Frozen shoulder is a complicated condition, that is difficult to pinpoint the exact reason why someone may develop it. It is defined as a condition that can affect one or both shoulders and is very painful during the beginning stage, and progressively the pain becomes less, however, the natural range of motion becomes limited in the second stage. As for the third and final stage, depending on if you have had treatment or not, you will start to feel as though you can regain some of the range of motion in the shoulder, but it will not be back to the way it was before you developed frozen shoulder. This amount of degree is lessened with the use of medical intervention, including injections and/or surgeries, physiotherapy, chiropractic care, or massage therapy, or any combination of these types of therapies.
This condition affects more women then it does men, and usually people who are between the ages of 40 and 70 years old. There are several different theories as to what can cause you to develop frozen shoulder, some of them being from postural dysfunctions, mainly a head forward or hyperkyphosis of the spine; trigger points in the subscapularis muscles, which are on the underside of the shoulder blade; musculoskeletal traumas or disorders, such as dislocations or muscular tears; not using the shoulder after a surgery; systemic conditions, people who have diabetes or hyperthyroidism have a higher chance of developing frozen shoulder, compared to those who don’t; or other disorders that you may have developed such as, but not limited to, chronic bronchitis, heart attacks, mastectomy, etc. This condition can last for 2 years, spontaneously seeming to resolve itself, however, some have experienced some of these symptoms for 5 to 10 years.
In this condition, there can be several factors that may need to be worked on, which will determine the type of treatment that you will receive. These include if you are hyperkyphotic, an exaggerated curve of the thoracic spine, tears or tendinitis of any muscles, swelling in the area, capsular adhesions, trigger points, especially in the subscapularis muscles, compensating factors, and what stage of the condition that you are in. If you have any one of these included in your frozen shoulder condition, then your treatment will have to evolve into treating the other conditions as well, rather then just focusing on the frozen shoulder itself.
If you have had any surgeries or injections, you will have to wait for approval from your doctor before starting a massage, but you will be able to start physiotherapy right away, which is usually recommended depending on the type of surgery. If you have an injection, usually you can have a massage between 24-48 hours after an injection, but you should ask your doctor to make sure as certain injections need the time to be increased to make sure that what they are injecting you with has a chance to do what it needs to, without the worry about fluids in the shoulder being moved around.
During a massage treatment, you can be in any position, most often it will be face up for face down. Sidelying is the only one that is a bit iffy, especially if you are experiencing a frozen shoulder in both shoulders, then it won’t be used. However if you only have one shoulder affected, there is a chance that the therapist will put you side-lying, as it can be easier to incorporate range of motion and work on trigger points in the subscapularis muscles. Either way, it will be what you are most comfortable with. As for the pillowing, it will depend on how many other structures you are affected with. This means it could be the same as every other massage you have ever had, or you may find some adjustments, like when being face down, and you have hyperkyphosis, there will be a towel roll under each shoulder. This helps to bring the shoulders back into a neutral position, and lessen the exaggerated curve of the thoracic spine.
Other techniques that are used, specifically towards the frozen shoulder itself, are passive pain-free movements, treating trigger points in the subscapularis muscles, and joint play for the surrounding joints that have any restrictions in them, including all the different parts of the shoulder itself. Of course, if there is swelling, ice will be used, and if there are muscular spasms then heat will be used in the treatment, along with lymphatic drainage. During the acute stage, or stage one, of this condition, only gentle joint mobilizations are done in the shoulder area, whereas in the later stages more intense mobilizations are used as long as you can handle them with no pain.
As for the passive range of motion, this is where you are completely relaxed and the therapist moves the shoulder into the different ranges. These include moving the shoulder up and down, left to right, front to back, and turning the arm/hand towards the body to away from the body. The main actions that are focused on, as they are the ranges that are most commonly lost or diminish with this condition, is moving the arm away from the body and turning the arm/hand away from the body. Again none of this should be painful, and if it does become uncomfortable, tell your therapist right away.
At the end of the session, ice may be applied, depending on how aggressive the treatment was. This will keep the swelling in the shoulder to a minimum. Afterward, the therapist will tell you different ways to help you keep proper posture, stretch any muscles that you need to stretch, and to keep doing range of motion exercises for the shoulder, as long as they don’t become painful.