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The big freeze eases

Frozen Shoulder? Pressure and stretching may be the Answer

The Daily Telegraph 13th October 1998 - Christine Doyle

HORRENDOUS is the adjective most used by sufferers to describe the pain of a 'Frozen Shoulder'. The condition starts simply enough: an unsettling ache in the joint that suggests you might have slept awkwardly. Then whoomph: you cannot lift your arm.
Anne Williams, 38, recalls: 'I reached out for something on a supermarket shelf - and gasped. There was an excruciating, burning pain deep inside the joint. It lasted for at least a minute. After that I found it increasingly difficult to lift my arm without pain. It seemed to be all over the shoulder joint and the area covered by a short sleeve.' It has taken 2 years for the condition to clear.

Roger Davis, 55, thought he had pulled a muscle and that he would be fine with painkillers and rest. But this was not the case. 'The pain was horrendous, and grew worse' he says. 'I had no strength and could not even lift a kettle. It affected both shoulders and the joints seemed frozen. Then I remembered that my Father-in-law once had physiotherapy for about 2 years for the same condition.'

Mr. Davis has been luckier: His condition 'thawed out' after early treatment by Simeon Niel-Asher, a registered Osteopath. For 2 years Mr. Niel-Asher has been pioneering a technique that he believes might dramatically speed up recovery. It involves pressure and the gradual stretching of deep soft tissues and tendons, and can be painful - but it only takes six sessions over a few months.

Such is his growing reputation that Mr. Niel-Asher recently set up The London Frozen Shoulder Clinic in Highgate, North London. In addition to a celebrity following - including Raquel Welch - his methods are attracting the attention of Rheumatologists and he has been invited to present his research to consultants at the University College Hospital in London.

Dr Helena Fitz-Clarence, a consultant Rheumatologist at UCH says 'I welcome any approach that might lead to faster alleviation of this painful condition.'
People become more susceptible to Frozen Shoulder after the age of 40. It is thought to affect 2% of the population; GP's see about 1 case per week and the cost to the NHS in physiotherapy and drugs is huge.

Sometimes, it follows an injury or repetitive exercise. Mr. Davies, for example, lurched down his loft ladder after searching for Christmas lights. But, usually the pain and stiffness arrive out of the blue. In most cases, only one shoulder is affected, but both can seize up and sometimes, as one recovers, the condition can spread to the other.

One medical name for the condition is adhesive capsulitis. All joints are surrounded by a capsule containing synovial fluid. When an arm is lifted above the head, this capsule is at full stretch: when lowered, the capsule sinks down into a loose pouch in the armpit.
Apparently, at the start of the freezing process, inflamed cells migrate into the capsule and cause parts of the 'sack' to stick together. As the shoulder becomes progressively stuck, muscle wasting, scarring and degeneration increase the pain and stiffness. Some people have less than 10-15% of movement in any direction. Specialists stress the importance of seeking help early, as mobility is impaired if the condition is leftuntreated for too long. However, today's treatments are mainly palliative.

'Frozen Shoulder is very difficult to treat and the outcome is unpredictable, ' says Dr Fitz-Clarence. 'It can be devastating psychologically and physically for patients, who might have to take long periods off work and who fear they will be handicapped for the rest of their life.'

Painkillers, steroid injection and physiotherapy are among the gentler treatments. If these fail, manipulation under anaesthetic to break up the adhesions might be advised, but some studies have shown that this traumatic approach can cause complications such as fractures, increased inflammation and dislocation. As a drastic last resort, surgeons sometimes recommend replacing the entire shoulder joint.

Anne Williams says that, in her case, 'painkillers and anti-inflammatories had little or no effect. steroid injections worked for a short time only. Then I was given steroids by mouth; I had 2 courses. They eased the pain temporarily, but were not a cure, and a specialist was horrified of my relying on them, because of possible side effects. My shoulder eventually thawed by itself….but it seemed a very long and painful time.'

In contrast Mr. Davies says, 'after six sessions over four months with Mr. Niel-Asher, I am largely defrosted. I still get small twinges, but I can drive and turn a steering wheel without pain and have not had to take pain killers for the past 6 weeks.'

Jack Kagan, whose shoulder seized up six years ago, when he was 62, was told recently that an operation was the next step. But X-rays and scans have now suggested an improvement and his Orthopaedic consultant has advised him to 'keep seeing that Osteopath.' Mr Kagan believes that his treatment has stimulated natural healing.
'I can't believe how well I feel. Life had been quite horrible and most nights I could not sleep. The pain seemed worse in cold weather. But now I can move my arm and am almost pain free. I can even reach into my back pocket to get my wallet out.'

Mr. Niel-Asher's treatment falls into 3 phases, during which all of the tissues of the shoulder joint are worked on gradually. The first phase involves deep pressure on what the Osteopath calls muscle 'trigger spots'. 'This takes 2 or 3 sessions and can be quite painful, but it is interspersed with more gentle stretching and mobilization. A detailed preliminary study of 14 patients suggests between a 10% and 30% improvement during this phase.

The aim of the next phase is to encourage increased flexibility of the biceps tendon, triceps muscle and the joint itself; this usually takes another 2 treatments. 'At the end of these sessions I would expect a 30-60% improvement, especially in range of movement.'
The final phase involves more gentle treatment: patients follow a programme of exercises using elasticised rep-bands™. By this time, Mr Niel-Asher expects 90% recovery; although it may take time to return to full and vigorous activity when shoulder muscles have not been used for months.

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