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Could you be Suffering from Frozen Shoulder?

What is Frozen Shoulder?
If you are experiencing stiffness and loss of movement in your shoulder joint, you may be suffering from frozen shoulder, also known as Adhesive Capsulitis.  This condition is very different from a rotator cuff injury or tendonitis, because the joint capsule is the area affected.  The other two conditions stem from issues with the muscles and tendons of the shoulder joint.

What Makes up the Shoulder Joint?
The shoulder joint is a very complicated area of the body. It contains a varied combination of bone, muscle and tendonous tissue and provides extensive range of motion for your arm. The fact that this joint is so moveable presents a downside – it is a very unstable joint.  This instability makes the shoulder joint an area that is easily injured.

There are three bones in the shoulder, the collar bone, upper arm bone, shoulder blade.  This joint is also made up of the tendons of four of the main shoulder muscles that attach to these bones enabling us to move our arm in a complete circle.

Frozen shoulder can develop in the area where the upper arm bone fits into the shoulder socket.  When this condition occurs, you get stiffness and lose your range of motion because of inflammation of the tissues.

What Causes Frozen Shoulder?
There is no known single cause of frozen shoulder.  However this condition usually begins after an injury to the joint, the development of arthritis in the joint, or from issues related to surgery on the shoulder joint.  Having poor posture can lead to this condition by creating a shortening of the ligaments and tissues around the shoulder. Other theories on specific causes that can lead to this condition are hormonal imbalances, which have led some doctors to label this as ‘menopausal frozen shoulder’.

What are the Symptoms of Frozen Shoulder?
Pain and stiffness are the most common reported symptoms of frozen shoulder. Pain is usually described as a persistent, dull ache and sufferers experience problems in taking the shoulder and arm through its full range of motion.  People with this condition have difficulty lifting their arm above their head or away from their bodies at all.  They also experience problems with inward rotation of their arm.

Frozen shoulder normally is said to have three stages.

Stage one, is the development of mild pain and stiffness in the shoulder. This stage can last from a few weeks to a few months and is usually known as the freezing stage.
Stage two, stiffness remains but the pain begins to subside. This stage can last from a few months to nearly a year and is known as the frozen stage.
Stage three, the shoulder and arm begin to regain movement and more normal range of motion. This stage can also last a few months and is knows as the thawing stage.

Recovery can happen within 4 to 6 months, but some cases have lasted for several years.

Treatment
Treatment for this condition consists of pain reduction and some sort of manual tissue manipulation like massage.  In the more progressed stages, physical therapy may be needed to help regain movement in the joint.  Anti-inflammatory medication is usually given at the start and during manual treatment to make it bearable for the sufferer.  Heat is also helpful to loosen the muscles and encourages new circulation to the joint, bringing in nutrition to the tissues.

One of the best ways to increase circulation to an injured area is massage therapy. Massage is also a good way to reduce scar tissue that can often result from injury to tissues.

Some doctors will tell their patients to stop moving.  This approach can actually aggravate and encourage this condition.  Gently moving the joint will help to keep good circulation to the affected area.  Don’t move in a way that causes pain, but don’t completely stop moving.  There are some specific exercises and stretches that can be done to help keep the joint lose and accelerate the healing process.

How Can I Prevent Frozen Shoulder?
Preventing injury in the first place is a great strategy.  The better condition your shoulder joint is in, the less likely you will become injured.  Two great ways to ensure healthy shoulder joints are stretching and strengthening the muscles and other tissues of the shoulder joint. The prevention of frozen shoulder and other shoulder injuries comes down the conditioning of the shoulder muscles, tendons and ligaments, which ultimately involves both stretching and strengthening of the shoulder.  A good rule to follow is to always warm up your muscles properly before strenuous activity.  Following are two stretches that are good for the shoulder area.

Warm up your muscles first with some gently movement and only take the stretch movements to a comfortable level, don’t cause yourself pain while doing these.

Shoulder Stretches

#1  Stand upright and clasp you hands behind your back. Keep your arms straight and slowly lift your hands upwards. Hold this stretch for about 15 to 20 seconds and then repeat it 3 to 4 times.

#2  Place one arm across your body, keeping it parallel to the ground. Then slowly pull your elbow towards your body. As above hold this stretch for about 15 to 20 seconds and then repeat it 3 to 4 times.

Stretching is a very effective technique that can help prevent injuries and improve athletic performance.  To help you improve your flexibility quickly and safely, you can’t go wrong with The Stretching Handbook & DVD.   In these helpful guides you can see step by step how to do each stretch correctly.  To see four great exercises to help strengthen the shoulder joint muscles, check out http://familydoctor.org/handouts/265.html.

A Guide to the Treatment and
Prevention of Golfers Elbow!

