I’ve treated frozen shoulders my entire career, and with good success. Recently using the Fascial Counterstrain approach has seen my patients achieve far better than good results, more like absolutely amazing outcomes! There are quite a few myths about frozen shoulders, including within the health care professions. In this blog I’ll give you the facts:
What is a frozen shoulder?
Why do so many people (erroneously) believe it will (1) get better magically by itself;
And (2) think that nothing much can be done about it?
Frozen shoulder, also known as “adhesive capsulitis”, is a shoulder problem involving inflammation, pain and stiffness. Initially inflammation causes pain which makes it hard to move your shoulder. Early on the pain can really interfere with sleep and prevent movement. If you don’t act early to seek treatment, the condition progresses to capsular fibrosis (which is where a lot of collagenous tissue similar to scar tissue is laid down in your shoulder joint capsule that makes the shoulder physically tight and stiff). Fibrosis is much slower and harder to treat than dealing with the problem at its onset. Early diagnosis is important and requires professional attention since it can easily be confused with other shoulder conditions such as bursitis or arthritis, which are totally different problems warranting totally different treatment.
Frozen shoulder has had a misleading theory coined in the 1970’s that it will somehow magically resolve in time, which is an absurd concept to anyone who understands the pathology involved with fibrosis. This theory was based on an author mistakenly combining citation information from two different studies, one of which didn’t even relate to frozen shoulders! For the record, the theory states that the condition progresses from freezing (painful), frozen (stiff) and recovery (curative) phases without any treatment being needed. I’ve never seen this clinically, simply because fibrosis doesn’t spontaneously resolve as this would defy all current understanding of human physiology. A recent systematic review* examined the scientific evidence for this theory and found the reality – being that there are no 3 stages and no magical cure just by doing nothing. In fact delaying treatment based on an erroneous medical myth from the 1970’s is the WORST thing you could do, as the spectacular and rapid improvements are usually obtained in the earliest phases of the condition. Doing nothing sees pain slowly improve and some very modest improvement in flexibility OVER 2 YEARS! At 4 years the shoulder is STILL stiff! Who wants that?
So what treatment works? Firstly, aggressive treatments that “push through the pain barrier and beyond” (that’s a direct quote from some studies believe it or not!) aggravate the pain. No surprises there – if it’s so painful you can’t move your arm and can’t sleep, having someone rough handle it sure isn’t going to help. Treatment requires skill and precision, and needs to be painless in the early stages. Manual therapy treatment, particularly Fascial Counterstrain which is a recent advancement of classical Counterstrain, works very well, especially in the early painful phase of the condition before true fibrosis has occurred. Usually there is a couple of hours of gentle painless treatment required to clear the underlying risk factors, which allows the pain and inflammation to subside fairly quickly. If you have delayed seeking professional care or have seen a junior practitioner without much success, and fibrosis has set in, then Fascial Counterstrain will still help but a home program and skilled Physiotherapy for specific capsular stretches will likely be required, and the course of your treatment will take longer. A corticosteroid injection is sometimes helpful.
This is a very treatable condition in skilled hands, so if you think you might have a frozen shoulder please contact David early to discuss.
* Wong et al (2017): Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy 103:40-47.
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