The Coldest of Shoulders
Understanding and Not Understanding Adhesive Capsulitis
Marilyn first noticed the right shoulder pain when she was sleeping on her right side. Over the next month, the pain became more frequent and more intense. Her shoulder ached in the morning and after any repetitive activity. Marilyn tried medications and ice, but the pain persisted. After eight weeks, the pain decreased, but her shoulder movement had become restricted. Her shoulder became so tight that she developed difficulty with activities of daily living such as fixing her hair, dressing, and bathing. Marilyn had developed a “frozen shoulder” and the frustrating thing was that she had no idea why it had happened.
No one fully understands why a frozen shoulder develops. For some reason, the envelope of tissue that surrounds the glenohumeral joint–the joint capsule, shortens and develops thickened adhesions or scar tissue. The medical term is “Adhesive Capsulitis”. This tissue restriction limits the ability of the humeral head (upper arm bone) to rotate and glide properly so your shoulder becomes tight and painful.
Most of the time, a frozen shoulder occurs with no associated injury or activity. Frozen shoulder most commonly affects patients between the ages of 40 and 60 years old. It is far more common in women than men. Individuals with diabetes are at far greater risk. If you have undergone a surgery or sustained a trauma to the shoulder, you can develop a frozen shoulder. This is especially true if you have held the joint immobile for a period of time. Several studies have linked Parkinson’s disease, thyroid problems, and heart disease to a greater incidence of frozen shoulder. Patients that develop a frozen shoulder are more prone to getting it in the opposite shoulder. Despite all of this knowledge, we continue to see many frozen shoulder patients that have none of these predisposing factors.
I would add another condition to the commonly mentioned predisposing risk factors for frozen shoulder. In my career as a physical therapist, it has been a rarity to find a frozen shoulder patient who was strong. From grip strength in the hand to the muscles that hold the shoulder blade on the rib cage, these patients are usually weaker than their same age and sex peers. The strength in the unaffected arm is often as limited as the arm with the frozen shoulder. My belief is that the most common risk factor for developing a frozen shoulder is upper body weakness. The glenohumeral joint is a fairly unstable joint that relies on the integrity of the muscles to kept it free from trauma. If the shoulder muscles are unable to properly control the joint, then excessive stress is transmitted to the joint capsule and an inflammatory response ensues that scars and tightens the capsule.
Physical therapy for a frozen shoulder consists of manual therapy to stretch out the shortened joint capsule and a program of exercise to restores shoulder range of motion, coordination, and strength. Most of the time, we get the patient when the shoulder is at its tightest point and recovery takes six to ten weeks. As with so many conditions, the patients that get to therapy earlier or before the shoulder is fully frozen do better with therapy.
In many ways, Marilyn is the typical frozen shoulder patient. She is the correct, age, sex, and fitness level. Further medical work up revealed that she was prediabetic and in need of some ongoing medical attention. Marilyn was a model physical therapy patient and her shoulder function was restored with six weeks of physical therapy.
Michael S. O’Hara, PT, OCS, CSCS
Keep your shoulders and spine happy and strong by following Mike O’Hara’s advice in “Pushing Up Performance”. Video explanation and performance of pushups and their variations included. Jeff Tirrell discusses the proper performance of pull ups in his article. “Movement You Should Master”. Is your mobility limited? Try massage sticks or foam rollers with the information provided in “Pain, Pressure, and Pliability”.
Train your hip adductors and bulletproof your legs by following the advice in Mike O’Hara’s article Adductors Galore. Video demonstration and explanation included. Mobilize your upper body by foam rolling. In Foam Roll T W I, Mike explains the importance of adding foam rolling to your exercise program.
Advice From The Experts At Fenton Fitness/Fenton Physical Therapy
Tara Parker-Pope wrote a great article in the October 17, 2016 edition of The New York Times entitled “The 8 Health Habits Experts Say You Need in Your 20s.” While I agree with some of these recommendations, we at Fenton Fitness and Fenton Physical Therapy have some suggestions of our own.
#1—Don’t do dumb stuff
The cumulative injuries you suffer in your twenties echo through a lifetime. My long and busy career as a physical therapist has taught me that this is true. The 20 year old with a knee arthroscopy returns as a 32 year old with a ligament reconstruction and then again as a 50 year old knee replacement patient. Surgery and rehab can only do so much. Resist participation in the “hold my beer” events that inevitably present themselves in the social lives of 20 year olds. Think twice before you enter that Gladiator Challenge Race, swing from that rope suspended over a river, or text and drive. Your sixty-year old self will thank you.
-Mike O’Hara, Physical Therapist for the last 32 years. Fitness coach and board certified orthopedic specialist
To read the article, click on the link below:
Listen to Mike’s advice: https://youtu.be/8JCtFzj539M
That Office Chair Can Be Keeping You From Your Fat Loss Goal
For many years, I have been preaching about the negative impact prolonged sitting has on our metabolic health and musculoskeletal system. All the research has demonstrated that adaptive shortening of connective tissues and weakening of muscles occurs with as little as two days of prolonged sitting. New studies of daily movement patterns demonstrate that sitting has an even more severe impact on our ability to metabolize body fat. Take the time to read the article “Keep It Moving” by Gretchen Reynolds in the December 9, 2016 issue of the New York Times.
Once again, the answer is to get up off the Aeron, Barcalounger, La-Z-Boy, or setee and move around. Every twenty minutes, stand upright and defy gravity with some good old fashioned ambulation. Do not exercise in a seated position–train in a standing position. More and more we are learning that consistent daily movement is an essential element of human health.
Read the NY Times article here: http://www.nytimes.com/2016/12/09/well/move/keep-it-moving.html
Michael S. O’Hara, PT, OCS, CSCS
Fitness training for those of us past 40 years of age is more complicated. Physical performance and recovery capacity are dramatically different. If you need proof, look for the forty year olds in the NBA or NFL. The good news is that with proper planning, consistent performance, and the wisdom that comes with age, we can stay fit and active for a lifetime. I have compiled a collection of tips for the forty plus fitness client.
As we age, we tend to move slower. Unfortunately, life happens at faster speeds. Those of us past forty should perform fitness activities that improve quickness and enhance the control of deceleration forces. I am sorry, but yoga and Pilates are not fast enough to be beneficial. You do not have to perform jump squats with a barbell on your back. Basic medicine ball throws and agility drills will work wonders.
Mr. V had pain in his lower back and right hip. The problem had been present for over a year and he had been diagnosed with spinal stenosis. He was sent for physical therapy by his family physician because he was having difficulty climbing the stairs and walking in his home. Mr. V was 78 years old and lived with his wife Miriam. Miriam reported that her husband had mild dementia and had fallen three times over the last month. Mr. V stated that he often felt dizzy when he got out of bed, but he was not sure why the falls happened. Miriam stated that they did not bother to tell the doctors about these falls.