Shoulder Manipulation - Should I Or Should I Not?

To start with, let me say up front that I've never had a shoulder manipulation under anesthesia. I treated my own frozen shoulder with great success (with a little help now and then from co-workers and my wife). I have however treated many a patient after having this procedure, the vast majority of which I did not have the opportunity to treat conservatively prior to the procedure. This makes the argument as to whether it was truly beneficial over tried and true physical therapy difficult to support.

I can say this however, not one single soul came to me after a shoulder manipulation with full range of motion. This makes sense though when one considers what takes place during this procedure. The idea is to take a shoulder which is frozen due to "tiny adhesions" around the joint capsule and forcefully take it through it's full range while the patient is asleep. Sounds simple, right? What typically takes place though is additional trauma to the shoulder's joint capsule, and/or possibly to the soft tissue surrounding the shoulder complex. This leads to a natural imflammatory reaction after the event, followed by swelling, muscle guarding, and believe it or not, more scar tissue eventually laid down in the shoulder.

The hopes of a quick fix solution can quickly fade as now more therapy and joint mobilization is required to return the shoulder to a functional state. The point of stating all of this is not to imply that a shoulder manipulation is never necessary. There are, in fact, some cases where this is the best option -- usually because the patient was inconsistent or non-compliant with their conservative program, or possibly because their pain threshhold was so low that they could not endure any amount of stretching or exercise during therapy sessions. The main point is to educate the patient that this procedure is not meant to be a quick fix, but rather a last resort if all else fails.

A properly designed program of stretching and movement can, in most cases, return a great deal if not all of a shoulder's previous range of motion. If results are not coming as quickly a one desires then he/she should consider the therapist's experience in treating frozen shoulder syndrome, how long the patient has had the condition, and how long they have tried conservative measures. My experience has taught me that persistence and properly applied exercise is the key to treating adhesive capsulitis successfully. Again, a shoulder manipulation should be the last in line of treatment options.

Reaching Behind Back Exercises - Frozen Shoulder Treatment

If you have adhesive capsulitis and you've lost the ability to reach behind your back, you are definitely not alone. In the middle stages of this condition it can suddenly be almost impossible to put on a belt, bra, or even scratch your back. In some cases just pulling up your pants becomes a major challenge. Frozen shoulder treatment for these activities is relatively simple if the patient is consistent and patient. In the next couple of paragraphs I've listed a few "reaching behind back" exercises, or formally called "internal rotation" exercises.

To do something as simple as reach behind your back, your shoulder must have two ranges of motions: 1) Shoulder extension, and 2) Internal rotation. You must have both of these in order to have the range of motion to put on a belt or fasten a bra (assuming this is not done from the front). The following exercises worked wonders for my internal rotation:

• Hold a towel with the hand of your non-involved arm and throw it over your opposite shoulder. Then grab the other end with the hand of your non-involved arm. Gently pull with your non-involved arm until a gentle stretch is felt. Hold initially for 10 seconds and repeat. Later, try to increase you hold time up to 30 seconds. This exercise is for those who have a little internal rotation to begin with.
  
• Hold a broomstick behind your back with both hands, palms facing behind you. Your elbows should be kept straight throughout the exercise. Stand fully erect with good posture and lift your hands away from your body (backwards). Hold 10 seconds, again building toward 30 seconds.
  
• Hold a broomstick in the same manner as the beginning of the above exercise. Try to slide your hands together until they meet. Don't worry if they don't meet to begin with, just keep trying. A mild to medium stretch or achy pull should be felt, but no sharp pain. The key to making this work is to do it several times in short bursts throughout the day. Stop if any sharp pain is felt.
• Lie semi-turned on the side of your involved shoulder (not fully on your side and not fully flat of your back). Slide your elbow/upper arm about 20 inches away from your side. Bend the elbow of the bad shoulder to ninety degrees (like an "L"). Next, use the opposite hand to gently push the other hand towards the bed while keeping the "L" shape or 90 degree bend in the elbow. Hold 10 seconds and repeat 10 times.
  

The previous frozen shoulder exercises will help to return the crucial ranges of motion needed to perform simple tasks involving internal rotation. They should be performed with care and caution and only under the guide of a physician or licensed clinician.