Wednesday, June 27, 2012
What you do with your shoulder on a daily basis is important both for managing pain and increasing the rate of recovery. There are simple things you can think about as you go about your daily life to make the ordeal of your frozen shoulder more bearable.
The instinct we have when something is hurting is not to use the painful area. Whereas this may be appropriate for other problems, such as a fracture or ligament sprain, it is not so for a “Frozen shoulder”.
Classically the frozen shoulder patient we see comes in to the clinic holding the arm in a protective posture. They tend to hunch the affected shoulder forward, bend the arm at the elbow, and cradle the arm close to the body even supporting it with the other arm. This position is very important to avoid as it only compounds the problem. In this position the biceps muscle is contracted, stressing the tendon and causing further shortening.
It is far better to try to keep the arm straight allowing the arm to hang along the side of your body. This position stretches the biceps tendon; the weight of the arm also slightly separates the shoulder joint which will allow fluid back into the shoulder capsule.
You can do most activities but avoid those that you know will cause that sharp catching pain. Use the arm where possible and don’t be too afraid, just try to avoid tweaking the tendon, you will not make it worse.
Walking through a busy supermarket or going on the Tube at rush hour may not sound much to most people, but for somebody with a frozen shoulder it can be a very stressful experience. The fear of a fellow shopper or passenger accidentally bumping into the shoulder is constantly present. In that type of scenario it may be difficult not to remain tense and protective towards the shoulder. However, whenever possible it is important to allow the shoulder to relax and straighten the arm when walking. The tension caused by fear of pain will only compound the problems.
This is what to do when walking:
- Relax the shoulder down
- Straighten the arm
- “Let it swing”, swinging the arm along the side of your body like you would under “normal”
circumstances. It may feel odd initially but if you persevere, you will soon get used to it.
- Breathe and relax
Swinging the arm during a very acute phase may be painful, so achieving the first two points is enough. This will help to separate the shoulder joint allowing fluid back into the shoulder capsule. Also gently moving the arm will improve blood flow into the shoulder area and thereby ultimately improve healing and reduce pain.
Night pain and sleeplessness are some of the worst aspects of the frozen shoulder, especially in the early days. At first, you will probably not be able to tolerate pressure on your affected side. As your symptoms ease, however, you will find you can gradually ease into some type of position. The degree of night pain is directly proportionate to the amount of inflammation within the joint.
Some comfort and relief may be obtained by:
- Lying on your back, with a pillow lengthways under the affected arm(s) and shoulders, supporting them
- Lying on the good side with a pillow or towel over your waist and under the arm
- Try to avoid sleeping with the arm above your head. This inhibits shoulder tissue repair,
which manly occurs manly at night
- Lying on your back with a good neck pillow