I am regularly online mentoring a regular blog reader in NYC. We do this via email and we do his difficult cases together via google hangouts, where I assist live with patients.
Recently, he asked me if there was some sort of secret to frozen shoulders, as he has a difficult time with them. My reply was simple, and it's the answer I have been giving for years. The Secret to frozen shoulders is....
Time and Patience - ROM - The Good News
- frozen shoulders fall under The Slow Responder category
- it's important to educate your patients that improvement will come slowly but surely
- remember true physiologic changes to length for real adherence occurs like hypertrophy for muscles - eventually and with hard work
- creep is temporary
- growing new sarcomeres for true muscle length only occurs after a bit longer than a week, and that's under constant stretch
- the slow response in these cases will be to ROM
- ROM can be helped with thoracic and possibly cervical manipulation (or mob if you prefer)
For Pain - The Even Better News
- pain for many frozen shoulders is usually a Rapid Responder (unless their nervous system is centrally sensitized for a long period of time)
- improvements in pain can be made with cervical mobilizations or retraction and sidebending to the frozen shoulder
- grade 1-2 oscillations joint mobs
- modulating the pain and raising the pain thresholds will make the patient more compliant with their HEP
- thoracic whips
- cervical retraction and SB to the involved side (if it changed pain and/or ROM of the shoulder)
- graded movement in various planes of abduction with careful attention to stabilize the scapula with the uninvolved side hand
- also, self scapular stabilization with light clockwise and counter clockwise shoulder circumductions in a pain free range helps keep the patient moving and motivated
Changes will come slowly but surely, be encouraging and tell patients there is light at the end of the tunnel. The research states most frozen shoulders take care of themselves, perhaps that just the pain, and not the ROM. Our education, treatments, and programs we give the patients can hopefully cut down this long recovery by months. Typically a tough frozen shoulder takes me between 4-6 months for close to full ROM and full function. That depends on many factors. The longer you see someone, the more important it is to space out visits. Seeing someone 2-3 times/weekly after the 2 month period is probably overkill. Space it out to continue performing your OMPT that helps modulate pain, raise movement thresholds, and vary and progress their homework accordingly.
Keeping it Eclectic...