Frozen shoulder. The inability to raise your arm more than a few inches without pain or restriction preventing the movement.
Often seen as a difficult condition to treat, many with the condition will have been seen by various therapists and medical professionals in an attempt to try and reduce their pain.
Often clients will have received various treatments to help improve their condition including massage, joint mobilisations and rehabilitation exercises.
The good news is that, for many, these interventions can usually make a positive difference to the clients pain and speed up recovery.
Unfortunately, for others, there is little improvement in their condition, despite keeping up with their exercises and treatment.
The last resort is usually the use of medicated pain relief in an attempt to numb the pain and simply mask the issue.
Well, don’t despair as there may be another option which may be worth a look…read on to find out more!
What Else can be Done?
When a client presents with a shoulder condition (or any condition for that matter) where previous treatments have not been able to make any lasting change, the answer can often be found by looking away from the shoulder to other parts of the body.
You see, there are occasions when a restriction may be present in another, seemingly unrelated area of the body, which can be directly impacting the area where the client is feeling their pain.
But how is this and how do we know when these restrictions can be having an affect on the presenting condition?
Well to try to answer this I’d like to talk about a little known tissue which exists within our bodies which can often be at the root cause of referred pain…fascia.
Fascia is one continuous sheet of connective tissue which wraps around all of the soft tissues within the body. Starting with the superficial fascia which lies just below the skin to the deeper layers which wraps around and runs through our organs such as our heart, blood vessels, nerves and muscles which make our limbs work. The ligaments that hold our joints together and the tendons which connect the muscles to the bones are all made of fascia.
Fascia, in it’s physical form, would be described as a flimsy, white membrane; this membrane is innervated by nerves which send signals back and forth to the brain and react to what is happening in the body.
If you have ever prepared a chicken breast for dinner and noticed the membrane which lies beneath the skin – then this is the superficial fascia.
The image above shows the fascia (the white tissue) as it wraps around the tissues of the body.
When areas of the body become injured or damaged the fascia in that area will begin to change from being a fluid, free moving tissue to a stiff, firm and solid like tissue. This stiffening (or ‘binding down’ as it is known) of the fascia helps to provide stability and support to the injured or weakened area. The problem with this is the fascia which has become bound down can begin to create lines of tension throughout the body. This, in turn, can create restriction in other areas of the body.
Example above of how tension within the fascial system can create lines of tension throughout the body, often creating pain in distant, seemingly unrelated areas of the body.
How Does This Affect My Shoulder?!
As mentioned earlier, fascia is continuous throughout the body, like one large sheet of tissue it connects everything to everything else. If one area of the body becomes injured or under stress – either due to injury, stress, bio-mechanical or postural issues, then the fascia in the area will stiffen or bind down in an attempt to protect and stabilise the weakened area.
Although this stiffening of the fascia can help to protect and stabilise the area which is stressed or injured the result of this hardening is the potential for a line of tension being created, causing a pull on another area of the body.
We Need an Example!
An example of how this can affect fa frozen shoulder may be if the client had an issue with their hip. The hip may have been injured in the past or may simply be because the client naturally places more weight on that side when running or walking. Whatever the reason for the hip issue if the body feels the area is weak or unstable then fascia can tighten or pull on the hip potentially having a ripple effect elsewhere in the body.
In this example, the fascia may begin to cause a pull on one one or both shoulders potentially restricting movement.
As can be seen in the drawn image above, tension or a pull on the hip (the clients right hip but our left as we look) can create tension in other areas, notably in the shoulder.
Try it For Yourself!
You can experience this for yourself by simply pulling on your shirt around the hip area (on one side), really pull the shirt from the lower part around the hip. Now try to raise your arm above your head. I’m guessing that you probably struggled to get your arm even halfway towards your head?!
Now release the shirt and attempt again to move your arm above above your head; you can probably move your arm much higher now?!
Imagine then that rather than you pulling on the shirt, the pull was actually coming from a restriction on the hip, pulling the shoulder down and restricting the movement? Can you now see how continually massaging and releasing the shoulder will have little effect if the restriction at the hip is not released first?
Obviously this is only one example where we are using a restriction in the hip to demonstrate the point, but similar restrictions can be present literally anywhere in the body, potentially creating various lines of tension.
Pulling on a shirt or t shirt at or around the hip area is a good example of experiencing how a line of tension can be created and result in restricted shoulder movement – just make sure you’re actually wearing the t shirt in order to feel the effect!
I hope this has given some of you suffering from persistent shoulder pain a little insight into how issues in other parts of the body can potentially be contributing to your condition. With any condition which is not responding to treatment locally, it’s important to look further afield to see what may be contributing to the pain.
The clue is often to simply ask if the client feels restriction in other areas of the body other than where the pain is presenting. Many clients will confirm this and often report how they feel as though their bodies are ‘out of balance’ in some way; many will describe how they feel as though they are leaning their weight to one side more than the other or perhaps their bodies feel twisted in some way; many will also mention how most of their pain is located down one side of their body. This is often a clue as there may be more to the problem than simply looking to the shoulder.
Perhaps there is a feeling of tightness in the rib cage or abdomen which can be creating a pull on the shoulder; maybe that feeling of pain or restriction down one side of the body needs to be investigated further to see if there is a link?
Due to the continuous nature of the fascial system, there are numerous areas of the body which can be contributing to pain located within the shoulder. Finding the the restriction and releasing it can often be the key to the problem.
If you have an issue, whether that be shoulder pain or anything else, then get in touch to find out how we can help…