Frozen Shoulder, Part 2

by Baxter

Anatomical Studies of the Shoulder by Leonardo da Vinci

For those of you out there who might have missed Nina�s original post on frozen shoulder from a while back (see Yoga and Menopause: Frozen Shoulder), I�d highly recommend it. And while Nina rightly points out a correlation between menopause and adhesive capsulitis (that�s its fancy name), it turns out that men fall victim to this conditions as well. In fact, I developed a case of it in my left shoulder over the fall and early winter months of 2015-16!

Some interesting statistics on and features of frozen shoulder: 

• It usually affects those over 40 years of age, with the peak period being between 40-70 year of age. 
• 70% of cases are women and 30 percent are men. 
• The jury is still out on what causes frozen shoulder. Although there is a connection between menopausal changes in women and the development of frozen shoulder, the other leading contenders are that it is an inflammation problem, an autoimmune problem, or simply a stiffening of the joint capsule problem (a process called fibrosis). 
• Since it does not always show up in isolation, it can be accompanied by other causes of shoulder pain, such as bursitis or rotator cuff injuries, making diagnosis and treatment tricky. 
• According to the Mayo Clinic, you are at higher risk of getting it if you have diabetes, heart disease, Parkinson�s disease, thyroid conditions, or a recent trauma that immobilizes your arm such a fracture or stroke.

When I started getting pain and limited range of motion in my left shoulder and arm last fall, I was not sure what was going on. It came on gradually and I did not have any of the risk factors I had read about, but I had tweaked my shoulder 15 years ago while climbing and had some chronic stiffness that my yoga usually worked out nicely. And then there were two events in September. First, I was swinging on a low trapeze bar for about two minutes, after which I noticed that my shoulder was not so happy with me. And, second, two weeks later I took a trip to an indoor sky-diving place, where a total of four minutes in the wind tunnel with the arms in bird-wing position made my shoulder even more unhappy. I recently came across research that connects direct or indirect trauma to the shoulder joint as a common cause of secondary frozen shoulder, which could explain my case.

When I finally got into to see the orthopedic specialist in late January of this year, initially I was offered a couple of steroid injections to cover both rotator cuff injury and frozen shoulder. At that point I asked for an MRI, since my physical exam could not confirm either diagnosis (it�s good to keep in mind that history and exam don�t always tell you what is going on for sure). And the MRI showed a healthy rotator cuff and definite frozen shoulder, so I only really needed one injection! That very same day, I got into to see an amazing physical therapist, who gave me a set of exercises to begin immediately. From a Yoga for Healthy Aging perspective, I was delighted to discover that some of the exercises were dynamic movements (similar to Arms Overhead Pose), done in sets of 10 repetitions, and others were static movements, held between 2-5 minutes. When I asked about the longer holds, my physical therapist mentioned that the joint capsule, made up of thick connective tissue, requires longer holds to loosen, similar to the timing we�ve discussed for stretching fascia here on the blog.

Now, I had read the studies that the average time for recovery of range of motion was 1-2 years and that really did not fit into my plans, so I asked the physical therapist if he had ever had a patient who recovered faster. He said, yes, one person who had actually taken his advice to do the physical therapist exercises hourly during the day had seen a rapid recovery in just a few weeks! (He pointed out that most patients only do them infrequently.) That was all the incentive I needed, and I started my practice immediately that day. After all, abhyasa (yogic practice) is not all that different (see Practice)!

One of the challenges of rehabbing frozen shoulder is that you actually have to move into far enough into stretch that it is painful. This is in contrast to physical therapy for rotator cuff injuries, where you would not go to the point of pain. I found that my ability to focus on my breath while holding painful stretches for 2-5 minutes was invaluable in staying the course without over triggering my sympathetic nervous system. And although I did not do them every hour, I often got 3-4 sessions in every day for the next few months. By April, my pain-free range of motion in that left shoulder was back to normal, and my physical therapist bid me farewell, with the important reminder to keep an eye on my right shoulder, as 25% of those with frozen shoulder will get a case of it showing up in the opposite shoulder in the 2 years that follow (Nina had this happen).

My takeaways:

1. If stiffness and pain persist in your shoulder, get it checked out by a specialist to get a solid diagnosis.
2. Try to see the best physical therapist you can in your community�it can make a difference.
3. Apply your yogic practice skills and your yoga tools to your rehab. (I was doing all the yoga poses I could do, although with left arm modified, along with my physical therapy exercises, and I believe it helped!).

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