Brian Schiff’s Blog

I am sure you or someone you know has suffered with or been affected by a frozen shoulder at some point.  Known in the medical world as adhesive capsulitis, this condition can be downright miserable for folks.

Who gets it?  It is often brought on after injury or a period of immobilization (e.g. arm in a sling after surgery or dislocation).  However, it also comes on insidiously too.  Statistics indicate it more commonly affects women and those with diabetes are at more risk for getting it in both arms.

Some feel it may ultimately be an autoimmune reaction that triggers it.  So, what is it exactly?  Well, in plain terms your shoulder joint has folds of connective tissue we refer to as a joint capsule.  In frozen shoulder cases, the capsule becomes shortened and inflamed making arm movement painful and limited at best. 

There are three distinct phases:

1. Freezing
2. Frozen
3. Thawing

These phases may progress over the course of months or in some cases last as long as 2-3 years to resolve.  In time, the condition will correct itself. 

Symptoms may include:

• Stiffness
• Difficulty sleeping
• Pain along the shoulder or down into the arm
• Certain movements more restricted than others
• Progressive worsening of motion and decreasing pain

No one wants to suffer with this for any prolonged period of time.  So, how do you accelerate the healing process?  You must move the shoulder daily within your available range of motion.  But doing the right exercise is critical.

In addition, I believe having an experienced therapist do joint mobilizations is critical in loosening up the capsule provided it is done within pain tolerance of the patient and followed up by appropriate stretching.  For those without insurance or looking to avoid the grueling stretching some docs and PT’s advocate, I recommend looking at my home therapy guide.

Want more info?  Visit www.frozenshouldertherapy.com for success stories and more details on my proven home remedy.  You can also click on the image below:

In addition, I think you can complement rehab with a tool like the Rotater to help restore mobility.  I have trialed this product myself and I really like the ease of use and control the patient has with the stretching intensity.  For more details, click on the image below:

Whether you are lay person, trainer or therapist reading this blog, I try to keep you up to date on science, training and my interpretation/application of exercise based upon the research and practical application in my practice.

Today, I want to touch on an article just published in the Journal of American Sports Medicine.  It was based on a  study conducted by Tim Tyler et al in New York.  They set out to determine what effect decreasing GIRD (aka glenohumeral internal rotation deficit) and posterior shoulder tightness had on reducing symptoms associated with internal shoulder impingement.

For those unfamiliar with GIRD, it basically looks at total shoulder motion side to side but focuses on deficits in internal rotation.  Throwers often lack internal rotation on their dominant arms and exhibit excessive external range of motion for cocking and ball velocity.  We tend to call this acquired laxity.  Pitchers tend to have higher GIRD as well.  Keep in mind total shoulder motion is critical as well.  So, you cannot assume one will have problems just becasue there is decreased internal rotation.

You may see similar GIRD and psterior shoulder tightness patterns in other overhead athletes (swimmers, tennis players, volleyball players, etc.)  This particular study looked at the effect on 11 men and 11 women who received manual mobilization by a PT combined with ER ROM, posterior shoulder stretches and scapular strengthening.

They studied all 22 subjects (range of symptoms from 1 to 24 months) and then compared data on the patients with and without symptom resolution.  In effect the study revealed that posterior shoulder tightness was significantly improved in 12 of the subjects that had complete resolution of symptoms (more so than in the 10 who did not).  In addition, changes in GIRD did not seek to impact the results.

What is the take away from this study?  In a nutshell, if you have symptoms related to internal impingement, you should be doing posterior shoulder stretches.  So, what are the best ones to do?  There was a recent article in the NSCA Strength and Conditioning Journal (December 2009) that laid out some effective stretches (two of which I will show you in the video).  Also, you should note that this pattern of tightness is common in weight lifters.

I have included a short video clip with 3 effective stretches that easily can be done at home.  The stretches are as follows:

1. Standing cross chest shoulder pull (across the chest) – this is a basic stretch I start most clients with who are experiencing pain.  The drawback is that the scapula is not stabilized (or fixed) so you do not isolate the posterior shoulder effectively.  However, it tends to be more comfortable for many early on and you will still get some benefit.  When you are ready, it can be done against a wall to fix the scapula.
2. Side lying cross chest shoulder pull – this would be equivalent to doing stretch number 1 against a wall.  The floor acts to stabilize the scapula and then you pull the arm up and hold.
3. The sleeper stretch – go easy with this one as pushing too hard may actually increase inflammation in my experience.  You may also vary the angle of the upper arm to hit different portions of the joint capsule.  For example, you may elect to stretch at 90, 70 and 45 degrees.

I advocate holding each stretch for 20-30 seconds and repeating 2-3 times daily.  If you are in therapy, the stretching should be done following the joint mobilization by your therapist.   Click the video below to see the stretches.