Practitioner Registration   |   Member Login   |    Search for a Therapist  |    News   |    Español

Frozen Shoulder affects 3-5% of the general population - What’s it all about?

What is Frozen Shoulder? (Adhesive Capsulitis)

Frozen Shoulder Syndrome (FSS) is a painful and debilitating condition. It is a clinical diagnosis and is only very rarely the result of an underlying illness or pathology. Frozen Shoulder is actually fairly common, affecting as many as 2-5% of the population. Frozen shoulder is somewhat of a medical enigma, for example, once it is cured it (almost) never comes back again on the same side.

One of the main problems is that frozen shoulder syndrome is often misdiagnosed, To keep things simple most experts define it as a "a stiff shoulder with less than 50% of normal range of active and passive motion in any direction".

The important point here is that you can’t lift the shoulder and neither can anyone else lift it for you – it is completely stiff and locked. Other conditions can cause the shoulder to stiffen but typically, only in certain directions of movement.


What does it feel like?

This depends on what phase you are in. The initial phase of Frozen Shoulder is characterized by an exquisite sharp catching spasm sometimes for no reason at all. Another characteristic of the early phase is night pain. The shoulder can ache and wake you up at night, disturbing your sleep (and your partners) and depleting your energy. You know you are in phase II when your night pain has gone away. Another key feature of all phases of a frozen shoulder is the loss of shoulder and arm movement. The stiffness can be very severe, especially when reaching behind your back or above your head. This can make the simplest of tasks, like brushing your hair, agonizingly difficult. Stiffness lasts through all three phases of frozen shoulder syndrome but starts to ease from phase II onwards.



Online Symptom Test Letters From Patients

What happens inside a frozen shoulder?

The shoulder ball and socket joint is surrounded by a fluid filled bag with 35-70ml of synovial fluid which helps to lubricate and nourish the joint; with Frozen Shoulder the capsule thickens and becomes tight and the fluid levels drop to an average of 5-10ml. Stiff bands of tissue (referred to as adhesions) may start to develop in and around the capsule. This is due to inflammation. The hallmark sign of a “frozen shoulder” is being unable to move your shoulder - either on your own or with the help of someone else.



Shoulder Anatomy

Inflammation

In Frozen Shoulder the lax capsular sack becomes sticky and can sometimes (though not always) form adhesions; hence the name of the condition. The stickiness is brought on through inflammation; research has pinpointed the source of this is in the rotator interval. This inflammation often starts in the groove behind the biceps tendon. This can occur after a small injury or can even be brought about by something simple like reaching for the back seat of the car. Once established this inflammation spreads into other shoulder soft-tissues and can cause swelling in other shoulder sacks (bursae). This happens because the muscles, ligaments and bursae within the shoulder are very much interconnected.


inflamed joint capsule in frozen shoulder


Stiffness

The stiffness is due to an 'over-reaction' of the body to the inflammation (within the rotator interval/biceps groove). The body then seems to 'switch off' muscles in a coordinated sequence; this sequence is the same for everyone and we call it the 'capsular pattern'.

Often in less than a week, the arm movements start to diminish, and within a few weeks the arm literally becomes “frozen” and for many, cannot be raised more than 40° in any direction. The muscles of the rotator cuff, which support, position and help to move the shoulder become weak and start slowly to waste away, leaving the arm to hang stiff, painful and immobile.


Causes of Frozen Shoulder

Despite the fact that Dr. Duplay first described the syndrome in the late 19th Century, the causes of frozen shoulder (or Adhesive Capsulitis) are poorly understood.

Frozen Shoulder often appears for no apparent reason (primary) but can stem from an injury to the shoulder (secondary). In our experience it tends to start with a 'tweak' in the shoulder that doesn't seem to resolve. This 'tweak' seems to occur in the region of the long head of the biceps - this is the cause of that horrible sharp “catching” pain that Frozen Shoulder sufferers will be familiar with.


The Lowdown

According to the American Academy of Orthopedic Surgeons (AAOS) - “More than 90% of patients improve with relatively simple treatments to control pain and restore motion”; in our experience, this is closer to 95%.

Over the past 15 years NAT therapists have treated literally thousands of frozen shoulder patients from all over the world. They know what you are going through, the pain, the sleepless nights, the stiffness, the inability to do even the simplest tasks. Worst of all, they know you look “normal” to the world outside and yet you are suffering within. The good news is that it will get better and there are many things you can do to speed it up.


What are your Options

Frozen Shoulder can last up to 30 months if left untreated, but the overwhelming majority of cases can be effectively treated with conservative (hands-on) treatment.

The absolute best thing to do if you feel you have a frozen shoulder is to seek advice from a qualified manual therapist or practitioner skilled in assessing and treating the condition.

Traditional Treatments Frozen Shoulder & NAT Manual Therapy Search for a Therapist


Manual therapy and NAT

Most hands-on therapists will have a level of skill and training in treating frozen shoulders. Therapists who practice NAT will have an extra level of training with identifying and treating frozen shoulders. NAT is 100% effective for 90% of patients. NAT is fast and effective and reduces treatment time from months to weeks. You can find out more about NAT here. Manual therapists will guide you by devising an exercise program to help you in your specific phase.

