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Frozen shoulder: It remains a challenge! - Need ideas.

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  • #31
    The picture on page 4 of the article shows a very Travell and Simons looking Big Red Spot right over where the axillary nerve (branch of radial) swings posteriorly and emerges through the quadrilateral triangle. Several sources point out that it is prone to entrapment syndrome there.

    Bas is right.

    Papers like this are not worth the effort of reading them, because of the deliberate conflation of mesodermalism into the clinical art of discernment, and the idea deliberately planted that spraying will somehow assist stretching with no clue provided about the neurology of it all, not anatomical (axillary nerve) or mechanistic (entrapment syndrome) or physiological (neural irritation), or of how treating in that manner might be presumed to help - really. This paper sources those impossibly simplistic trigger point books, and is therefore a completely suspect source of meme infection.
    Diane
    www.dermoneuromodulation.com
    SensibleSolutionsPhysiotherapy
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    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

    “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

    “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

    "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

    "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

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    • #32
      What comes first?

      Isn't it possible that the capsular contracture is what is responsible for the entrapment of the nerve? Sure it is. Studies show that intracapsular volume is decreased with frozen shoulder/adhesive capsulitis. One could argue with chicken or egg, and either might be right.

      Comment


      • #33
        Originally posted by Steve Hill View Post
        Isn't it possible that the capsular contracture is what is responsible for the entrapment of the nerve? Sure it is. Studies show that intracapsular volume is decreased with frozen shoulder/adhesive capsulitis. One could argue with chicken or egg, and either might be right.
        And supposing we entertain that hypothesis for a moment, what might be responsible for "increased capsular volume"?
        Diane
        www.dermoneuromodulation.com
        SensibleSolutionsPhysiotherapy
        HumanAntiGravitySuit blog
        Neurotonics PT Teamblog
        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
        Canadian Physiotherapy Association Pain Science Division Facebook page
        @PainPhysiosCan
        WCPT PhysiotherapyPainNetwork on Facebook
        @WCPTPTPN
        Neuroscience and Pain Science for Manual PTs Facebook page

        @dfjpt
        SomaSimple on Facebook
        @somasimple

        "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

        “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

        “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

        "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

        "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

        Comment


        • #34
          Are you asking what would bring about a return to the previous state of increased capsular volume? If so, a return to normal movement in all directions should return the extensibility of the contracted tissue, thus essentially restoring the axillary redundancy that is thought to magically disappear as the capsule contracts.

          There are also studies of injections into the capsule with intent to distend it, but I have never seen this performed, nor seen someone on which it was performed. Those are supposed to achieve increased intracapsular volume.

          Comment


          • #35
            There are also studies of injections into the capsule with intent to distend it, but I have never seen this performed, nor seen someone on which it was performed. Those are supposed to achieve increased intracapsular volume.
            Pushing on mesoderm from the inside out. Doesn't sound like a winner to me.
            John Ware, PT
            Fellow of the American Academy of Orthopedic Manual Physical Therapists
            "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
            “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
            be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

            Comment


            • #36
              Hi Diane.

              Thanks for your advise. I am not sure if it is Copyright so I took it out. The paper is free acess and I prefer to use the link.

              ADHESIVE CAPSULITIS: USE THE EVIDENCE TO INTEGRATE YOUR INTERVENTIONS

              http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096148/

              Comment


              • #37
                I just found this thread. I had a new client the other day who has a DX of frozen shoulder. I've worked with 3 other cases over the years and came to the conclusion that they were some sort of neurological dsyfunction. I tried talking to an local PT I know about it and got no reaction. I've never known anyone who would understand the experience I was describing until I came here.

                All four cases are women over 40 - three are post-menopausal and one in her mid-forties. All had fairly sudden onset. Two eventually had full recovery. Whether what I did made a difference or not, I don't know. The one in her 40s only saw me twice and the last one, I've only seen once. She lives 80 miles away, is a farm wife, so I don't know if I'll see her again.

