Shoulders are tricky complexes with lots of moving parts. It allows the shoulder to be so mobile. The movement depends on motion through the shoulder blade, the upper arm bone (the humerus), the collar bone, rib movement, upper back vertebrae movement. One thing that I have found to be constant clinically, is the position of the complex. It was once declared that many of us are fixed in a Flexion Dysfunction. The front of our hips are shortened, our heads are being pulled forward and our shoulders are being pulled inward. As the shoulders are pulled inward, the end range of motion is reached prematurely in all planes of motion. If the limitations of motion exist for long enough, the brain begins to assume that this is the new normal. If we try to push the shoulder too far, the brain will assume that we are in danger of going too far and produce muscle guarding around the shoulder to stop it from going further. It also will produce a pain response limiting us moving further as well.
Frozen shoulder is also called Adhesive Capsulitis. This means that deep in the joint, the ligament/capsule has adhered and shortened, also contributing to the limitation of movement. There are all sorts of receptors in the ligament capsule that will also send premature signals to the brain that the end range has occurred (when in fact, the shoulder is only at a portion of it’s motion). This also contributes to premature muscle guarding and pain on movement.
It has been said that frozen shoulder can exist for 6-12 months and maybe more. In my experience, this time frame can be reduced significantly if, as practitioners, be are slow, deliberate and gentle with our approach. Think of the whole system including the mobility of the ribs, the movement of the shoulder blade over the ribs, the movement of the collar bone. Most importantly we need to involve the brain in our attempts to convince it that it is safe to re-establish full range of motion again. We need to be good listeners as well as traditional orthopedic practitioners. Everyone presents differently so we can’t apply cookie cutter approaches.
It’s so important to involve the client as much as possible. Let them understand the mechanics of the shoulder and where the deficits are. Their success will be 50% of what the practitioner does and 50% what they do. If they understand what is happening and why they are doing what they are doing, success will come much more quickly.