Lately, we have been seeing a lot of cases of frozen shoulder in our office.  This is normally a condition that one would associate with someone who had had a lot of injuries to the shoulder or who was older, but the cases we have been seeing are in younger people.  We are seeing this equally in male and female patients.  There is a lot of debate on what the cause of this problem is, but the solution, at least in our office, is very straightforward.

Frozen shoulder is a condition involving the tightening and contracting of the muscles surrounding the shoulder joint which results in the inability to move the shoulder and may cause intense shoulder pain. The shoulder is a very complex joint in the body, made up of several bones, ligaments, muscles, and tendons.

Our office takes a very specific approach to treat patients with frozen shoulder and this does not involve using pain medication or cortisone injections.

The first thing we do is to assess the movement of the shoulder and whether the problem is being caused by an anatomical problem (stuck joint or impingement), is muscular in nature, or is a combination of both. X-Rays are the first tool we use to see what is happening to the bones that make up the shoulder. Then our doctors test the muscular strength of those muscles including the rotator cuff muscles. We then palpate these muscles to find out where the greatest areas of muscular spasm are present. Trigger points may also be palpated in these muscles. These are noted as a treatment for this is going to be our next step.

Once a diagnosis of a frozen shoulder is confirmed, the next phase is treatment. Our office does not use pain medications or muscle relaxers for treatment, nor do we utilize cortisone injections. Our first goal of treatment is to start to relax the musculature and reduce any resulting inflammation. The way the body works is that it causes muscles to spasm (muscle guarding) and tissue inflammation (edema and swelling) as a result of irritation to that area. This is a normal physiological phenomenon of stress in an area. It is the same response if you were to twist your ankle while playing a sport. The shoulder starts to become frozen normally slowly over time, therefore, the faster we start treatment the faster we can get our patients back to a pain-free range of motion.

Why does our office choose not to use medications or cortisone injections?

The body is designed to heal from within.  Using medications or steroidal injections will certainly reduce the pain, decrease the spasm of the muscles and reduce the inflammation. However these methods do nothing to address the cause of the problem, which may be poor biomechanics, improper muscle balance due to poor posture, or prolonged sitting which cause the anterior (front) muscles of the body, such as our pectoral muscles and Sternocleidomastoid (SCM) muscles to become stronger while our posterior (back) muscles, such as our trapezius, and rhomboid muscles to become weaker.  Being out of balance can be a factor in the development of the shoulder becoming frozen. Therefore, just artificially treating the symptoms and not the cause may have long-term detrimental effects later in life.

Treatment in our office however will address 3 important factors.  Reduce inflammation, improve muscle balance and reduce joint restriction found in the shoulder and upper thoracic and lower cervical regions of the spine.

Treatment will normally begin on the first day a patient is examined in our office.  The inflammation is reduced using techniques we have the world on and developed over the past 30 years of practice.

We then start to mobilize the joints, improving their movement, and at the same time, we begin working on the muscle structures of the shoulder region to work out any lactic acid buildup in those muscle tissues.  After a week or two of passive care to reduce inflammation, and reduce tension in the muscles, we then begin to strengthen the complex muscular structures of the shoulder and upper back region.

If after 4-6 weeks of rehabilitative treatment including muscle strengthening both in the office along with at home treatment we have not resolved the frozen shoulder to a pain-free 100% range of motion, our doctors have been trained in the use of  Acoustic Shockwave Therapy.  Acoustic Shockwave Therapy is a type of treatment that a lot of professional sports teams are using to help get their athletes back in action faster than just resting alone. Also referred to as extracorporeal shock wave lithotripsy, this is a non-invasive treatment that uses the mechanical force of a powerful acoustic shock wave within injured tissues to reduce pain and speed healing of the affected area.

Here is an article from the National Library on Medicine that goes into detail on the use of Acoustic Shock Wave therapy:

If you are looking for relief and do not want to consider drugs, cortisone injections, or even surgery at this point, please call our office.  The results we see with Frozen shoulder are incredible and if you are suffering from this please know that we may be able to help you.  We offer consultations with our doctors who can talk with you about the problem and help to guide you to the best treatment approach for you.

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