Fix Your Frozen Shoulder

The Slow Unwinding

2006-10-30T17:45:00.000-08:00

It's about a year since my shoulder began to unfreeze. At this point, I have complete range of motion. Over the last several months, my shoulder still gets a little sore from typing a lot. It's often stiff and a little painful when I wake up - something that it did not do at all when frozen! This lasts only until I shower and warm it up and move it a little. The pain is very mild and does not wake me up at all - just something I notice when I get out of bed.

I have experienced a slow reversal - it seems to me - of the original freezing process. For a long time, the area that was most "triggered" still was my rhomboids. Those let go and what is still giving me trouble is my superspinatus and the scalenes. Now, if I work on those with massage, my shoulder will feel virtually normal for a day or two.

I just began doing yoga again. I find that I can do yoga freely without restriction. Yoga also seems to do much the same things that massage does for the shoulders. Down dog is especially good for releasing the muscles. It will be interesting to see if a month of yoga finally "cures" me.

Update

2006-04-19T18:58:00.000-07:00

I've recovered full range of motion from my shoulder now. I can lay it flat on the floor now by my side. I still have slight muscle soreness in the shoulder - in the infraspinatus and the rhomboid. It is improved by massage or strength training. I am working out with dumbbells and doing pushups to strengthen the shoulder - and both arms in general.

While my arms don't feel exactly the same - I no longer have any actual disability. It's been a long time since I had a muscle spasm. If you still have frozen shoulder, I feel for you. This is the most painful experience of my life. I am glad that it's over for the most part.

I will continue to work on my arm strength and report back in a couple of months.

Almost Perfect

2006-01-22T16:50:00.000-08:00

Since my last post, I have been doing yoga and weight training every other day faithfully. By now, I can do all this without any problems with my shoulder. It's really almost normal now! There is a small amount of stiffness and pain when I stetch it to extreme positions. But, there is no pain or stiffness at all most of the time when I just raise my arms over my head - even stretching very hard. My arm no longer spasms at all and I no longer experience aches in my wrist or forearm. To all intents and purposes, I have full functionality. My arm has better range of motion than many people without any shoulder problems at all.

When I massage my shoulder, there is still a little tenderness in my infraspinatus - the muscle on top of the shoulder blade. It seems to go away with the lightest massage. My rhomboids are still sore in one place. But this also goes away with massage a lot of the time.

I am able to do the Total Gym and pull downs on the Soloflex without any problem.

At this rate, I expect to be totally normal, without any reminders of my shoulder problem in a month or two at most.

My progress

2005-12-18T19:09:00.000-08:00

I am down 20 degrees of external rotation as my main range of motion limitation now. This weekend, my arm "freed up" a little more. I have been diligently working on fascia bumps in my pectoral area. Wow - I never realized these were fascia problems. I always thought they were lymph nodes or something. My arm feels much freer from working on them.

How do you find fascia problems and fix them. Well - trigger points are these very painful spots in your muscles. But fascia bumps are less painful little lumpy spots - often right under your skin or the fat layer that goes with in. These will melt away if you knead gently on them for a minute or two. Just keep working on them. It seems to work best if you start from one end and work towards the other.

I've had these little bumps across my chest and under my right arm for decades! My right breast has always been somewhat tender. So know I find out this is caused by stress on the fascia - from overuse of my right arm and being round shouldered.

This means I may actually be more functional that I was when I get through with all this self-therapy.

Weight training

2005-12-11T16:49:00.000-08:00

Now that my shoulder has improved and is only a little frozen, I find that weight training really makes it feel better! I get almost as much relief from doing light presses as I do from any other therapy.

The ART therapist told me to do light presses against the wall with a pillow between my palm and the wall. Just pressing my weight. My frozen arm is very weak, so this is actually worth something. However, I think it is even more effective to do a light forward press on the Total Gym. I set the angle very low and push forward with my hands on the stirrups. My whole shoulder feels better for hours afterwards.

I worked for almost an hour on the shoulder today, with my husband's help. Lots of trigger point massaging - especially to the serratus and latissimus dorsi. He did "spray and stretch" with ice to my shoulder area while I tried to raise my arm behind my back. I couldn't even take my hand back to my hip at all two months ago. Now I can get it halfway up the back without any pain. Still a ways to go, though. I still don't have 100% extension or external rotation most of the time. Every now and then, though, things click into place and I can do it.

Active Release Therapy

2005-12-10T20:04:00.000-08:00

I have been going to an ART chiropractor - every couple of weeks for 4 weeks. Though ART alone is probably now enough, I think everything she had done has been helpful and sped things along. Every now and then, she really makes a difference. Friday was one of those days. I had improved things so much on my own that she was able to locate new muscles that I did not know about - serratus, for example - and work on them. When I came back, I was able to move my arm better than I have since July. It's so great!