Manual therapists include: Osteopaths, Chiropractors, Physical therapists, licensed massage therapists, acupuncturists and a range of other approaches.


How long does Frozen Shoulder Last?

We generally observe four distinct phases, which - without treatment - will last an average period of 30 months. In most cases, treatment with the Niel-Asher Technique will speed up recovery by about 10 times.



Without Treatment Niel-Asher Technique™
Pre-Freezing (0-4 weeks) 1-5 Sessions
Freezing (1-8 months) 7-13 Sessions
Frozen (9-16 months) 5-8 Sessions
Thawing (12-40 months) 4-7 Sessions


Tell me what happens with ‘hands-on therapy’

Your therapist will start by taking a comprehensive medical history. They will ask you specific questions about restricted movement, pain (especially night pain) and certain daily activities. They will ask you about your general health and past medical history. This will allow them to make a working diagnosis and eliminate any underlying complications.

Next, your therapist will perform an examination of your shoulder. Your range of motion will be gently assessed in various ranges. Your therapist knows you are in pain so they will try to be as sensitive with you as possible. Your therapist may then perform specific tests to help them narrow down a diagnosis.

If you do have a frozen shoulder, your history and examination results will help you therapist define the type of frozen shoulder you have and the phase you are in. This will allow them to tell you how long they think it will take to treat. If you don’t have a frozen shoulder, the therapist will tell you what they think is happening and what further tests may be required.



Traditional Treatments Massage Therapy Frozen Shoulder & NAT Manual Therapy Bowen Therapy Search for a Therapist

Frozen Shoulder Facts


Frozen Shoulder and Diabetes

Frozen shoulder is much more common in diabetics; about 10-20% are affected (compared to 2-5% of the general population). It is not clear why this should be the case but experimental studies have shown that the soft tissues of the shoulder are stiffer than normal. All muscle fibres are ‘packed’ within other tissue called parenchyma. This packing substance is made of collagen. Collagen helps to make up the elastic component of the skin and muscles (as we get older our skin wrinkles as a result of decreased collagen production). US doctors NA Friedman and MM LaBan published a paper in 1989 in which they put forward two theories as to why frozen shoulder is more common in those suffering with diabetes.

Diabetes and Frozen Shoulder - Theory 1

Because Type I diabetics are unable to regulate their blood sugar levels naturally, there are many times during the day that the sugar levels may be high, which can lead to an accumulation of sugar-alcohol in the tissues. This sugar-alcohol is called sorbitol and it accumulates in the ‘ground substance’ of the connective tissues (collagen) where, because it has a higher osmotic pressure, it attracts water, making the tissues stiffer.

Diabetes and Frozen Shoulder - Theory 2

An alternative explanation has been put forward, whereby the properties of the collagen itself are attenuated. It has been suggested that the collagen becomes embedded with excess sugar called glycogen. This ‘glycosylation’ of collagen leads to more bonds and bridges being formed at a molecular level between collagen molecules, thus changing the internal structure of the collagen. This means that enzymes cannot efficiently replace normal collagen wear and tear, and the tissues get stiffer.

NAT Network Survey - Winter/Spring 2014

During the period March - July 2014, Niel Asher Healthcare interviewed 109 therapists who regularly use NAT as part of their treatment protocols and who have treated one or more diabetic frozen shoulder patient within the previous 12 months. As part of this study, the therapists (including osteopaths, physiotherapists, chiropractors, massage therapists, sports massage therapists) were questioned regarding the effectiveness of NAT when treating diabetics. 88% (or 96) interviewees agreed with the statement that "Diabetic Patients treated with NAT responded with significant reduction in pain and increased range of motion".



Frozen Shoulder & NAT Frozen Shoulder & Statins Living with a Frozen Shoulder Frozen Shoulder & NAT

Frozen Shoulder and Menopause

It’s a fact that more women are afflicted with frozen shoulder than men - and the majority of these women will contract frozen shoulder when they are undergoing menopause.

Here are some useful tips to help avoid “menopausal shoulder”:

We know it’s a cliche - but regular exercise could help you avoid a frozen shoulder. Find an exercise regime that works for you and which includes exercises specifically related to your shoulders. Long term lack of mobility is one of the major suspected causes of frozen shoulder syndrome. Please visit our shoulder exercise section for more information.

Always remember to stretch before exercise. You need to be sure that your body is warmed-up so that your shoulders can move more freely and easily. Visit our shoulder exercise page for more information.

Where possible, avoid strenuous activity of the shoulders during the time of the month. This is the time when your hormones are acting to loosen ligaments and thus make you more prone to injury.

It’s another cliche - but you’d be well advised to watch what you eat, especially as your diet relates directly to bone density and general health. Be sure to include plenty of fresh fruit and vegetables. Stick to low-fat milk and dairy products made with low fat milk; and try to limit the amount of red meat that you eat to a healthy minimum.

If you are currently suffering from a “menopausal” frozen shoulder, you should follow the general advice within this website. In particular, we recommend that you read the information regarding common treatments.



Frozen Shoulder & NAT Frozen Shoulder & Statins Living with a Frozen Shoulder Frozen Shoulder & NAT



NAT® Explained

Symptom Test

Exercise Videos

Home Healing


Download our FREE Guide to Frozen Shoulder