A dramatic sounding diagnosis. Although it is probably better just to call it a stiff and painful shoulder. The textbooks call it adhesive capsulitis (AC). Patients will generally have very limited and painful movement of their shoulder in any direction rather than a specific movement. You will hear lots of weird and wonderful treatments and reasons for it online, however a thorough review performed by the University of Bath (1), found the following;
It is a very common presentation, especially in the over 40's age group
It usually resolves in 1-2 years
There is probably a disruption to the autonomic nervous system (fight or flight response), with your body shifting to the "fight or flight" side, which enables a persistent low grade inflammation to be present.
Obesity (excessive weight) is linked to metabolic syndrome. Metabolic syndrome is a group of biological changes which include increased blood insulin, lipid (fat) changes and an immune response which all lead to a chronic, low grade inflammatory state.
Do cricket bowlers, javelin throwers and kettlebell users avoid frozen shoulder? Evidence suggests that our shoulder has evolved for high speed throwing of projectiles, e.g. rocks, spears etc. The modern human doesn't do much of this anymore, so it’s possible the soft tissue components of the shoulder aren't exercised or stretched enough for what the shoulder has evolved for. This leads to increased metabolic (waste) products in the tissues, leading to increased inflammation as discussed before. Secondary to all this, an injury below the shoulder (e.g. wrist or elbow) or above the shoulder (neck) may initiate an inflammatory cascade to set off the shoulder. We also know psychosocial stressors (general life issues), which modern man has a lot of, can add to the low grade inflammatory state.
So the take home messages are if you’re unsure if you have frozen..., I mean, stiff and painful shoulder, get it checked to make sure you have no other issues causing it. Manual therapy can be useful but it should not be intensive or vigorous as this may increase the pain leading to more stress and inflammation. Exercise therapy is beneficial. Addressing other underlying factors (if present) such as diabetes and cardiovascular disease is important as well.
Also taking an overall look at your lifestyle and stressors in your life to reduce any pro-inflammatory factors or habits and find healthy alternatives, that will reduce the inflammatory response.
1. Adhesive Capsulitis: An age related symptom of metabolic syndrome and chronic low-grade inflammation? Max Pietrzak. Full text here
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