Overview on Frozen Shoulder

There are few conditions that osteopaths encounter as acutely painful as a full-blown frozen shoulder (also known as adhesive capsulitis). And it’s not just pain, it’s also the restricted movement, not to mention trying to lie on the affected side at night. The shoulder is amazing when you consider how it enables you to manoeuvre your hand into all sorts of different positions, from scratching between your shoulder blades to tying your shoelaces. But, there’s a trade-off. This flexibility of the shoulder makes it susceptible to injury.

Frozen shoulder pic.2Causes and types of Frozen Shoulder

Common causes of frozen shoulder are falls, muscle strains, and immobility (e.g. after being in plaster). When there seems to be a clear cause, this is called a Secondary Frozen Shoulder (i.e. secondary to a fall). When patients are not able to pinpoint any cause, this is described as a Primary Frozen Shoulder.

What is Frozen Shoulder?

Most joints in the body are called synovial joints, because they rely upon a fluid (called synovial fluid) for lubrication. This fluid needs to be contained by a capsule (like a bag). In frozen shoulder an inflammatory cycle takes hold which essentially results in a loss of fluid and an increase in a protein called collagen, which results in things becoming stiffer. The combination of these changes results in the stiffness and pain that characterise frozen shoulder.

The signs and symptoms of Frozen Shoulder are typically the following:

External rotation

External rotation

• general loss of range of motion, especially raising the arm above the head; a loss of external rotation compared with the unaffected shoulder is a strong indicator of a frozen shoulder

• pain in most movements
• pain on lying on the affected shoulder at night

Typically, people have difficulty putting their arm into a shirt/jacket/coat, raising their arm to brush their hair, and putting things away in cupboards. For unknown reasons more women than men get frozen shoulder, with most cases in the 40-65 age range. (The Japanese call it “fifties shoulder”.) It’s also more common in people with diabetes.

How long does Frozen Shoulder last?

Frozen shoulder pic.4 graph
The average duration is 30 months, with 3 distinct phases:
The freezing stage – pain and restricted movement
The frozen stage – less pain, but still restricted movement
The thawing stage – movement gradually returns

The Niel-Asher Technique
At Sutton Osteopathy we use the Niel-Asher Technique (NAT), which was developed by the osteopath Simeon Niel-Asher. Peter Andrews has undertaken postgraduate training and is a qualified NAT practitioner (see www.frozenshoulder.com). In essence, NAT is a completely hands-on approach using a combination of treating trigger points, soft tissue techniques, and stretch. Most people find it slightly painful at times, but also soothing. A trial (RCT) carried out by Addenbrookes NHS Trust in 2003 found the following:

• The two main outcome measures were improvement in active range of motion (i.e. lifting the arm higher without help) and pain-relief
• Range of motion improved by 52.6° degrees for the Niel- Asher Technique™ compared to 24° degrees for physiotherapy and 0.8° degrees for placebo
• Pain improved by 38.7 points for the Niel-Asher Technique™ compared to 19.9 points for physiotherapy and 22.8 points for placebo. In fact those patients treated with the Niel-Asher Technique™ reported an 80% decrease in pain over 9 weeks!

So, in summary, do not despair if you have a frozen shoulder! The aim of our treatment is to reduce your pain and to shorten the healing time. For more information, please visit www.frozenshoulder.com, or ring Sutton Osteopathy on 0121 354 7306.

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