There are a number of conditions that affect the elbow area. The three most common conditions are “lateral epicondylitis” (tennis elbow), “medial epicondylitis” (golfers elbow), and medial collateral ligament sprain (throwers elbow).

The first two conditions are very similar, however the first affects the outside of the elbow (lateral), and the second affects the inside of the elbow (medial). For the purpose of this newsletter we’ll stick with the treatment of medial epicondylitis, or as it is more commonly known, golfers elbow.

What is Golfers Elbow?
Before we can understand just what golfers elbow is, it’s important to have a general understanding of the structure of the elbow joint, and how the muscles, tendons, ligaments and bones help the elbow joint to function.

As you can see from the diagram to the right, there are many muscles and tendons that make up the elbow joint and forearm. The diagram shows the anterior (or front) view of the forearm. The left picture shows the muscles and tendons closest to the surface of the skin, while the picture on the right shows some of the muscles and tendons deeper within the forearm.

There are also three bones which make up the elbow joint. They are the “Humerus,” the “Ulna” and the “Radius.”

Now that we can see how the elbow functions, lets look at what exactly golfers elbow is.

Golfers elbow occurs when there is damage to the muscles, tendons and ligaments around the elbow joint and forearm. Small tears, called micro tears, form in the tendons and muscles which control the movement of the forearm. They cause a restriction of movement, inflammation and pain. These micro tears eventually lead to the formation of scar tissue and calcium deposits. If untreated, this scar tissue and calcium deposits can put so much pressure on the muscles and nerves that they can cut off the blood flow and pinch the nerves responsible for controlling the muscles in the forearm.

Causes!
By far the most common cause of golfers elbow is overuse. Any action which places a repetitive and prolonged strain on the forearm muscles, coupled with inadequate rest, will tend to strain and overwork those muscles.

There are also many other causes, like a direct injury, such as a bump or fall onto the elbow. Poor technique will contribute to the condition, such as using ill-fitted equipment, like golf clubs, tennis racquets, work tools, etc. While poor levels of general fitness and conditioning will also contribute.

Symptoms!
Pain is the most common and obvious symptom associated with golfers elbow. Pain is most often experienced on the inside of the upper forearm, but can also be experienced anywhere from the elbow joint to the wrist.

Weakness, stiffness and a general restriction of movement are also quite common in sufferers of golfers elbow. Even tingling and numbness can be experienced.

Prevention!
There are a number of preventative techniques which will help to prevent golfers elbow, including bracing and strapping, modifying equipment, taking extended rests and even learning new routines for repetitive activities. However, there are three preventative measures that I feel are far more important, and effective, than any of these.

Firstly, a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the forearm area, which will result in a lack of oxygen and nutrients for the muscles. This is a sure-fire recipe for a muscle or tendon injury.

Before any activity be sure to thoroughly warm up all the muscles and tendons which will be used during your sport or activity. Click here for a detailed explanation of how, why and when to perform your warm up.

Secondly, flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. When this happens, strains, sprains, and pulled muscles occur. To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine.

Stretching is one of the most under-utilized techniques for improving athletic performance, preventing sports injury and properly rehabilitating sprain and strain injury. Don’t make the mistake of thinking that something as simple as stretching won’t be effective.

For an easy-to-use, quick reference guide of 135 clear photographs of every possible stretching exercise, for every major muscle group in your body, get a copy of The Stretching Handbook. You’ll also learn the benefits of flexibility; the rules for safe stretching; and how to stretch properly. Click here to learn more about The Stretching Handbook.

And thirdly, strengthening and conditioning the muscles of the forearm and wrist will also help to prevent golfers elbow. There are a number of specific strengthening exercises you can do for these muscles, but instead of me going into the details here, I have simply found another web site that has already done all the hard work.

The following site explains a number of exercises you can do, both with, and without weights, and also includes diagrams and comprehensive explanations of each exercise. Although the site is specifically about tennis elbow, the exercises also relate very well to golfers elbow. You can find these strengthening exercises by going to http://www.physsportsmed.com/issues/1996/05_96/nirscpa.htm.

Treatment!
Golfers elbow is a soft tissue injury of the muscles and tendons around the elbow joint, and therefore should be treated like any other soft tissue injury. Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regime should be employed. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis.

It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. The application of heat and massage is one of the most effective treatments for removing scar tissue and speeding up the healing process of the muscles and tendons.

Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscle and tendons that have been injured. Click here for a complete and comprehensive article on the treatment of soft tissue injuries.

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Copyright © 2008 The Stretching Institute™
Article by Brad Walker. Brad is a leading stretching and
sports injury consultant with nearly 20 years experience
in the health and fitness industry. For more free articles
on stretching, flexibility and sports injury, subscribe to
The Stretching & Sports Injury Report by visiting
The Stretching Institute.
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