Frozen Shoulder

“Frozen shoulder” (F/S) describes a situation where so much pain is felt in the shoulder joint that the sufferer finds virtually any movement extremely painful and holds the arm as still as possible in the least painful position, which is often still quite painful.

The first thing to be aware of as a bodyworker is that a F/S, like all body problems, is not in any way a purely local phenomenon. The shoulder is not functioning separately from the rest of the body; as those of you who have taken our Advanced Tensegrity class or Patterns at WMTI are aware, the problem is not in the shoulder – the site of the pain is the symptom or effect of the problem.

Every frozen shoulder dynamic is unique, but there are aspects that will be, more than less, common.

Begin frozen shoulder work by putting the client in his or her most comfortable/least painful position. Pillows, body position, whatever it takes. Their least painful position may be sitting up, so you might be working in a massage chair. Or a kitchen chair – you never know.

The next steps are in the order I would follow, but they don’t have to be. Vary them according to how the client responds, seeking out the moves most acceptable to his/her body and proceeding from there.

My first exploration would be the opposite side of the neck to the frozen shoulder, focusing on the mid-neck. Much more than likely, there is severe hypertonicity centered there. I would combine that with occipiut/C1-2 on the same side as the F/S. I would look to get the hypertonicity to reduce somewhat – to any discernible degree. Combine pressure and movement to these areas simultaneously, play them off of each other, and, most importantly, follow the client’s tissue. It will always lead you to releases of hypertonicity.

Next I would look to the sacro-iliac joints, if the client’s body position allowed. I can find a way to work the SI joints from any position, really. Even if they are face up with pillows in the way, I should be able to hook my fingers into the SI joint cleft and mobilize a leg to get effective movement into the joint. My goal here is similar: improve movement in both joints to any discernible degree. I would also assess how balanced the movement is between the joints, looking of course to get them similar.

I would somewhere in here asses the action of the knees, ankles, and feet. If they are ‘players’ in the F/S dynamic, they will have functional issues – some type of hypo- or hyper- mobility. Address the situation.

Once I made progress on these fronts, I would almost certainly see how the shoulder responds to Floating Joint. Basically, if it responds and starts moving, I’d stick with that for a while. If it doesn’t, I know that the pattern is still too established in their structure and I’d go back to the above steps, maybe adding the rib cage, always looking for a way into the dynamic pattern behind the F/S. It will be there, I have to deconstruct it.

If you haven’t taken Floating Joint, Move the arm as slowly and gently as you can. If you are deconstructing the pattern behind the F/S, the shoulder’s range of motion will increase.

I would return often to the neck/occiput, as I feel it is the key. Float the head or move it slowly, working the myo-fascial structures, feel for joint movement. As the neck softens, so will the shoulder open. It probably has scar tissue/severe adhesions, and this work you would begin as the shoulder softens and gives you some access: any earlier would almost certainly be too painful for the client and only aggravate the situation. The arm itself probably only needs some thorough tune-up work.

I’d love to hear from you and what you think of this, and anything that is unclear please ask for more clarity. Grazie, ciao (thanks, later).

Chuck

7 comments on “Frozen Shoulder

  1. Mr. Lafrano, as I have read through your frozen shoulder blog, I often wonder if some frozen shoulder sufferers have gone right to surgery without the possibility of utilizing bodywork or physical therapy. I could understand how painful this condition might be. When the “body fears motion” it may be a long road back to what was once normal. I see in your article that you start with opposite side of the body instead of diving right into the problem area. I must say this article is beneficial and can do a great deal to serve therapists that have the ability to really help frozen shoulder along. Thank you for sharing your knowledge with us, I look forward to future articles. map

    • Thanks, map, and things are changing; people slowly but surely are coming to understand, or at least inquire into, what knowledgable bodywork can offer. As you know, I believe a situation like frozen shoulder can be addressed by effective massage better than other health care approaches. Situations like F/S are our thing. Being a knowledgable bodyworker is the key.

  2. Chuck! Great site!!!!
    As you MAY remember, my mom suffered from frozen shoulder after the accident when my dad died. I dragged her to school and wherever else and was very frustrated when I couldn’t help her either! A couple of weeks ago I was writing an Article about her (was talking about her doing all of the shows with me and relating all of this to my website) Any way, here is my belief, at that point, that FS had everything to do with the memory of my dad’s death. As I was writing my article, I had a moment that I had not even thought of before. Shortly before she passed I leaned down to hug her and she grabbed me with BOTH of her arms. Wait a minute! She was totally paralyzed on her right side and at THAT TIME all I could think of if WHAT IF RIGOR MORTIS SET IN AND I COULD’NT GET OUT OF THE GRIP?(Nice, huh?) She finally relaxed and started to snooze but 2 hours after that I heard no noise and knew she passed into the light. I just really think that because she didn’t let him go that it was in that area that she held him firmly till she finally ascended!
    I know that you do cranial work etc. but don’t forget to remind the student who finds a patient’s resistance to FS about THEIR(client) memories so they don’t feel like a failure in the work!!! xoxoxox

    • Thanks so much Jeanne, for such a heartfelt comment. My best to you in your mom’s passing, I remember how close you were. You bring up the point of the emotional aspect of client’s physical issues. We as massage therapists must take that into account, but what exactly do we do with it? It’s not an easy part of our work to address effectively. That deserves an extended article and I’ll do one soon; the short of it is acknowledgement and respect shown by us. The pitfall here is looking to be the catalyst for resolution for the client; not only is it beyond our scope, more to the point is it can disrespect the client’s experience, and really the client’s life. We are in their service, and let’s explore what that means in this forum. Anyone’s experience here is very welcome, love to hear from you.

    • Wow! Thanks for sharing your personal experience Jeanne… the more we share, the more we all can learn and the more people will realize the importance of massage/bodywork.

      All we can do at this point is allow the safe space for the client to feel what they need to feel without judgment – allowing things to surface and just Be; and that they are perfectly okay in having those feelings. Ultimately, I think its more important to have thoses memories, feelings, emotions, etc. be released from the body than the actual reasons why they are there, or to over analyze them.

      Anyway, thanks!

  3. Hello Chuck, several years ago I suffered from a F/S of the right (dominant) arm. I surmised at the time that the situation came from the fact that I had an over use injury to my right bicipital tendon which in turn inflamed the joint (encapcilation) making it quite painful for me to use my arm. I still continued to massage though (had to) and it took several months of PT and your excellent bodywork to get things moving properly again. In all that time I had never stopped to think about how much my emotional issues played a part in that painful senario. I was going through a terrible divorce at the time and that certatinly did not help get my frame of mind into the healing mode. I survived it all and then some. To this day my shoulder is still not 100% but most of the motion is restored thanks to you and some very good PT exercises. Just a reminder as to how much our emotions play such a significant role in our physical issues. Thanks again for your wonderful work and a great article!

    • You’re very welcome, Pat, and I will not only write an article on the emotional aspect of pain and physical dysfunction but we’ll revisit the subject regularly. As massage therapists we’re in an odd situation: it’s outside of our scope of practice to directly address emotional issues, and yet we deal with them, literally, all the time. No one has pain or dysfunction without an emotional response to it of some degree.

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