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Frozen Shoulder

The frozen shoulder is also called "a stiff shoulder" or "adhesive capsulitis" and its biological mechanism is still not well understood. A frozen shoulder is mainly defined by acute pain and stiffness. These two phases come one after the other.

The pain caused by a frozen shoulder is located on the shoulder articulation complex but can also extend to the arm and sometimes the wrist. Most patients experience both pain and stiffness in the articulations but it sometimes happens that only one of these is present.

2-5% of the population might one day suffer from a frozen shoulder. For patients with diabetes the probability is 10%.

In most cases patients with a frozen shoulder are between 40-60 years old and in 20-40%  of the cases both shoulders will be affected one after the other.

Generally, a frozen shoulder symptomis due to either a physical or emotional trauma but in some cases it comes from no apparent reason (called: idiopathic).

The acute shoulder:

Usually, the patient starts to feel acute shoulder pain. Especially during the night or when moving the shoulder.

Sudden movements, like grabbing a falling object, can typically trigger acute pain in the shoulder region.

Lying on the affected shoulder is also very painful.

This phase is where an inflammatory process is occurring in the shoulder caps which are highly innervated (large supply of nerves). This is why the first phase is so acute and painful.

If you go to the sections on "inflammation" or "Anti-Inflammatory Diet" here on my website, you will understand how to do your best to minimize the inflammatory process and how osteopathy and a good diet can help minimize this process .

The stiff shoulder:

When the inflammation phase is getting to an end (after around 6 - 8 weeks), the so-called stiff phase starts. As pain is decreasing, stiffness in the joint is increasing. It is mostly the abduction (side way elevation) and the external rotation of the shoulder which are restricted because of the retraction of the shoulder capsule.

It is during this phase that osteopathy can be very efficient.


Osteopathic treatment of a frozen shoulder
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The process of a frozen shoulder is called: algoneurodystrophy. To keep it simple: the brain is the computer and the nerves are the electrical wires connecting the different organs (muscles, articulations, skin, visceral organs, etc.) To monitor and regulate the organs' functions, the brain constantly communicates with the different organs through the nervous system (the wires!).

The algoneurodystrophy is when this system doesn't function properly.

It is essential to consider different aspects when treating a frozen shoulder:

- Assessing and maintenance of the shoulder's bio-mechanics

- Releasing potential shoulder or arm nerves compression

- Daily exercises to maintain the shoulder's mobility

- Anti-inflammatory diet

If you wish to know more...

First of all, your body always tries to compensate for any type of dysfunction! When there is pain, our brain will find strategies to avoid it. Which is good and bad. It is good because, the affected structure will heal faster as we are not using it so much. The bad part is that because we stop using one region another one will have to work more to sustain the global function as the mobility of the first one decrease progressively.

In the case of a frozen shoulder, patients can physically not use their shoulder anymore but instead, they will compensate by using the scapulothoracic articulation (the shoulder blade/scapula) which will bring higher pressure on the cervical spine and upper thoracic spine. This elevates the risk of cervical tensions, nerves compression or thoracic outlet syndrom which could affect the shoulder or arm.

Osteopathy can help to ensure that the cervical spine and adjacent structures will stay mobile and healthy.

The osteopath will of course also work on the actual shoulder complex. There are two main levels: the shoulder capsule and the surrounding muscles.

In a frozen shoulder, the shoulder capsule is tightening, this is why the mobility is reduced. Mobilization and gentle stretching of the shoulder capsule will help the patient to remain less 'stiff' in the joints and this will diminish possible compensations in other muscles/joints.

Furthermore, muscles like the long biceps or muscles of the rotator cuff can make adhesions with the humeral head (the 'ball' at the end of the arm bone), the acromion (outer end of the shoulder blade) or the coraco-acromial ligament. Osteopathy uses very efficient techniques to soften these potential adhesions and thereby limit the phase of the stiff shoulder.

It is also very important to explain specific and daily exercises that patients can easily do at home. This will help to maintain steady shoulder mobility and the overall healing process.

Finally the patient can chemically limit the inflammation process. Not with medics but with his/her choice of diet. A healthy and anti-inflammatory diet is very important to decrease the amount of protons (free radicals) in the blood. Please read about this in the sections named "Inflammation" and "Anti-inflammatory diet".

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