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How Naturopathic Medicine Can Help Thaw Out a Frozen Shoulder

Tanya Hollo Head Shot2By Tanya Hollo, Boucher Student (Cohort ND14)

“O, that this too too solid flesh would melt
Thaw and resolve itself into a dew!” - William Shakespeare, Hamlet 131-132

It's springtime in New Westminster: the cherry trees are blossoming, the birds are singing, the ground is thawing, and, luckily, so are the shoulders of some of the patients that the Boucher Naturopathic Medical Clinic is seeing. Frozen shoulder is a relatively common condition (up to 3% of people will experience it at some point 1) that has three characteristic stages, including a freezing stage (Stage 1), a frozen stage (Stage 2), and like spring, a thawing stage (Stage 3). Treatments for this painful condition range from a watch-and-wait approach to surgery, and although frozen shoulder is somewhat enigmatic and quality research is somewhat scarce,1 Naturopathic Medicine can play an excellent supportive role in management and healing.

Known medically as adhesive capsulitis, frozen shoulder is a condition that can affect anyone, but tends to occur more commonly in people over 40, in women, and in people who have diabetes.1 The condition is characterized by a progressive loss of range of motion, especially with shoulder elevation and rotation, and increasing pain in the absence of trauma or injury to the area. Those who have experienced the condition, or are acquainted with someone who has, will know that “frozen” is not synonymous with “numb”: the condition tends to be quite painful, and can interfere significantly with daily activities and quality of life. Restricted joint movement and pain is often worse at night, and can interfere with sleep, which further limits daily activities and healing, and can contribute to depression. The three characteristic stages of frozen shoulder are generally seen regardless of the length of time the condition takes to heal. Untreated, frozen shoulder is self-limiting, meaning it heals on its own, within two years. This means that it often takes up to two years to progress through the three stages, and a diagnosis of frozen shoulder can severely impact a person's ability to function over quite a long period of time.

The pathophysiology, or cellular mechanisms of disease, of frozen shoulder are not completely understood. The shoulder or glenohumeral joint is very complex. It is called the glenohumeral joint because it is an articulation between the glenoid fossa of the shoulder blade, and the humerus. Several ligaments attach the humerus to the shoulder blade, and the joint also has a joint capsule that surrounds it. It is this joint capsule that is affected in frozen shoulder, and this is where the term adhesive capsulitis comes from. There is some speculation that there may be an autoimmune component to some cases of adhesive capsulitis, as is seen in conditions like rheumatoid arthritis and celiac disease. A keynote symptom of frozen shoulder is that the active and passive ranges of motion are equally limited, meaning that if you try to move your arm and I try to move your arm, it will get stuck in the same place. If I can move it farther than you can on your own, it is more likely that the muscles of the rotator cuff are causing the pain. Even when it is frozen shoulder, it is common for there to be stiffness and trigger points (areas of localized tenderness) in these muscles. It is important to include these trigger points as part of a comprehensive approach to treatment.

Goals for treatment of frozen shoulder will vary from patient to patient, but will likely include increased range of motion and decreased pain. If possible, shortening the course of the condition is desirable. Standard medical treatments for frozen shoulder include watch-and-wait (benign neglect), physical therapy, steroid injections into the joint (intra-articular corticosteroid injections), chiropractic-type adjustments either with or without anesthesia (closed manipulations), and surgery (arthroscopic capsular release).2 Most published evidence does not offer strong support to these approaches,3 but many case studies exist that do. Naturopathic medicine is well suited to help treat the condition, because several of the commonly used approaches fall within our scope of practice, including joint manipulation and range of motion exercises. Additionally, I've seen improvement in this condition using injections of vitamin B12 into local trigger points, cold laser therapy and ultrasound, soft tissue mobilization, and a whole-person approach that includes stress management, blood-sugar control, and acknowledgement of any underlying emotions that may be contributing to the shoulder freezing.

Naturopathic medicine's foundational principles are fundamentally different from conventional approaches to medicine, but this doesn't mean conventional medicine does not have a place. Indeed, most physical conditions do better with a multidisciplinary, integrated approach than with any single modality. Because we treat the cause and treat the whole person, we come up with individualized treatment plans for patients. One person's shoulder may be frozen for different reasons than another person's, and we take this into account when working with you. That we use the healing power of nature means we may use botanical medicine, nutritional counseling, homeopathy, and a range of physical medicine techniques to stimulate your shoulder's ability to heal itself. Student clinicians at the Boucher Clinic of Naturopathic Medicine – who are supervised by licensed naturopaths – have extensive training in all of these areas, and can help to get you back on track.

1. Ewald, A. (2011). Adhesive capsulitis: a review. American family physician, 83(4).
2. Hannafin, J. A., & Chiaia, T. A. (2000). Adhesive capsulitis: a treatment approach. Clinical orthopaedics and related research, 372, 95-109.
3. Green, S., Buchbinder, R., Glazier, R., & Forbes, A. (1998). Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy. BMJ: British Medical Journal, 316(7128), 354.

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