Frozen Shoulder - Two words that describe a very painful shoulder joint that has very limited movement that is often difficult to resolve
Medical Science does not have a clear idea of what leads to Frozen shoulder and as a result does not have a clear treatment guideline
Within the Western Medical Establishment, frozen shoulder is sometimes not recognised as a distinct condition. It is often diagnosed as shoulder capsulitis, Impingement syndrome, or bursitis of the shoulder. All of these descriptions merely describe the obvious, the shoulder joint no longer moves freely. As we have discussed previously, the shoulder joint is one of the least stable joints of the body. To achieve the movement that we expect and mostly experience in the shoulder, it has to have a range of movement that makes it very prone to injury causing instability. The impact of such an injury is usually a loss of good range of motion and strength of movement.
One of the distinguishing factors of frozen shoulder is that it commonly is not the result of any sort of injury or overload strain. On the contrary, the shoulder slowly begins to loose easy movement. This progressively gets worse, so that the arm cannot be lifted sideways, or even in front of the body. Women make up by far the majority of those who have a frozen shoulder. The onset is between age 50 to 60, as menopause occurs. In Chinese Medicine, it is called a “50s Shoulder”. The medical profession is reluctant to link the presentation to the changes in hormones that occur during perimenopause and menopause.
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Frozen shoulder does occur in men, but at a much lower frequency, however, the commonality is that it occurs at around the same age of 50 to 60 year age. Within the standard medical paradigm frozen shoulder is seen as untreatable, although it has a “natural history” of about 2 years. What this means, is that for a majority, the shoulder will resolve on its own about 2 years after it first occurred.
There does seem to be a change within the shoulder joint itself, with the humeral head no longer sliding smoothly within the glenoid fossa. In addition the SITS group of muscles seem to become tonic and unable to either contract or relax. When I have worked on frozen shoulders, in particular the muscles that control internal and external rotation of the upper arm become exquisitely painful and rigid. The Sub scapularis, Infraspinatus, Teres Major and Minor and Deltoid and Supraspinatus all contract strongly and stop reacting to nerve messages to either relax and lengthen or contract and shorten. Soft tissue release of these muscles is eye wateringly painful.
The nerve supply for the SITS muscles is from C4-C7 nerves, from spinal levels C5-T1. Chiropractos often find that correcting subluxations or motor unit dysfunction, at these levels will improve the function of the shoulder joint and will often see significant improvement in symptoms.
The vast majority of cases of frozen shoulder are found in women between the ages of 50 - 65 years. This is also the common age for menopausal hormone changes. The percentage of women who experience frozen shoulder is just 2% of the population. Diabetes increases the likelihood from 2% to 10-20%, quite a significant increase in risk. The other factor that has been noted to increase risk is thyroid disease.
There are in my opinion several reasons why these two diseases may increase the changes of developing a frozen shoulder. Diabetes will increase inflammation, and this is usually felt in the joints. The latest research that I have looked at points to carbohydrate intake and the resulting increase in blood sugar as the underlying cause of many diseases as diverse as mental illness and cancer. Changes in blood sugar will disrupt the hormones by increasing the demand for insulin. Thyroid disorders will also have an associated alteration in hormones, as this is how they are diagnosed, resulting in changes in the balance of all hormones in the body. Add the changes in hormone levels at menopause, and you have a firestorm that will rapidly get out of control and hard to manage.
Men do get “frozen shoulder”, but in much lower numbers. The age range is similar, 50-65 years age, which lends further credence to the idea that a driver of frozen shoulder is hormone
changes with ageing.
Treatment options are several. Your GP may say that there is no cure, and that if you do nothing it will likely do away on its own in about 2 years. Cortisone injections are often prescribed, however, it seems that this treatment is most helpful in the early stages when the issue is just starting to emerge.
If we take an Chiropractic approach, then the first thing that most chiropractors will check and correct is any alterations to ideal joint position, posture and movement in the lower neck. ( C5-T1 ). Because there seems to be a strong indication that hormone changes are a contributor, I would address cranial balance with specific cranial adjustments. The skull influences how the brain balances the hormone demands of the body. Because body has many areas of feedback and reciprocation I would look at the whole body including the organs. By taking a wholistic approach we can be sure that we do not overlook issues that if not addressed may lead to a sub par result.
There are a few ideas to include with your movement drills. Most of these can be done at home with body weight and no special equipment. Give them a try and watch your ease of movement and joint mobility improve.
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