Frozen Shoulder and Yoga – Do they go together?

Guest post by Mike Munro, PT

Should You Practice Yoga With A Frozen Shoulder?

Frozen shoulder is technically called adhesive capsulitis. The question of whether you should be practicing yoga with a frozen shoulder is not so simple to answer. Where you are in the stages of frozen shoulder matter a great deal! Please, before self-diagnosing, much less trying to do too deal with it, make sure you get a proper diagnosis and a professional opinion.

Anatomy of The Shoulder

• The shoulder joint is a ball and socket joint.
• Three bones come together to make the shoulder girdle: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone).
• The ball is the round head of the humerus which fits into the socket created by the scapula.
• The shoulder capsule surrounds the shoulder joint where the bones come together.

Characteristics of Frozen Shoulder

Some things are common to frozen shoulder that are not found in other conditions. If you really have this condition and have not been misdiagnosed, which is not uncommon, then the condition should behave quite consistently in the following ways:

Active movement is stiff and/or painful in most directions and so is passive movement. This contrasts with a tendon tear of the rotator cuff, for example, which may have limited active movement yet passive limitations are much less. It is important to have a clear diagnosis, and you may need a physical therapist assessment to determine this.

The phases of freezing, frozen and thawing are the hallmark pattern of frozen shoulder. It starts off sore, and not as stiff, often aching at rest and then gradually the pain lessens as the second phase sets in. The second phase is marked by decreases range of movement in all or most directions, yet the pain is now mostly produced at end range and is not as acute with less pain at rest. The final phase sees a lessening of all pain and the range of movement gradually comes back. This whole process is somewhat resistant to treatment effecting a more rapid recovery, so treatment is more focused on managing the process and optimizing recovery rather than a cure.

Studies have shown that the duration of the whole process varied from 1 year to three and a half years (McKenzie 2000.)

Possible Risk Factors May Include:

• Diabetes
• Hypothyroidism
• Hyperthyroidism
• Parkinson’s disease
• Cardiac disease
• Immobilization of the shoulder for some period of time due to surgery or injury
• Previously had a stroke
• Heart disease
• Cervical disk disease
• Open heart surgery

Good News and Bad News

The good news about frozen shoulder is that it gets better on its own. There is some evidence that exercise at the right stage can improve function, yet most people will recover even without regular therapy.

I tell people that I can help them with recovery yet reassure them that slowly but surely it will get better on its own as well. Most people will agree to doing some exercises to help optimize recovery and try to get function back sooner and will hopefully with greater strength as the condition resolves.

The bad news is that it takes its own sweet time lasting anywhere from one to three years, with most people recovering full function while some are left with some residual stiffness. The first part of the condition is the most resistant to treatment or exercise and the shoulder will generally only get sore with stretches and mobilizations. Once the shoulder freezes and is less painful, moving within available range will at least be possible without aggravation. Real changes in function will not be seen until the third “thawing” phase of the condition.

Staying as active as you can is important so keep moving. For people practicing yoga you may have to do more standing and floor poses with the arm in modified positions temporarily, such as warrior 2 with a hand on a hip. In general, keep your body moving: walking, hiking, modified gym routines, whatever you can manage.

Physical Therapy for Each Stage according to MDT (Mechanical Diagnosis and Therapy, aka the McKenzie Method.)

1. At first all but painless movement is avoided. Pendular exercises where you wave the arm dangling like an empty coat sleeve, are an option . Active movements that cause pain are avoided as they will more likely cause unnecessary bouts of increased pain. The pendular exercises may help decrease the constant ache that comes with the first phase. Nsaids are often recommended yet one has to weigh the costs and benefits. There are increased risks of GI problems, which can be quite serious, while the benefit of them is only some temporary relief in a condition that will naturally resolve.

2. The condition will improve even without treatment yet most people like to try and do something pro-active and this phase is where that becomes more available. One can move into available range even if it produces some end range pain as long as there is not increase in pain afterwards. Still it will take time and it is often not until stage three that any noticeable improvement starts to show up.

3. This stage is usually the most responsive to exercise. McKenzie recommends working at internal rotation of the shoulder (hand behind the back positions), before external rotation (eg. arm elevated with elbow out to the side: goddess arms) , as working the external rotation first will often be more aggravating. Eventually, once the internal rotation is improved then progress to working external rotation and elevation from there. Specific guidelines for exercise during the second and third phases of Frozen Shoulder can be found on pages 46 and 78 in the self-management book “Treat Your Own Shoulder” by Robin McKenzie.

Frozen Shoulder and Yoga

What this means for frozen shoulder and yoga practice is simply “patience”. You can modify your practice as to not aggravate the condition in the first phase, try to include more movement where possible in the second phase and then start to explore more range and stretching with the shoulder in the final phase. You simply have to modify, do what you can and avoid aggravating the shoulder until is it ready. This may mean your practice does not include regular sun salutes during the first phase and second phase, and can gradually re-introduced during the final phase with whatever range of movement you have available. If you are following the MDT (McKenzie) approach an emphasis on the hand behind the back variations will be more productive than working the arm overhead: this is during the second and third phases of the condition.

References:

http://www.mckenzieinstitutecanada.org/
McKenzie, May. The Human Extremities. Mechanical Diagnosis and Therapy. Spinal Publications. New Zealand, 2000.
McKenzie. Treat Your Own Shoulder. Spinal Publications. New Zealand, 2009.