The Role of Osteopathy in Frozen Shoulder
The ‘50 Year Old Shoulder
Frozen shoulder or adhesive capsulitis is a very real condition but one which is poorly understood. It is characterised by a period of intense pain at the shoulder, followed by severe restriction. It mostly affects women of peri-menopausal and menopausal age (40-60 years), hence it’s nick name, the ’50-year-old shoulder’. The condition is self-limiting, meaning the likelihood is it will go away, although this can take anywhere from 6 months to 3 years, and it goes through three distinct stages:
1) Freezing (Painful) Stage – This is the worst part for many as it tends to be the most uncomfortable. It is often described as a constant, deep pain that is worst at night. In this stage, the shoulder capsule is becoming inflamed and thickened, hence the pain and beginnings of loss of movement.
2) Frozen (Adhesive) Stage – The restricted part. Fortunately, for many the pain reduces at this stage but the range of movement at the shoulder is very limited, making it difficult to carry out normal activities and sports. This is because the shoulder capsule has become scarred and contracted.
3) Thawing (Recovery) Stage - There is a gradual improvement in shoulder mobility and a reduction in pain, as the shoulder capsule slowly loosens. Manual therapy such as osteopathy can make a big difference at this stage, in speeding up the shoulder’s return to normal function.
What Causes Frozen Shoulder?
Unlike other shoulder injuries that are brought on by injury or repetitive movements, the primary cause of frozen shoulder is, frustratingly, age. Despite science’s best advances, no one has been able to find the magical elixir of youth yet and so increasing your awareness of this as a possible cause of your shoulder pain is important. This is because the right type of care is important for managing the symptoms and avoiding further inflammation to the joint structures. There are also other factors that tend to increase the risk of frozen shoulder, such as diabetes, thyroid dysfunction, being of Asian descent and prolonged periods of shoulder immobility, for example, after surgery.
One of the main reasons for frozen shoulder affecting women at menopausal age is hormonal. Oestrogen plays a significant role in making and maintaining connective tissue in the body, including collagen and elastin. As oestrogen levels reduce, this directly impacts the joints, meaning that around 50% of menopausal women experience joint pain and increased stiffness.
What Are The Symptoms Of Frozen Shoulder?
The generalised symptoms of frozen shoulder are:
· Constant pain
· Stiffness and limited range of motion
· Gradual onset
· Pain at night/difficulty sleeping
More specific signs of a frozen shoulder include:
· Restriction in external rotation (turning the arm out) and abduction (bringing the arm out to the side. This can then progress to limited motion in all vectors. This is particularly noticeable when dressing, such as putting your arm through a sleeve.
· An inability to get any more movement at the joint when stretching, feeling that ‘it just won’t budge’.
There Is Some Good News
One of the main reasons that frozen shoulder has been so poorly understood, is the lack of research in this area, although this is starting to change. There have been suggestions from a couple of researchers that the pregnancy hormone, relaxin, has contributed to frozen shoulder symptoms relief in pregnant women. It is possible that eventually, hormone therapy may be utilised in frozen shoulder care. As oestrogen also plays a role in reducing inflammation, there are some studies that show peri-menopausal women taking HRT have a lower risk of developing frozen shoulder, compared to those not taking oestrogen replacements.
What Is The Treatment For Frozen Shoulder?
As frozen shoulder is a self-limiting condition, the good news is that it will likely resolve, even without intervention. However, early diagnosis, manual therapy and an exercise programme can help speed up recovery time and reduce pain levels.
Typically, conservative treatment focuses on pain relief medication, anti-inflammatories and physical therapy. A corticosteroid injection, whilst not a cure, can reduce the inflammation which provides a window of time where further stretches can be done to improve the range of movement. Surgical intervention is rarely needed and is only considered if all other methods have failed.
How can osteopathy help?
Firstly, an osteopath will be able to distinguish the difference between a frozen shoulder and a different shoulder issue. However, this can be tricky initially, as the first symptoms of frozen shoulder can mimic that of a shoulder impingement or biceps tendonitis.
When treating a frozen shoulder, an osteopath will aim to reduce pain, improve mobility and prevent compensatory issues developing elsewhere in the body, such as neck pain or mid-back stiffness.
What will an osteopath do?
The main treatment strategies an osteopath will use are:
· Manual therapy. These include, soft and deep tissue techniques, joint mobilisation and manipulations and stretching exercises.
· Dry needling. Some osteopaths use needling to target trigger points in the shoulder muscles and improve blood flow, which is crucial for encouraging the tissues to heal.
· Exercise rehabilitation. Personalised stretches and exercises are given to gentle stretch the shoulder capsule and enhance mobility. These can include exercises such as the pendulum, wall walking, and a towel stretch.
· Postural and lifestyle advice. Osteopaths can give plenty of guidance on posture and daily activities to prevent further strain on the shoulder, and they may also be able to assist in recommending supplements to further support your joints.
Conclusion
Whilst frozen shoulder can be a challenging condition, early diagnosis and a specific treatment plan can provide you with the tools to manage your symptoms and regain function of your shoulder quicker. In addition, your best bet to avoid the chance of a frozen shoulder is to do regular strength and mobility exercises and recognise that increasing aches and pains could be due to the menopause.
If you’re experiencing shoulder pain or stiffness, don’t suffer in silence. Seeking advice from an osteopath can help you get a clear diagnosis, reduce your pain and improve your mobility, helping you get back to doing the things you love.
Get in touch!
Concerned about your shoulder pain or lack of movement? Make an appointment with one of our osteopaths by contacting Kate, our friendly receptionist on 01895 200050 or email kate@bridgetohealth.co.uk.
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