by Rob Stanborough ~ PT, DPT, MHSc, MTC, CMTPT, FAAOMPT ~ First Coast Rehabilitation
Mayo Clinic defines frozen shoulder as, “a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years, also known as adhesive capsulitis.” Clinically, frozen shoulder usually presents with painful motion in all directions. The pain can be quite intense, and the motion can be significantly limited, effecting everyday activities.
Mayo Clinic also states a frozen shoulder will most likely “thaw” or return to normal function within 1-3 years. But that is a long time to live with pain and/or be unable to lift or move an extremity. During that time the shoulder can grow weaker, compensations can develop, and the pain can move into the neck.
Each synovial (fluid filled) joint is surrounded by what is called a capsule. The capsule helps hold the joint together, its reinforced by ligaments and supported by muscles. If the capsule itself becomes contracted or adhesed, then treatment is difficult during the “thawing” period. But there is a growing body of research suggesting myofascial trigger points are a contributing factor, limiting the motion of the “frozen” shoulder as well as being a significant contributor to the pain. Muscles around the shoulder can be overloaded, developing myofascial trigger points and cause pain with motion in all, or nearly all, directions, thus mimicking a frozen shoulder. This same thing can also happen in other chronic painful shoulder problems.
In cases where the capsule is adhesed, therapy can include several modalities for pain and manual therapy may be used in an effort to increase range of motion and function. But the capsule changes slowing and the process painful. The benefit of having a myofascial trigger point “frozen” shoulder vs an actual adhesed capsule is the recovery. Pain is usually experienced with motion in all directions because the entire rotator cuff is usually involved. But trigger points are much easier to treat than an adhesed capsule. Trigger points can be treated within a few treatments, often full motion can be restored and restoring function is quick.
The reason why the recovery is quicker and easier is because myofascial trigger points are in the muscle. They are sarcomere contractures that impede the blood flow, which in turn causes damage to the tissue. The tissue and cells respond by releasing pain producing chemicals, just as they would with any other trauma. But when the trigger point is treated and eliminated, the contracture is released, the muscle is restored to its normal length and strength, and the pain reduces or subsides.
If a patient has a true adhesive capsulitis, a history of a frozen shoulder that is ‘thawing’ or has thawed, myofascial trigger points may still be a contributing factor. And are just as easy to treat. Again, when the eliminated with a classic frozen shoulder, the pain can be reduced, producing a manageable pain level through the thawing period.
Trigger points are easy to find if you know what to look for. Our therapists at First Coast Rehabilitation have been trained in myofascial trigger point therapy, including dry needling. If you are experiencing constant or re-occurring shoulder pain, it could be, in total or part, from trigger points. If you suspect this is the case, please see our ad and call one of our clinics today.
Rob Stanborough was one of the first PT’s to be permitted to use DN in FL and doing so since 2017. He has trained others in DN since 2010 both nationally and internationally as a Senior Instructor for Myopain Seminars (www.myopainseminars.com). He is a co-owner of First Coast Rehabilitation, est 2006 (www.firstcoastrehab.com), has presented and published regarding DN and co-authored Myofascial Manipulation: Theory & Application, 3rd ed by Proed Inc.