Osteopathy for Frozen Shoulder

treating frozen shoulder with osteopathy

Up to this point no treatment for frozen shoulder (including manipulation, injections and surgery) has proved consistently successful. However the gentle, but effective option of osteopathic treatment works in months.

What is Frozen Shoulder?

Frozen shoulder (also known as adhesive capsulitis) is an extremely painful and debilitating condition, characterised by pain and stiffness in the shoulder. If left untreated, the symptoms of frozen shoulder last an average of 2-3 years in total, though in some cases it may be less than this. In a minority of cases, the symptoms last for several years. The typical symptoms of frozen shoulder are pain, stiffness, and limitation in the range of movement of the shoulder.

There are other disorders of the shoulder including impingement syndrome, sub-acromial bursitis, and tendinitis of the biceps and supraspinatus muscles. Shoulder disorders are common in part because of the complexity of the shoulder joint, and very often one disorder will lead to another and the end result may be a frozen shoulder.

Frozen shoulder symptoms typically have three phases.

  • Phase one – the ‘freezing’, painful phase. This typically lasts 2-9 months. The first symptom is usually pain. Stiffness and limitation in movement then also gradually build up. The pain associated with frozen shoulder is typically worse at night, and when lying on the affected side.
  • Phase two – the ‘frozen’, stiff phase. This typically lasts 4-12 months. Pain gradually eases but stiffness and limitation in movement remain and can get worse. All movements of the shoulder are affected but the movement most severely affected is usually rotation of the arm outwards. The muscles around the shoulder may waste a bit as they are not used.
  • Phase three – the ‘thawing’, recovery phase. This typically lasts 5-24 months. The stiffness gradually goes and movement gradually returns to normal, or near normal.

The symptoms of frozen shoulder often interfere with everyday tasks such as driving, dressing, or sleeping. Even scratching your back, or putting your hand in a rear pocket may become impossible. Work may be affected in some cases.

Risk Factors

Although the exact cause is unknown, certain factors may increase your risk of getting frozen shoulder. These factors include:

  • Age. People 40 and older are more likely to experience frozen shoulder.
  • Diabetes. For unknown reasons, frozen shoulder is more common in people with diabetes.
  • Immobility. People who have experienced prolonged immobility of their shoulder — perhaps due to trauma, overuse injuries or surgery — are at higher risk of developing frozen shoulder.
  • Systemic diseases. People with a systemic disease, such as an overactive thyroid (hyperthyroidism), underactive thyroid (hypothyroidism), cardiovascular disease or Parkinson’s disease, may experience frozen shoulder.

Assessment

The primary means of diagnosing frozen shoulder is a physical examination. During the exam, the osteopath will assess the muscles around the shoulder by pressing on them. Then she will test your active movement (movement without assistance) by asking you to raise and lower your arm to the front, sides and back of your body. She will also test your passive movement (movement with assistance) by manually moving your arm and shoulder to determine your range of motion. Loss of both active and passive movement and a pattern of generalized (diffuse) shoulder tightness and pain are strong indicators of frozen shoulder.

If the osteopath believes that there are other problems (eg tendon rupture or arthritis), she may request an X-ray, ultrasound or magnetic resonance imaging (MRI) scan of the shoulder.

Osteopathic Treatment for Frozen Shoulder

There is no quick-fix for treatment of frozen shoulder or other shoulder dysfunctions. Usually the problem will have developed over several months and will therefore take many weeks to repair. Osteopathic treatment is non-invasive and relies on movement and positioning of the arm, along with massage of the soft tissues. Sorrel uses a variety of techniques, adapting the treatment to suit the needs of the patient. She also advises on exercises which the patient can do at home to speed up healing. The core of Sorrel’s treatment is the Niel-Asher Technique®, which is described below.

The Niel-Asher Technique® for Frozen Shoulder Treatment

Sorrel uses a relatively new technique for treatment of frozen shoulder, the Niel-Asher Technique®. A breakthrough for the treatment of frozen shoulder, the Niel-Asher Technique® usually takes between 6 and 9 sessions over an average of 10 to 12 weeks. (Please note this can be longer in a phase 1, post-surgical, traumatic or diabetic frozen shoulder). The results speak for themselves: 9 out of 10 of the cases treated in The London Frozen Shoulder Clinic have demonstrated a full recovery of movement with no residual pain.

Clinically Proven Results

The Niel-Asher Technique® was compared to standard physical therapy in a randomized placebo-controlled pilot trial, conducted in association with the Rheumatology Research Unit at Addenbrookes Hospital, Cambridge. It showed an 80% decrease in pain, and a significant improvement in range of motion and strength over and above traditional physical therapy.

What is the Niel-Asher Technique® and how does it work?

The Niel-Asher Technique® is truly osteopathic in that it utilises the body’s own healing mechanisms. It is a hands-on therapy. It uses a specific and unique sequence of manipulations to the shoulder joint and soft-tissues.

How is it different to current treatments?

Traditional physical therapies attempt to improve the range of motion by forcing the shoulder through the blockage; this in our opinion can make things considerably worse. The Niel-Asher Technique® works differently. In a frozen shoulder there is considerable inflammation, on top of this the brain starts to recruit the ‘wrong’ muscles to move the shoulder.

Cortico-Neuro-Somatic-Programming® (CNSP®)

This technique ‘fools’ the body/brain into healing itself by addressing the two main components of the problem – pain and stiffness. Initially the technique aims to significantly reduce the pain, by treating the swelling around various tendons associated with the shoulder (especially the biceps tendon). Following this, the technique moves on to rapidly defrost and improve the range of shoulder motion by stimulating a unique sequence of reflexes hidden within the muscles. This works on the parts of the brain that co-ordinate the shoulder muscles. It uses a unique sequence of reflexes. One reflex is triggered against another in a choreographed sequence. We do not force the arm; instead you keep it still whilst we apply the pressure.

Patients treated with this technique should see a tangible improvement with each treatment session. If you attend for treatment, you will be given some simple exercises to help loosen up your shoulder. If you wish you can get started straight away. Remember to take care!

To help your recovery always swing your arms when you are walking. Avoid allowing the injured arm to become immobilised.

For further information on the Niel-Asher Technique® see the Frozen Shoulder website, where there is information about the technique, research, and self-help.

For further information about managing a frozen shoulder, please see our four-part blog post: What can I do to heal a frozen shoulder?

Part 1. What is a frozen shoulder?

Part 2. What are my treatment options?

Part 3. Alternatives to NHS treatment

Part 4. Exercises

It was the news that a frozen shoulder was likely to cause pain and inconvenience for about two years which pushed me into looking for alternative treatment (or, I should say, some treatment). Finding Sorrel on the internet proved to be the best thing that I could have done. Immediate reassurance that something could be done was followed up by sessions which resulted in slow but steady improvement and regained movement in a matter of months.

Subsequent problems have also been dealt with by Sorrel. She views the whole person, not only physically but also in relation to the other stresses of everyday life. It is also just as important to be told what is NOT the problem as understanding the origin of pain and possibly working out likely causes.

I fully recommend trying Sorrel’s treatment for pain, stiffness and similar difficulties. Her knowledge and experience attracted me in the first place and have proved invaluable.

Liz C, 63