ART is another form of trigger point therapy. As she worked on my arm, I could understand what she was doing. She holds a muscle firm and makes me move my body in ways that stretch the muscle out. She does it incrementally, so the fibers are stretched a little at a time.

At this point - I've tried three kinds of trigger point therapy - "spray and stetch", ART and massage. Massage is the easiest to do - but the slowest and most painful. "Spray and stretch" is the hardest to do and do right - but it doesn't hurt at all. ART is somewhere in between. I actually would recommend doing them all. Keep working on your arm.

Today, the day after lots of ART, my shoulder is a little sore. Yesterday, though, it was moving very well. It's almost 100% now. She showed my that I was "weak" and really could lift my arm 100% without pain. I was flinching and bending unnecessarily. I have new exercises to build up strength in my back muscles. They are very weak.

Massage Techniques

2005-12-05T16:57:00.000-08:00

Another approach to eliminating trigger points is massage. I strongly recommend buying the book at this link. At this link you will find instructions on massaging the barely accessible trigger points on the underside of the scapula. These will be very, very tender. Mine give up very quickly though and give immediate relief from some of the discomfort.

You are likely to have a whole set of trigger points all over your shoulder area. The book at the link The Trigger Point Therapy Workbook by Davies is a really excellent book. It's practical and easy to follow. Clair Davies is a joy to read. I found this book really useful. It allowed me to eliminate all of my trigger points except the ones under my scapula through massage. When I got to that point, my shoulder was much better, but still not totally healed. When the only main trigger points you have are the ones in you subscapularis muscle - under the scapula, it generates a characteristic pain in your arm. It aches at the top of your arm, down the back towards your elbow and then again around your wrist, especially on top. The top of your scapula aches as well.

If you get to this point, you are very close to better, but still far away - since these trigger points are the hardest to resolve. I am still working on these.

Stretching and strengthening

2005-12-04T17:50:00.000-08:00

I would only do exercises if you feel better after you do them. I do not think it's a good idea to do them if they still make you spasm!

Once you are past the spasming stage, then they tend to make you feel better afterwards. I really have doubts that they actually fix anything. Massage and cold "spray and stretch" fix things.

But - you will need to stretch and strengthen your shoulder as soon as you can. This will help it get back to normal. You will have lost muscle mass in your shoulder and need to build up strength. You may have lost flexibility in the shoulder too.

Here's some exercises:

Using very light weights (between 1 and 6 pounds), bend over at the waist. Starting with the weight in one hand at your waist, try to touch the opposite foot. Bring the weight back to your waist and then extend the arm out horizontal to the ground, over the opposite foot. Bring the weight back to your waist. Repeat until the arm is tired. You will feel it in your shoulder, too.

In an open doorway, put your forearms along the edges of the door, with your elbows at 90 degrees and your upper arms horizontal to the ground. Your arms are making an L, and you are against the doorframe with your lower arms. Lean into the doorway as much as you can, stretching your shoulders back. This may be painful. Don't push too hard - just until it feels a little stiff. Hold there for as long as you can - a minute or two if possible.

My progress

2005-12-04T17:34:00.000-08:00

At this point, I have 100% range of motion when I raise my arms over my head - either sideways or in front of me. There is slight pain in my deltoid when I do this - so it's not entirely normal. This is a big improvement over 2 months ago, when 90 degrees was the best I could do. I can do at least 180 degrees in any direction now.

I have been having a lot more trouble with external rotation - the movement in the picture above (that is not me - by the way). As of this morning, the best I could do was 40 degrees. Then I would "hit" something solid in my shoulder and it would not move any more.

This is caused by spasmed muscles in the subscapularis - the muscle under your scapula that attaches it to you shoulder joint at the top of your arm. It is too tight and won't let your scapula move down and out of the way. Klunk! Your bones collide.

I did the ice treatment for subscapularis and my husband massaged the trigger points under there on the edge (this takes some work, they are hard to get to). He also pushed on the scapula as I did the rotation. I was able to rotate it normally when he did this without pain. Very odd. Now, I can do 60 degrees all by myself.

I am also very limited in reaching behind my back. I can reach across at waist level. But trying to go higher, something doesn't work correctly in the main shoulder joint. I will have to have my husband watch me do this too and see what is not working correctly. Probably the subscapularis again. All it takes is one muscle not doing it's job to mess up the works.

