When is Treatment for Frozen Shoulder Needed?
Understanding Frozen Shoulder
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. It can significantly impact a person’s daily activities and quality of life. In this post, we’ll explore when treatment for frozen shoulder becomes necessary and what options are available.
Adhesive capsulitis (true frozen shoulder) gets often misdiagnosed with presentations with a better prognosis involving the rotator cuff muscle group when there is reduced range of motion and pain involving the shoulder joint. We’ll also look at the difference between the two.
What is true Frozen Shoulder?
Adhesive capsulitis or true frozen shoulder occurs when the capsule surrounding the shoulder joint becomes inflamed and thickened, leading to restricted movement and pain. It typically develops in three stages:
- Freezing stage: Gradual onset of pain and limited range of motion
- Frozen stage: Pain may decrease, but stiffness increases
- Thawing stage: Gradual improvement in range of motion
Prognosis of adhesive capsulitis
The prognosis for adhesive capsulitis (true frozen shoulder) varies, but generally follows a predictable course:
- Duration: The condition typically lasts between 1 to 3 years if left untreated.
- Spontaneous recovery: Many cases resolve on their own, but this can be a lengthy process.
- Treatment impact: Appropriate interventions can significantly reduce recovery time and improve outcomes.
- Recurrence: The risk of recurrence in the same shoulder is low, but there’s a 5-34% chance of developing it in the opposite shoulder.
While the natural course of adhesive capsulitis tends towards eventual improvement, early intervention and proper treatment can greatly enhance the recovery process and minimise long-term limitations.
Best Treatment Option for Frozen shoulder - The role of Myofascial release
The goal of treatment is to reduce pain and restore mobility.
Our in clinic experience so far shows that all clients presenting with a diagnosis of Frozen shoulder show hypertonic muscle and tight myofascia surrounding the shoulder joint*
*The body is a complex interrelated system so there are usually more structures involved.
Releasing these soft tissue has shown to be effective in reducing the symptoms associated with a Frozen shoulder diagnosis.
Myofascial release therapy is therefore particularly effective as a treatment method for frozen shoulder symptomatology.
Going back to our introduction to this blogpost, it’s important to note that very often we come across a misdiagnosed Frozen shoulder, where the client responds to treatment with symptoms ceasing after a course of between 1—6 sessions (which varies depending on the person and their individual life characteristics).
This fast recovery doesn’t align with a true Frozen shoulder diagnosis, which is often lengthier and requires more time to resolve.
In these cases of clients presenting with a presentation that mimics Frozen shoulder symptomatology, the restriction in range of motion and the pain doesn’t usually involve adhesive capsulitis but seems to be exclusively caused by the myofascial tissue involving the rotator cuff muscle group.
What’s the rotator cuff
The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint. These muscles work together to stabilise the shoulder and allow for its wide range of motion.
The four muscles that make up the rotator cuff are:
- Supraspinatus: This muscle helps lift the arm away from the body.
- Infraspinatus: It assists in rotating the arm outward.
- Teres minor: This muscle also aids in outward rotation of the arm.
- Subscapularis: It helps rotate the arm inward.
The rotator cuff plays a crucial role in shoulder movement and stability.
When these muscles or their tendons become inflamed, injured, or tight, it can lead to pain and restricted movement that as we mentioned above might be mistaken for frozen shoulder.
This is why proper diagnosis* and specialised treatment, such as myofascial release therapy, can be crucial in the client/patient experience with the presentation, recovery time, feeling of reassurance and wellbeing and reducing catastrophysing.
As we mentioned above, our experience in clinic shows that all Frozen shoulder diagnosed clients we’ve seen to date show important restrictions of the myofascial tissue surrounding the shoulder joint, regardless of whether or not there was inflammation of the shoulder capsule.
This makes it therefore obvious that releasing these soft tissue structures is the first step in a diagnosis of frozen shoulder or any presentation involving pain and limited range of motion of the shoulder joint, regardless of whether or not it also involves inflammation of the joint capsule.
*Always seek the opinion of a Myotherapist or soft tissue specialist after a diagnosis involving the soft tissue is made by your GP or other medical profession (physio, chiro).
What is Myofascial Release
Myofascial release is a hands-on treatment method that focuses on addressing the myofascial tissue.
Myofascial tissue is a type of connective tissue that surrounds and supports muscles, bones, and organs throughout the body:
- Myo-: Refers to muscle tissue
- Fascia: A connective tissue that forms a three-dimensional web throughout the body
This tissue plays several important roles in the body:
- Provides structural support and stability
- Allows for smooth movement between muscles and other structures
- Helps transmit force and tension throughout the body
- Aids in proprioception (body awareness)
The fascia was seeing for a long time as an inert tissue; today science has proven that couldn’t be further from the truth. The Myofascial tissue (fascia) is also extremely sensitive!
With more nerve endings than the skin itself, the fascia is very sensitive and reactive to pressure and chemical changes within our body and it has contractile properties of its own.
I like to mention this sensitive and reactive quality of the fascia because it really helps us to understand the deep interconnection between this tissue and our brain/mind, emotional processing, stress and trauma.
Important therefore to note that the mind and the myofascial tissue deeply affect each other. Stress and trauma reflect in the myofascial tissue affecting its behaviour.
In exchange, the myofascial tissue possesses nerve endings (unmyelinated free nerve endings), responsible for interoception and reporting to the insular cortex of the brain in charge of emotional processing, which means that the quality of the fascia can also directly affect the way we feel and not just the other way around.
At Inside we’ve observed over and over again the benefits of Myofascial release.
If you’re struggling with frozen shoulder or other musculoskeletal issues, myofascial release therapy should be at the top of treatment methods to seek a solution from, due to its effectiveness and equally important the capacity this treatment method has to adapt to the new science, treating the body and mind as an interconnected unit.
At INSIDE we firmly stand behind the unity mind-body-spirit and the importance of approaching either aspect of a person in treatment including the other two.
About the author
Rocio Santiago
MA in Nursing, Dip. Soft Tissue Therapy
Ro initially began her career as a nurse. Following this and after a difficult time in her life that resulted in a career change, Ro went on to train at one of the leading soft tissue therapy schools in Europe, completing a 3 year degree level course and specialising in effective soft tissue manipulation for the treatment of musculoskeletal pain.
The treatment method Ro uses consists of a combined approach using different specialised techniques, myofascial release and trigger point work among others, with the intention and focus on providing effective results in the least possible amount of time.
Combining her training, science background and life experience, her treatment method is based in science and built using a whole body approach, where mind and body are addressed as one.
Ro has been seeing clients as a soft tissue therapist for 8 years, successfully treating a wide range of conditions.