Greetings yogis!
Did you read our last episode, where we explored Dislocated Shoulder & Shoulder Instability, and how yoga can benefit these issues?
In the fourth instalment of our monthly Samadhi Anatomy with Greg Walsh article we are going to look at Frozen Shoulder, what is is, how it effects you, and how long it takes to recover. We will also discuss at how to execute some poses which can help to regain mobility and ease discomfort in your shoulders through yoga.
Please be aware we always advise that you get the opinion of a medical professional, be it your GP or a physiotherapist, before you embark on any treatment or exercise regime.
Episode 4: Frozen Shoulder (Adhesive Capsulitis), and how yoga can help
Do you remember Episode 2 of our Yoga for Shoulder Pain series? We discussed the anatomy of the Glenohumeral (GH) Joint. 1
The joint is enclosed in a sealed sheath of strong fibrous connective tissue, which creates the glenohumeral joint capsule2. This sheath is actually quite slack, it is built for movement and flexibility rather than stability.
Frozen Shoulder (Adhesive Capsulitis)
There is an irony in the name: Frozen Shoulder. The condition actually describes a heated and inflamed joint. The medical name for it is Adhesive Capsulitis. Capsulitis refers to inflammation of the Glenohumeral Joint 3. It denotes inflammation. So the glenohumeral joint is inflamed. Adhesive means sticky or glued together.
An expressive translation of Adhesive Capsulitis would be “Hot Sticky Capsule”.
Imagine you pleat a sheet. And then put glue in-between the pleats. You would not be able to lay out that sheet. Well that’s what happens to your shoulder capsule, it has adhesions. The shoulder capsule effectively becomes shrink-wrapped. As the shoulder capsule tightens, you may even feel that your frozen arm is shorter than your other arm. The tightening can pull the head of the humerus deeper into the shoulder socket.
Occurrence of Adhesive Capsulitis
How can a frozen shoulder occur? It often occurs after an illness or health problem which necessitates physical immobilisation. For example if you have a shoulder injury which necessitates immobilisation, or if you hold and guard your shoulder from movement due to trauma. Another example could be after abdominal surgery, and you have to keep the whole torso still to allow healing. Sometimes frozen shoulder simply creeps up on you, for no apparent reason. It is most common with women between the ages of 40 – 60, so there may be a hormonal element to its inexplicable occurrence.
Whatever the cause, the condition is somewhat self perpetuating. Adhesions in the capsule are painful, and so you tend to guard and hold your shoulder. The lack of movement causes more adhesions to form.
There are three stages of Frozen Shoulder:
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- Freezing/inflammatory stage: The shoulder starts to seize up, and there is pain with any movement.
- Adhesive/Frozen stage: Pain may decrease, but range of motion is greatly reduced.
- Thawing stage: Shoulder’s range of motion starts to return. This stage of slow return to motion without pain may take months or years.
Some Symptoms
- A dull ache in one shoulder
- Reduced shoulder mobility
- Possible sleep disturbance, due to pain worsening at night
Conventional Treatment of Frozen Shoulder
It is always recommended that you see a medical professional if you feel you have any injury or illness. They will have the skills to diagnose you. If you think you have a frozen shoulder, you should go to a doctor, physiotherapist or physical therapist.
The aim of frozen shoulder treatment is firstly pain reduction, and secondly to regain a healthy and pain-free range of shoulder motion. Treatment options include medications, therapeutic shoulder manipulation, steroid injections and surgery.
Therapeutic Shoulder Manipulation
A good physical therapist or physiotherapist can really help with regaining some mobility in the shoulder capsule. This treatment may not be without pain. You will probably also be given exercises to do at home to help you to help yourself.
Steroid Injection
If over the counter pain medication is not enough your doctor may recommend a steroid injection, right into the capsule.
Surgery
In really bad cases of Adhesive Capsulitis surgery may be recommended. Under general anaesthetic the joint will be mobilised and stretched, to bring back some movement and break up the adhesions. Scar tissue and adhesions may also be removed.
How yoga can help with Frozen Shoulder:
Yoga is a really useful tool in helping to recover or heal shoulder pain of many types. It is a safe and controlled method of rehabilitation, and the mindful approach of yoga lets us carefully work to but not beyond our safe limit.
A key note: resting does not help frozen shoulder. It can lead it to freeze further as the adhesions multiply.
Yoga can really help with frozen shoulder. Yoga should be practiced carefully and sensitively, so as to prevent muscle guarding4, and a more painful and inflamed shoulder later.
In Tadasana it is worthwhile to explore shoulder mobility: take the arms out in front, out to the sides, and back behind the body. Remembering that arms above shoulder height may be painful but you can try both walking the hands up a wall (see creeping Urdhva Hastasana below), and arms overhead while lying on your back on the floor. Supta Hastasana in Supta Tadasana, and other supine poses.
Explore standing poses which do not involve weight bearing in the arms, such as Trikonasana or Virabhadrasana 2.
