Tag Archives: shoulder pain

Frozen Shoulder/Adhesive Capsulitis

By Carla Cranbury, PT

What is it?

Frozen shoulder, also called adhesive capsulitis, is a gradual onset shoulder condition characterized by pain and limited range of motion. This is caused by inflammation and tightening of the shoulder capsule. Typical initial symptoms are pain midway between the shoulder and the elbow and difficulty reaching behind the back. Most women will report that they have difficulty doing up their bra and men difficulty putting on their belt.

Why does it happen?

Limited research has been able to discern one certain cause of frozen shoulder – in short, we don’t know. We do know that it is most common in middle aged women (aged 40-65) and people with diabetes. It also is more likely to occur after a virus, a lingering shoulder injury or after shoulder or upper limb surgery.

How long does it take?

Frozen shoulder goes through three main stages, each of which can take weeks to months:

  • Freezing – pain is noticed and range of motion becomes progressively limited
  • Frozen – pain is reduced, but range of motion is further restricted
  • Thawing – pain is reduced and range of motion gradually returns

Can physio help?

Physiotherapy cannot speed up the course of the condition – everyone has to go through each of the three stages in order to recover. The total process of frozen shoulder can take one to two years to resolve

What physio can do is help you retain function while going through frozen shoulder, decrease some pain, and ensure a full recovery. Maintaining mobility through the process is important and is where physiotherapy can help the most. Physio will also help prevent other injuries that can be caused by compensating for the frozen shoulder – this is especially significant as it is common for the other shoulder to get the same condition.

Your physiotherapist will give you exercises to maintain as much movement as possible and instruct you on how to perform them properly to ensure you are not compensating for the limited range of motion. Hands on manual therapy will help stretch out the capsule to make the exercises easier to perform. Modalities such as ice, heat, TENS, and acupuncture can also be used to decrease pain.

Though frozen shoulder can be a lengthy and frustrating process, the right care can make it more manageable and prevent any further complications.

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Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4:193–6.[PubMed]
Greene WB. Essentials of musculoskeletal care. 2. Rosemont, IL: American Academy of Orthopedic Surgeons; 2001
Pal B, Anderson J, Dick WC, Griffiths ID. Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin dependent diabetes mellitus. Br J Rheumatol. 1986;25:147–51. doi: 10.1093/rheumatology/25.2.147. [PubMed] [Cross Ref]
Bridgman JF. Periarthrits of the shoulder in diabetes mellitus. Ann Rheum Dis. 1972;74:738–46.
Hazleman BL. Frozen shoulder. In: Rockwood CA Jr, Matsen FA III, editors. The shoulder. 2. WB Saunders: Philadelphia; 1990.
Harryman DT, Lazurus MD, Rozencwaig R. The stiff shoulder. In: Rockwood Cam Matsen FA, Wirth MA, Lippitt SB, editors. The shoulder. 3. Saunders: Philadephia; 2004.
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Snow Shoveling Safety

Snow.jpegIf you are like us, you have probably spent a good chunk of time clearing off your car, driveway, and sidewalks these past few weeks. If you are not used to this kind of strenuous activity, you also might have felt tired and sore once you were finished. At BodyTech Physiotherapy we have already seen an influx of people with low back pain due to shoveling snow. As a result of this, we have compiled a list of safety tips to keep you moving injury-free until spring rolls around.

  1. Consider hiring snow removal services if you have lower back issues or heart problems, including a previous heart attack, a known cardiac disease, high blood pressure, and/or high cholesterol.
    • Snow shoveling can be as strenuous on your body as lifting weights – a sudden increase in physical activity levels, especially without proper form, can predispose you to injury.
    • Studies have shown that exercise using your arms (like shoveling) significantly increases blood pressure levels compared to leg exercise (like walking), putting you at a higher risk of a heart attack.
  2. OLYMPUS DIGITAL CAMERAUse the proper tools
    • Sturdy, non-slip winter boots and salting are essential to prevent slips and falls.
    • An ergonomic shovel can help reduce excessive amounts of forward bending, which could otherwise put a lot of strain on your lower back.
  3. Use proper form
    • Stand with your legs hip width apart
    • Hold the shovel close to your body
    • Space your hands apart to increase leverage
    • Bend from your knees, not your back
    • Engage your core/tighten your stomach while lifting
    • Avoid twisting while lifting
    • Walk to dump your snow instead of throwing it
    • Pushing is easier than lifting
  4. Warm up
    • Cold, stiff muscles are more prone to injury. Get your body warmed up and ready to go by marching on the spot, doing some small squats, and rotating your upper body from side to side.
  5. Shovel early and often
    • Freshly fallen snow is lighter and fluffier than snow that has been sitting for a few hours, which makes moving it much less stressful on your body.
  6. Slow and steady wins the race
    • Though it may be tempting to power through and get your shoveling done as fast as possible, work at a slow and steady rate while focusing on proper form to decrease your risk of injury.
    • If there is a large amount of snow, work in layers of 2-3 inches instead of trying to lift it all at once.
  7. Take breaks and hydrate!
    • We recommend shoveling for 15 minutes followed by a 15 minute break
    • Remember to drink water or other non-alcoholic beverages during your break – shoveling is hard work!

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It’s all in the shoulder blade

Shoulder Diagram

Shoulder injuries are among some of the most common injuries that occur; luckily, the shoulder joint is an area that we have extensive knowledge in treating at BodyTech Physiotherapy. The shoulder is one of the most complex joints in the body because of its unique anatomy, structure and function. Due to the complexity of the joint, there are multiple factors that contribute to and influence the function of the shoulder. In most cases the rotator cuff muscles are the source of pain, but they are not always the cause of the problem.

The key to treating this difficult joint is a comprehensive assessment and thorough understanding of how the shoulder functions. An essential concept in treating the shoulder is building a good foundation for the shoulder muscles to work. This requires focusing on the shoulder blade because it provides a stable base for the shoulder joint. The rotator cuff muscles attach to the shoulder blade, therefore it is important for the shoulder blade to function properly in order to prevent injury to the rotator cuff. Posture and strengthening for both mobility and stability of the shoulder and shoulder blade are key concepts in rehabilitation.

At BodyTech Physiotherapy we use a comprehensive approach for both the assessment and treatment of a shoulder problem. Our assessment will focus on identifying the cause of the shoulder injury as well as the contributing factors that led to the injury. Our clinical experience and advanced physiotherapy training ensures that the entire shoulder problem is treated, not just the symptoms. In addition to correcting posture and increasing strength, we work on normalizing the pattern and coordinating the muscles involved in shoulder mobility, thus helping to prevent a re-occurrence of the shoulder injury.

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