to me!

My friends and I have again seen much variation in recovery from this. Which may be based on whether it is true adhesive capsulitis in the first place...

In cases, where your flexion range of motion is less than 120 degrees for a long period of time (months), manipulation under anesthesia/nerve block has been very effective, followed immediately (same day or next) of P.T. treatment.

My take on this.... Address all questions and concerns to your physical therapist. Ask them what time frame they expect you to make significant improvement. Give them that time fully and be faithful to their instructions and ask them before you decide to add or delete anything to your treatment. At the end of that period of time, see where you are at. If it is not what you expect (or what the therapist expects), ask them why they think you are at this point, and inquire about further options. Of most importance is giving the therapists program a fair chance. But of course, of equal importance is being proactive about your needs after you have given that fair chance.

Good luck, I know how painful and frustrating this condition can be.


James, good post, I would suggest that this exercise also serves as a soft tissue release to the various muscles that attach in the axilla (lat dorsi, subscapularis... etc.,)

[bob_stra]

Everything Jarlo said.

Soft tissue wise, I've found the following implicated -

** Subscap - v. important to address, manually and with stretching
Infra scap
Pec
Biceps - spillover effect
Rotator cuff, esp terres.
Lats
Deltoids - secondary

I especially like to focus on musculo-tendenous junctions. I also like to use alternativing hot : cold packs at some stage of the treatment, usually after I finish the soft tissue stuff.

A lot of it is dependent on timing too. Beyond a certain stage, all the soft tissue stuff becomes ancillary. This is when cortisone, manipulation under anesthesia etc needs to be considered.

IMHO - and this is personal observation, not medical protocol. ASK YOUR PT.

Begin treatment 1-3 months after onset: soft tissue stuff + shoulder joint manips + stretching + possibly acupuncture should help address the problem nicely. Warrior wellness type stuff is vital here.

Begin treatment 4-5 months after onset: cortisone injection / saline injection. Soft tissue stuff etc to halt progress

If begin after these windows, then look into manip under anesthesia to break down restriction.

This will vary from case to case. I had a women come to me 8 months into it. The soft tissue stuff was a great assistance to her, but in the end, it was cortisone that halted / began reversing the problem.

Cortisone has its own problems tho.

[dmiksisu]

Hello Bob, James and Jarlo,

Thank you for your feedback and comments. Its pretty clear that I have some work ahead of me to get my shoulder back in shape.

I am off to the Physical Therapist armed with your feedback, the Warrior Wellness videos and many questions.

Again, thanks for the comments. Its much appreciated.


Dave Miklasevich

[guyb]

Dave~

I've had FS since Jan, 2011. I was wondering how long it took you to get over your pain and mobility issues. What worked and what did not. Thanks.

Guy Bedard