                The first person I worked with was a regular client who was already coming for weekly massage. Obviously, this did not stop her from developing it. It came on suddenly after a weekend of playing a lot of golf. My first approach was to use the "trigger point" approach since that is what I was schooled in at the time. It became immediately apparent this was not going to be helpful.

                What I noticed was that when I had my hand on the back of her shoulder, when she was lying supine, relaxed, on the table, and I went to move her shoulder even very gently and just a little, I could feel muscles contract reflexively. The slightest movement initiated this strong, protective reaction. So, I tried doing some very subtle, Trager-like movement, inspired by a Feldenkrais class I'd taken years ago. My intention was to try to create some safe movement, get the brain to accept movement, even if it was subtle.

                It "worked" in the sense that we were able to achieve very very incremental improvements at each session. This was long before I knew any of this neuro stuff we take for granted here. However, it was a long, slow recovery. I'm not sure if what I did made a significant difference or not. The client was already a weekly client. However, she regained complete ROM and has maintained it for several years.

                It was clear to me that the problem was not "adhesions" but seemed like a neurological problem. I've never known anyone I could talk to about it.

                With the most recent client, she has restricted ROM and so it interferes in her life. She does not have pain at rest but has pain with certain movements. I did some Explain Pain pain education. On the table, I did some of the DNM I learned in Montreal and also made up some of my own. I didn't do any sort of "massage." She does have an area of tenderness on palpation near the biceps tendons at the shoulder, don't remember what nerve that is. I don't know the names of nerves very well. When she got off the table, she had less pain and a small but noticeable gain in abduction.

                Talked to her about graduated exposure to movement, looking for and building on successful movement. I gave her a link to Cory's Novel Movements for the Shoulder and suggested she see if any seemed like a good thing to be doing.

                She had been in PT where they did painful stretching. It seemed to make her condition worse. One movement they gave her which she found helpful was letting her arm hang down loosely and letting it swing in circles. She found it relaxing but, ironically, developed an aversion to it because they had her do it just before they did the painful stretches, so she associated it with that. We talked about the possibility of doing it - since the movement itself felt good and useful to her - but now doing it with the awareness that it was not going to be followed by pain.

                If I see her again, my approach for now is DNM and continuing to look for easy, comfortable movement and reinforce that. I told her if she wants to try, we could do three appointments and see if it seems to help. I gave her as much info as I could - including a link to Moseley's Why Pain Hurts TED talk - so she has some tools to work with at home.

                IF I see her again, if there are any suggestions here, I'm interested in hearing them.


                As for "adhesive capsulitis," the idea that there are adhesions restricting movement doesn't seem plausible in many of these cases, certainly not the ones I've seen. The two clients I saw over time both had complete recovery. How did the "adhesions" appear so rapidly and then, months later, mysteriously go away? Perhaps there are cases where there are adhesions, I don't know about this, but the ones I've encountered seem like a very strong, protective action and in that case the name is a misnomer.

                Comment


                • #38
                  I agree that it's neuro.
                  Here is my little story about getting, then getting rid of "frozen shoulder." Mine lasted less than two weeks.
                  Diane
                  www.dermoneuromodulation.com
                  SensibleSolutionsPhysiotherapy
                  HumanAntiGravitySuit blog
                  Neurotonics PT Teamblog
                  Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                  Canadian Physiotherapy Association Pain Science Division Facebook page
                  @PainPhysiosCan
                  WCPT PhysiotherapyPainNetwork on Facebook
                  @WCPTPTPN
                  Neuroscience and Pain Science for Manual PTs Facebook page

                  @dfjpt
                  SomaSimple on Facebook
                  @somasimple

                  "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                  “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                  “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                  "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                  "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                  Comment


                  • #39
                    Originally posted by John W View Post
                    Dissociative movements that improve interoceptive awareness of the various segments of the body involved in raising the arm I think are a good start.
                    I agree, and with regards to terminology, would this describe, Feldenkreis, and somatics?

                    Geralyn

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