Wellness

 

Demystifying Frozen Shoulder, Plus Exercises That Can Help

A frozen shoulder is exactly what it sounds like: Your shoulder stiffens, your range of motion is limited, and even day-to-day activities, like reaching for a coffee mug, can be painful. What’s less expected is that this condition predominantly affects women going through perimenopause or menopause. Consequently, some doctors believe frozen shoulder may be caused by a drop in hormones, like progesterone, or rooted in hormonal imbalances. (See our perimenopause primer with Dr. Dominique Fradin-Read, who explains how progesterone acts like an anti-inflammatory.)

Physical therapist Allison Oswald sees clients who are coping with mysterious shoulder pain and have been diagnosed with adhesive capsulitis (the formal term for frozen shoulder) by their physician. Oswald likens it to a diagnosis of exclusion because many other conditions are typically ruled out until no other suitable explanation remains. While there’s still a lot to learn about frozen shoulder, the good news, according to Oswald, is that 1) it’s not permanent and 2) there are simple exercises to reduce pain and increase range of motion. (If you think you might have frozen shoulder, talk to your doctor and physical therapist.)

Oswald also specializes in pelvic floor health—her practice is full of women who are pregnant or postpartum. (If you’re in LA, you can find Oswald at Plumb Line, her physical therapy and Pilates space. She also offers virtual consultations.) Her approach to every issue is untraditional, thorough, and holistic. She has an extraordinary knack for figuring out how the alignment of one body part affects the movement of another, and what seemingly unrelated factor is throwing the whole thing off. We always roll out of her office a little easier than we came in.

A Q&A with Allison Oswald, P.T.

Q

How do women wind up with frozen shoulder?

A

Frozen shoulder, technically called adhesive capsulitis, is the progressive limitation of shoulder range of motion and stiffness that leads to pain when you attempt to move your shoulder. The onset is not usually linked to a direct trauma. Frozen shoulder is associated with women in their fifties and sixties, which is when I generally see patients experiencing these symptoms. They are typically referred to me by a women’s health physician, such as an obstetrician, a gynecologist, or a urogynecologist. Midwives and doulas also send women my way. And sometimes I’m already seeing women in my clinic for something else when they mention that their shoulder is beginning to hurt or that they’re noticing limitations in their functional tasks.

Almost all of the clients I have seen with frozen shoulder are also experiencing perimenopausal or menopausal symptoms. The correlation has always intrigued me and is not very well researched. Symptoms are so individual that it’s been difficult to get a good sample and conduct a quality study. So much of what we know about this condition is what it is not. Frozen shoulder is almost a diagnosis of exclusion—meaning that it is diagnosed after many other conditions are ruled out.

Q

How long does it last?

A

Frozen shoulder can last for years, and it typically goes through three phases. The first phase starts with progressive pain and range-of-motion limitations (i.e., “freezing”). In the second phase, there is less pain but continued stiffness. Finally, in the last stage, we see increased pain-free range of motion as the shoulder begins to “thaw.” While each phase can last for months, the way frozen shoulder progresses is different for each individual.

Q

What kind of physical therapy is best for frozen shoulder?

A

Treatment is completely individualized. We focus on each patient’s range of motion, limitations, and pain triggers. The goal is to gain as much pain-free range of motion as possible and maintain strength in the muscles that support the shoulder girdle. Looking at the entire body is key so that we ensure alignment, movement patterns, and breathing are all functioning as efficiently as possible. I find that supported range-of-motion exercises work very well for my patients. Using props, such as balls or towels, can be helpful, as well as using the opposite arm for support. These exercises are also simple to implement at home, which makes them easier for patients to do consistently. Patients advance to a range that they can tolerate and hopefully continue to improve as time goes on.

Soothing Shoulder Techniques

These basic exercises are designed to support and enhance shoulder mobility. They are all meant to be done in a pain-free range of motion. Before starting any physical therapy plan, consult your doctor.

  1. Alignment: For starters, focus on your body’s alignment to engage and support your core and shoulder girdle. You want your rib cage stacked directly over your pelvis. Stand with your weight evenly distributed between both feet and equally on the balls and heels of the feet. Do not lock your knees. To get a feel for your body’s ideal posture, bend your elbows to ninety degrees at either side of your body and open your chest slightly. (It looks like a lowercase t.) Notice where your shoulder blades rest and how this feels. Come back to this exercise any time you need to reset your posture.
  2. Diaphragmatic Breathing: Breathing into your lower rib cage, as opposed to up into the shoulders and neck, is key to decreasing tightness in the shoulders. Practice daily for five minutes in a comfortable position. Inhale through the nose, expand your rib cage, and exhale through the mouth as your chest recoils back in. Keep your neck and shoulders relaxed.
  3. Thoracic Spine Mobilization: Grab a foam roller and place it perpendicular to your spine, on the mat. Lie back and rest your bra line on the roller. Bend your knees and lift your hips so your butt is hovering above the mat. Cradle your head in your hands; you can either open your elbows up to the side or keep them up depending on your comfort level. Roll back and forth on the foam roller about ten to fifteen times, breathing slowly.

Q

Are there other forms of therapy that help?

A

Absolutely! I am a big supporter of other healing modalities and will often refer my patients to acupuncturists for pain and overall well-being. I also recommend naturopaths for working on hormonal balance. If a patient’s symptoms are not improving or are worsening after physical therapy and other holistic modalities, I recommend visiting an orthopedist for other treatment options.

Allison Oswald, P.T., D.P.T., W.C.S., is a physical therapist and the founder of Plumb Line Pilates in Los Angeles. She received her doctorate in physical therapy from Mount Saint Mary’s University. Oswald takes a personalized and holistic approach to women’s wellness, integrating different modalities, such as Pilates, manual techniques, and visceral mobilizations, movement education and more. She specializes in treating women who are pre-, mid-, or post-pregnancy or experiencing pelvic pain, incontinence, or frozen shoulder, among other conditions.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.

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