The first phase of FSS is the most painful phase to practice yoga. When the 2nd and 3rd phase begin, stretching is easier.. If you want to take your arms forward and upward, like say in Virabhadrasana, try taking them backward first. This will help to open up mobility. If and as the pain eases, tabletop pose can be attempted, and you can try bringing weight into the hands and arms.
Then tabletop to Adhomukha Virasana may be attempted, and eventually even Adhomukha Svanasana, or at least Ardha Adhomukha Svanasana, with the hands on a wall or chair.
1. Supta Tadasana
Supine tadasana or mountain pose, actively lying on the floor. While on the floor you can explore arm movements while using the floor for support. Do you remember making snow angels when you were younger. Imagine you are out in the snow again. Tuen your palms upward and explore how large you can make your snow angels wings.You may find that your arms will only go to shoulder height, and that is fine. Rather than pushing into pain why don’t you try rotating your arms in the shoulder sockets?
2. Urdhva Hastasana or Ardha Hastasana in Supta Tadasana
That is a long title for a simple pose: supine Tadasana with arms attempting to go above the head. Ardha means half. With normal range of motion we would hope to take the arms onto the floor above the head, but while caring for an injury we are happy to take the arms halfway, straight up toward the ceiling. With a frozen shoulder you will probably find that one and will move and one is very restricted. Why don’t you take a stick or a broomhandle, and hold it in both hands. Then try and lift the arms over the head into the pose. The healthy shoulder would provide strength and support for the injured shoulder.
3. Tadasana variations
Tadasana is a great pose to help to read the body. It is very active yet neutral in its positioning, so you can use it to take stock of pain levels and/or progress. I recommend using it to explore shoulder mobility. Try taking your arms back behind the body, arms out in front, arms to the sides. Remember, taking the arms above shoulder height may be painful. Remember: try taking the arms behind the back before taking them forward, as this will help with mobility. You can use a a stick or broom handle to help control and guide the injured shoulder.
4. Creeping Urdhva Hastasana
Face a wall, and take your hands onto the wall. Your distance from really depends on how much movement you have in your injured shoulder. Begin creeping your fingers up the wall. The elbows will bend as the arms rise. Watch the width of the elbows, try to keep them at shoulder width. As your fingers walk up the wall, you will need to step closer to the wall. Walk the fingers as high as you can, and then hold at that height. If you want to add more weight and work into the shoulders, you can stand further from the wall, to ease weight and lighten the work stand closer to the wall.
5. Virabhadrasana 2
Virabhadrasana 2 or Warrior 2 is primarily a leg and pelvic pose, but it also has great potential as a gentle shoulder mobilising and strengthening pose. You may find that you cannot hold your arms at shoulder height, so you can just release them onto the hips. Once you feel that you are strong enough to go a little further, why don’t you try doing the pose with a stick or broom handle?
As you hold the pose, feel the shoulder blades spread, so that the glenohumeral sockets move into the humerus heads.
I recommend playing with the shoulders in the pose. If you can take the arms out to the sides, explore how the shoulders feel as you externally rotate the upper arms. Try turning the palms upward. Compare how the shoulders feel when you broaden the shoulder blades vs. the collarbones. Get to know your safe range of motion in the pose!
You can also explore the range of comfortable motion in your shoulders in other standing poses, as they bear no shoulder weight.
6. Uttitha Trikonasana
Uttitha Trikonasana has a similar spacious shoulder opening feel to Virabhadrasana 2, except that the arms are vertical. Again explore spreading the shoulder blades, allowing the glenohumeral sockets to move into the humerus heads. Vertical arms may be too challenging due to shoulder pain, but you can use your strong shoulder to support your immobile shoulder using a staff or stick.
7. Bharmanasana
Bharmanasana is commonly known as tabletop pose. It can gently strengthen the arms and shoulders, without irritating a frozen or injured shoulder. Try grounding into the finger bases, particularly the index fingers (as they tend to lift). then push the floor away, and grip into the upper arms. As you push the floor away let your shoulder blades spread.
8. Ardha Adhomukha Svanasana
If you can do all of the above poses without pain, you could think of bringing Dog back into your yoga practice. Adhomukha Svanasana is a weight bearing pose, so if you are rehabilitating a dislocated shoulder or working to stabilise shoulder instability, I recommend doing Adhomukha Svanasana with your hands on a height. It can be the seat of a chair, or the wall. If you know Samadhi yoga studios, the upstairs window ledges are perfect for this. Having the hands on a height takes much of the weight out of the shoulders, allowing you to control the amount of effort and stretch, and to focus more directly on spreading and drawing down the scapulae, and drawing the humeral heads into the glenohumeral sockets.
As I say each month:
Recovery takes time, and requires patience. Always practice with care and carefully observe each movement. That way you can feel any unhealthy movement as it occurs, and you can pull back from it, which will aid your recovery and reduce the risk of re-injury.
Next episode:
Shoulder Arthritis (Shoulder Osteoarthritis)
Hi Greg..great to see you posting this:)
The pics are top quality..trust your finding your way in this new Covid world?
Lovely to hear from you Mr Yoga-ha! Finding my way in the dark sometimes! And you?
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