Every day I am closer to normal - now that I am using the cold "spray and stretch" technique with the ice. I have very little pain in the shoulder when I use it now and never get the horrible spasms in my arm that I was getting in September.

Trigger Point Therapy Recommendations

2005-12-03T08:10:00.000-08:00

If you can find a physical therapist who uses "spray and stretch" in your area and can afford to go - go to them ASAP. Make sure this is one who follows Travell and Simons. You will be fixed soon and my blog will have some information in it to help you avoid recurrence.

If you want to save the money, or like me, you can't seem to find such a person, then don't despair. You can have your partner or caregiver do this for you and can even do it to yourself, if your good arm is pretty flexible.

I did massage to all my accessible shoulder trigger points, and got a lot of improvement, but not 100%. What I found out was that the real culprits were two muscles that are not available to massage. One is the supraspinatus, deep in the top of your shoulder, hidden under your trapezius. The biggest villain of them all is the subscapularis, which lies under your scapula and on top of your rib cage, wedged in there with a poor blood supply.

Here's how to unstick those muscles. We're going to do two different "Spray and stretch" techinques with ice.

Making the Therapy Popsickle

Take a dixie cup or small plastic bowl and fill with water, stick a spoon in it and put it in the freezer overnight. Take it out, tear off the dixie cup or pull it out of the bowl, and cover it with saran wrap. I put a rubber band around it to hold it. It's kind of a therapy "popsickle".

Supraspinatus treatment
You will have to take off your shirt for this. I would suggest removing your bra, too, if you are a woman. Now, sit on a stool and bend forward slightly. Stretch your bad arm behind your back straight and across your hips, lift it away from your back, holding it straight as much as you can without pain. Now, have someone (or do it yourself if your other arm is flexible enough) stroke an edge of your "popsickle" starting from your neck, going over the top of your shoulder and down over your upper arm. Do this in "stripes", starting from the front edge of your shoulder and working backwards. After stroking the top with 4 or 5 strokes, you should be able to stretch your arm out more. Repeat a couple of times.

Subscapularis treatment
Again, no shirt and for this one, definitely no bra. Lay on the floor on your good side or your back. Lift your arm, like you were going to put it over your head as much as you can. Take the popsicle and using an edge, "paint" stripes starting from the middle of your side, going up to your underarm and up the underside of your arm. Stretch your arm up more if you can as you continue to paint. I found that the trigger point on the inner edge of the scapula was a problem for me, and I needed the stripes to include my scapula and continue back to across my upper back. For this reason, I think its better to be on your side than your back. Repeat the painting sequence a couple of times.

Once you are done, take a hot shower, or put a hot warm cloth over the area. Don't stress the shoulders out too much for a couple of days. Gentle stretching is fine. I will provide some easy stretches for these muscles that you should do several times a day. I hope, like me, that you find that you can instantly move your shoulder in ways that you haven't for some time! You can do this treatment every day until the shoulder is free. The trigger points will have a tendency to stick again until they become desensitized.

This sounds very unpleasant, but you will be surprised. The edge of ice does not really make you cold and the release of the muscles will feel great! If you get a partner to do this for you, it will help to relax as much as possible, keeping the rest of your body warm and relaxed. Pretend you are at the spa! Have some wine or a warm drink. Soft music wouldn't hurt.

I've also done a version of this in the shower and had it work pretty well. I bring the popsickle, minus the saran, into the shower with me. Paint one set of stripes and then put the shoulder under the hot water. Paint some more and then warm up again. This is not the conventional treatment by any means, since T&S don't like you to get wet, but it did me a lot of good.

Contributing Nutritional Factors

2005-12-03T07:45:00.000-08:00

Frozen shoulder is very common in women going through menopause. Travell and Simons emphasize the role of vitamin B-6 insufficiency in generating trigger points. B-6 requirements go up with the use of birth control, in pregnancy and lactation. Could the hormonal conditions of menopause also increase the need for B-6? Since moderate doses of B-6 are well tolerated and free of side affects, why not assume this is the case? It can't hurt!

My recommendation to anyone experiencing a frozen shoulder is to start taking 50mg per day of B-6 and to continue taking this indefinitely. B-6 is used by your body to make many things needed for the proper functioning of your nervous system.

Other vitamins needed to support proper functioning of your muscles and their related nerves are vitamin C, thiamin and B12. Since you need thiamin and B-12, two other B vitamins, a good way to get the B-6 would be to take a "B-50" or "B-100" tablet every day. These formulations are easily found at any pharmacy and cost pennies a day.

