written by Slava Kolpakov in 2015
My wife got a frozen shoulder for the first time in her life. She woke up and couldn't move her arm without excruciating pain. The only position that felt comfortable was to keep the arm completely immobilized alongside the body.
As a therapist, I tried to figure out what caused it. If you know the cause of the injury, you can stop doing the darn thing that caused it. ... And you can determine which muscle fibers got injured and treat them.
Theresa took a yoga class the night before. They held the Plank Pose for a long time, and did a few Up-dog-Down-dogs in class. Those can certainly stress the rotator cuff muscles, and is a common injury for yoga practitioners.
She walked a couple of big dogs a few days back, and clearly remembers how they tugged and jerked on the leash as she held them back with the same arm. That could have done it.
And then, she tried to lift our 2.5 year-old son into his crib for his nap. Ouch. That's when she could not use her only good arm, and realized this was the exact movement that has been giving her a mild ache for months. Finally, it gave out.
Every time you lift a heavy load that your body is not ready for, or put too much stress another way, like too many Down Dogs, muscles tear. These are usually small microscopic tears that build up overtime.
Your body heals these tears with inelastic collagen, aka scar tissue, which slowly becomes a blob of tissue within the muscle and is more susceptible to injury (because it's inelastic). Additionally this blob of tissue can get impinged between bones as in the case of the frozen shoulder - between the arm bone (humerus) and the joint socket.
What not to do?
The first thing is to stop any activity that may have caused it.
Second, stop trying to stretch it - it will only make it worse - because you are stretching a tear - which will only create more tearing.
Finally, make an appointment with a qualified therapist. I am biased, but I would recommend seeing a massage therapist first, trained in Neuromuscular Therapy. We've seen many successful recoveries from frozen shoulders over the years. Give us a call!
Which muscles are involved?
In Theresa's case, I initially thought it was the Infraspinatus which lays on top of the Scapula, winds around the arm, and attaches on the Humerus. It's stressed in the Plank and Down Dog, and stabilizes the arm in the socket when pulling and lifting. Theresa also indicated initially that the majority of pain came from that area.
However, after a couple of days of spot treatment, any pain in the Infraspinatus disappeared, and migrated over to the front of the arm deep between the arm and the Pec muscles. Any pressure there would send a sharp sensation down the arm into the elbow.
I pressed into the attachment of another Rotator Cuff muscle - Subscapularis which lays on the inside of the Scapula. That's when Theresa jumped off the couch. It was clearly the epi-center of pain.
Working on the Subscap involves tractioning the Scapula out to release the fibers on the inside, as well as breaking up any scar tissue at the attachment on the Humerus. Not a fun process.
The next day Theresa woke up with a fully mobile arm, and more than 50% of pain gone. We were on the right track.
After the treatment, it's important to monitor which movements aggravate the shoulder joint, and minimize them in the beginning.
When the pain is completely treated, it's critical to strengthen the rotator cuff muscles with a PT, or a trainer specializing in injury recovery who is able to design a gradual training plan for you.