On 2002, at a seminar in Denver, a doctor in his 30’s stated he had had only 90° shoulder abduction for ten years. After applying this technique, his arm immediately rose to almost full abduction of 160°. In Oregon, a doctor had had severe pain and limitation of motion for over thirty years. In front of 150 DC’s, his ROM increased from 30° to 130° and almost all the pain was eliminated within minutes. This improvement maintained itself the next day, which he demonstrated by waving his arm over his head!
I’ve now treated over 35 DC’s and MD’s at seminars with frozen shoulders of many years duration; over 85 percent of them have had immediate restoration of full movement; generally this improvement is permanent after just one or a few treatments.
Painful or frozen shoulder is one of the most frustrating symptoms many DC’s are confronted with. This condition occurs in up to 2 percent of the United States’ population.1,2 Painful and limited shoulder movement of any kind is much more common than true frozen shoulder (adhesive capsulitis). The treatment discussed in this article is extremely effective for all kinds of shoulder pain, if there is pain on movement, and has been successful in well over 85 percent of cases in restoring almost full range of abduction and other movement in minutes.
Non pathologic joint dysfunction responds best, but even severe arthritic degeneration may greatly improve.
Obviously, a true adhesive capsulitis with adhesions or severely arthritic joint will have a worse prognosis than a joint with no pathology that just has pain on motion.1,2,4,7,9 Nevertheless, I saw a sixty-eight-year-old patient with severe crepitus and degeneration of the shoulder joint. His abduction was restricted to 50°, and he had severe pain in the shoulder. I cautioned him that our expectations were limited. However, by the end of the first treatment, he was able to abduct easily to 135°, with no pain! After several sessions, he regained almost full movement to 150° or so, with no pain.
Frozen shoulder can last for years or decades.
Most surgeons agree that this condition is “unresponsive to treatment, including physical therapy, injections and medication”16 and generally self- limiting, usually lasting up to a year. I’ve seen many patients who’ve been frozen for years or decades. Three patients come to mind who had the problem for thirty years; they all responded within minutes with full restoration of pain free movement.
Here’s how to unlock a shoulder that is painful on motion.
These procedures are highly effective at eliminating pain on movement. If there is no pain, but the restricted ROM is due to adhesions or muscle spasm, it’s much more difficult to improve. Sometimes the pain will immediately improve but the motion will stay restricted.
The following procedure is non manipulative, with no thrusting. It aims to realign the soft tissues and retrain them to take the humerus through a normal range of motion as it rides on the glenoid cavity, in shoulder abduction. There are advanced procedures for other planes of movement, but this simple technique is often effective at immediately reducing pain on motion and allowing increased ROM on abduction.
1. Have the patient straighten their arm and actively abduct the arm away toward the ceiling.
2. Note where pain begins.
3. Search the insertion and origins of the deltoid tendons for tender areas; if you find them, apply firm pressure on each area for ten seconds. The deltoid is the prime mover for shoulder abduction; this procedure will facilitate full functioning.
4. Stabilize the patient’s scapula with the palm of your hand pressing anteriorly, and gently pull the humerus posteriorly. Maintaining this pull, have him again abduct the shoulder. He may immediately have less pain when it moves. If so, have him continue to slowly abduct and lower his arm five to ten times. Remember, no thrusting!
5. Note: this procedure will not affect palpatory pain (trigger points) or the subjective pain the patient feels; it is only for pain on movement. The subjective pain will usually improve as the ROM increases. (Other procedures that instantly inhibit trigger points are described in The American Chiropractor, Aug. 2007, “Can Trigger Points Be Turned Off in Seconds, Using Neurological Reflexes?”.)
Of course, in your office, you may need to continue treatment for several weeks for an injury of this duration. There are other techniques to restore shoulder internal and external rotation, flexion, adduction, etc., as well as different procedures for instantly neutralizing trigger points in the shoulder. Many shoulder problems are complicated by local trigger points and it may be necessary to eliminate these using Pain Neutralization Technique (P.N.T.), as described in a previous issue of The American Chiropractor.8
Stephen Kaufman, DC, graduated from Los Angeles Chiropractic College in 1978, and practices in Denver, CO. After studying dozens of techniques and being dissatisfied with the lack of consistent results, he finally developed P.N.T. to relieve pain in seconds. For more information, visit www.painneutralization.com. He can be reached at 1-800-774-5078 or 1-303-756-9567.
References
1. Amir-Us-Saqlain H, Zubairi A, Taufiq I. Functional outcome of frozen shoulder after manipulation under anaesthesia. J Pak Med Assoc. 2007 Apr;57(4):181-5
2. Andrews JR. Diagnosis and treatment of chronic painful shoulder: review of nonsurgical interventions. Arthroscopy. 2005 Mar;21(3):333-47. Comment in: Arthroscopy. 2006 Jan;22(1):117-8; author reply 118-9.
3. Bunker TD, Anthony PP. The pathology of frozen shoulder. A Dupuytren-like disease. J Bone Joint Surg Br. 1995 Sep;77(5):677-83.
4. Cutts S, Clarke D. The patient with frozen shoulder. Practitioner. 2002 Nov;246(1640):730, 734-6, 738-9.
5. Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005 Dec 17;331(7530):1453-6.
6. Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess. 2003;7(29):iii, 1-166.
7. Hand GC, Athanasou NA, Matthews T, Carr AJ. The pathology of frozen shoulder. J Bone Joint Surg Br. 2007 Jul;89(7):928-32
8. Kaufman, Stephen. Can Trigger Points Be Turned Off in Seconds Using Neurological Reflexes? The American Chiropractor, Aug. 2007. p. 40-42.
9. Malhi AM, Khan R. Correlation between clinical diagnosis and arthroscopic findings of the shoulder. Postgrad Med J. 2005 Oct;81(960):657-9.
10. Need patients be stuck with frozen shoulder? Drug Ther Bull. 2000 Nov;38(11):86-8 [No authors listed]
11. Nitz AJ. Physical therapy management of the shoulder. Phys Ther. 1986 Dec;66(12):1912-9.
12. Noël E, Thomas T, Schaeverbeke T, Thomas P, Bonjean M, Revel M. Frozen shoulder. Joint Bone Spine. 2000;67(5):393-400
13. Polkinghorn BS. Chiropractic treatment of frozen shoulder syndrome (adhesive capsulitis) utilizing mechanical force, manually assisted short lever adjusting procedures. J Manipulative Physiol Ther. 1995 Feb;18(2):105-15
14. Wadsworth CT. Frozen shoulder. Phys Ther. 1986 Dec;66(12):1878-83
15. Warner, JJ. Frozen Shoulder: Diagnosis and Management. J. Am. Acad. Ortho. Surg., May 1997; 5: 130 – 140.
16. Frozen shoulder. www.mayoclinic.com.