Vitamin C is also a vitamin that can be taken at very large doses without any ill effects. I take at least 500mg a day every day. During the cold and flu season, I make a nice warm drink with 1/2 a teaspoon of Vitamin C powder and 2 packages of Splenda in hot water. This gives me 2-3 grams a day of C. I think this makes me feel better. Another benefit of C is that it helps you avoid sunburn and improves your skin in general. Your gums will be healthy as well.

All these vitamin supplements are inexpensive and do not interfere with other medicines. Please take them.

What Causes Frozen Shoulder?

2005-12-03T06:57:00.000-08:00

Your shoulder is a very complicated complex of muscles, tendons, ligaments and bones. It's amazing that it works as well as it does. It's no wonder that things often go wrong with it. Our shoulders were an adaptation of a limb that was originally designed to be a front leg, so it retains some of the structures from that legacy, while nature has added more to it to make it support the use of our hands.

Muscles in our body typically attach two structural elements together, usuall bones. A nerve is connected to the center of the muscle, its "belly", to send it signals. The nerve signals the muscle fibers to contract or relax, the basis of all movement. In the case of the shoulder, there are many intertwined muscles and lots of bones. The shoulder is not a true joint in the same way that your hip, ankle and knee are. This is why you arms are much more flexible.

Frozen shoulder occurs when some of the fibers in two of these muscles become "stuck" in the contracted position. The more fibers, the worse the sticking. This causes your shoulder to be out of alignment and lots of other related muscles become stressed and "stick". Over a period of weeks or months, your shoulder freezes, painfully, until it's hard to use at all. Then, over time, these muscles relax, and if you are lucky, after two or three years, they will all let go and your shoulder will be back to normal.

These "sticky" muscles are known as trigger points. You will be able to find them right away. Press hard all around you shoulder and you will find several "knots" of hard muscle that feel like a knife when you press on them. Yes - those are the culprits! They are bands of muscle cells that are stuck in contraction and won't let your shoulder stretch out to normal. You will need to unstick them all to get 100% relief. The good news is that you can do this quickly, within weeks, and that you don't have to wait two years to get better.

My Story

2005-12-03T06:13:00.000-08:00

My frozen shoulder is 90% resolved as I start this blog. I have managed to unfreeze it quickly - in a matter of weeks - when typically it takes years. I felt that this is important to share, especially since the most effective treatments have been ones that I was able to do at home, without a doctor or even a therapist.

My shoulder had some small inklings of a problem starting in December 2004. The top would cramp up and the back would ache. This was mostly due to carrying a heavy purse on the right and spending waaaaay too much time on the computer in non-ergonomic conditions. It was especially aggravated by using the touch pad at home, with the surface too high. By May and June, I was annoyed by the pain and signed up for Dahn yoga. This was perhaps not the best therapy for it, since this was not real yoga and included bouncing exercises that might have aggravated it. By early July, my arm started to spasm and really hurt. By August, my range of motion was really limited and the pain was so severe that I was barely using the arm at all. I started seeing a chiropractor who does myofascial release therapy in August. Her therapy seemed to help a little and perhaps kept me from getting much worse and prolonging the "freezing" stage - but it has not eliminated the problem.

In September, my husband, a massage devotee, started massaging the "sore" spots. This seemed to help! It actually helped as much or more than the chiropractor, it seemed to me. I then decided to do more Web research. I read any published papers about frozen shoulder. I was pretty shocked at what I found. The usual therapies that doctors provide have no evidence for healing frozen shoulder - cortisone injections and manipluation under anesthesia. Physical therapy and trigger point therapy had the best track records - though there are few studies. Considering the pain, disability and common occurrence of frozen shoulder - 6% of us will get it - it's amazing that so little attention is paid to it.

I proceeded to learn as much as I could about trigger point therapy. I purchased several do-it-yourself books about trigger point massage, some of them very good. Using the techniques in these books - especially this one, I was able to progress to the "thawing phase" quickly and was able to regain 80% of my range of motion. Still, I was unable to lay the back of my hand flat against the floor with my arms at 90 degrees. That last 20% still left me with significant disability and some pain. Several weeks went by with no real improvement, despite continued massage and active release therapy.

Finally, I decided to invest in the medical textbooks behind these "for dummies" versions, Travell and Simons classic texts Myofascial Pain and Dysfunction. They arrived last Monday. Here on Saturday, I was able touch the floor with my hand for the first time in 6 months. And, best of all, the way I did it was easy, safe, and free. I am hoping to get that last little 5% out of the way in the next few weeks, affecting a complete cure. If you listen to your conventional doctor, the typical orthopod, they will tell you this is not possible. I will tell you how I did it and give you the benefits of the knowledge that I am gaining from Travell and Simons and the massage therapy experts.