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Frozen Shoulder Treatment

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Frozen Shoulder or Adhesive Capsulitis

Frozen Shoulder is an extremely painful condition in which the shoulder is completely or partially unmovable. Frozen shoulder often starts out of the blue, but may be triggered by a mild injury to the shoulder. The condition usually goes through three phases, starting with pain, then stiffness and finally a stage of resolution as the pain eases and most of the movement returns. This process may take a long time, sometimes as long as two or more years.

Frozen shoulder may be associated with diabetes, high cholestrol, heart disease and is also seen in patients with scar tissue in their hands, a condition called Dupuytren¹s contracture. It may follow an injury to the shoulder or surgery. 

The lining of the shoulder joint, known as the capsule, is normally a very flexible elastic stucture. It's looseness and elasticity allows the huge range of motion that the shoulder has. With a frozen shoulder this capsule (and its ligaments) becomes inflamed, swollen and contracted. The normal elasticity is lost and pain and stiffness set in.

Typical frozen shoulder develops slowly, and in three stages.:

     •     Stage One: Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2 to 9 months.

     •     Stage Two: Pain begins to diminish, however, the range of motion is now much more limited, as much as 50 percent less than in the other arm. This stage may last 4 to 12 months.

     •     Stage Three: The condition may begin to resolve. Most patients experience a gradual restoration of motion over the next 12 to 42 months

     •     Surgery may be required to restore motion for some patients, as most people never regain full shoulder motion.


Traditional Treatment

Physiotherapy – to prevent any further stiffness and regain range of motion

Painkillers and anti-inflammatories

Injections – reduce inflammation and provide pain relief

Surgery – Surgery has been shown to be of benefit in both the early and later stages of a Frozen Shoulder. It can be useful for both pain relief and restoring movement, although intensive physiotherapy is essential after the surgery. It involves a manipulation of the shoulder under general anaesthetic for most cases. Some people may require surgical release of the tight shoulder capsule done with keyhole (arthroscopic surgery).  

Prevention

Largely unknown. However, since frozen shoulder may set in as a result of underuse or immobilization of the shoulder, it is important not to neglect a painful injury as it may lead to stiffness.

Traditional approaches to the frozen shoulder either address the inflammation (steroid tablets, steroid injections and hydrodilatation) or the stiffness (physical therapy, exercise therapy and surgical manipulation). Physical therapies attempt to improve the range of motion by forcing the shoulder through the blockage; this in our opinion can make things considerably worse.

The Niel-Asher Technique® works differently. We keep the arm still whilst we apply a sequence of pressure points to specific tissues. The treatment can still be painful, especially in the early freezing phase, but it is no worse than the pain of the frozen shoulder (you will know what we mean if you have had one of those nasty spasms). The first few sessions of the technique initially address the inflammation in the rotator interval, after this the emphasis is on improving the range of motion. Depending how long you have had the problem and which phase you are in, results can be seen in as few as 4 sessions (range 4 –13). The results can be dramatic and fast and the method is ‘totally natural’. We believe it should be the first line of treatment before injections and or surgery.

The technique can be used to treat a wide range of shoulder problems, but it does not end there – the technology behind these ideas applies to the whole body.

How does it work?

In a Frozen Shoulder Syndrome the lax capsular sack becomes sticky and can sometimes form adhesions; hence the name of the condition. The stickiness seems to result from the way the brain responds to inflammation around the long head of the biceps, in the capsule.

In some people, and we still don’t know why, the brain over-reacts to this inflammation by switching off groups of muscles and changing their dynamics. (This can occur after a small injury, like reaching for the back seat of the car but often you may not remember anything).

Once established this inflammation spreads into other shoulder soft-tissues and can cause swelling in other shoulder sacks (bursae).

The resulting stiffness is an ‘overreaction’ to the inflammation (within the biceps groove). The body seems to ‘switch off’ muscles in a co-ordinated sequence; this sequence is the same for everyone and we call it the ‘capsular pattern’. In less than a week the arm movements start to diminish, and within a few weeks the arm literally becomes frozen and for many, can not be raised more than 40° in any direction. The muscles of the rotator cuff become weak and start slowly to waste away, leaving the arm to hang stiff and immobile.

Traditionally, muscles are thought to operate around joints in triangles; one muscle group holds the joint still (fixators), one muscle tenses up and pulls the joint one way (agonist) whilst another opposite muscle (antagonist) relaxes.

In shoulder problems these smooth and seamless operations no longer operate properly and agonists, antagonists and fixators become confused. The brain responds to this by recruiting alternative muscles to do jobs they are not designed for (synergists).

The Niel-Asher technique® stimulates groups of receptors embedded in the muscles to fire their messages to the brain. This creates a new and specific neurological profile within the part of the brain called the somato-sensory cortex. By stimulating these reflexes in a specific sequence, it is possible to change the way the brain fires muscles (the motor output).

This situation occurs in most shoulder problems and there are specific treatment sequences for a range of conditions such as Rotator cuff problems, biceps tendonitis, bursitis, arthritis and tendinopathy.


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