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Frozen Shoulder
We offer Continuing Education hands-on workshops, for shoulder issues. 


Some believe that Frozen Shoulder cannot be successfully treated, and that it has to simply run it's course

... I disagree with that belief.


Frozen Shoulder Treatment

I (as well as other comprehensive Trigger Point Therapists) seem to 'go against the flow' when it comes to conventional models and methodology concerning the initial approach to rehabilitation of shoulder issues.

It appears that when there is a problem with the shoulder, exercise and stretching is the primary rehab technique employed. Fundamentally, I do agree with this methodology, but only if the involved muscles have first been checked for trigger points (TrPs). Keep in mind that muscles that have trigger points will NOT build mass (i.e. strengthen). If you subscribe to the belief that the symptoms require the shoulder muscles to be strengthened then shouldn't you also ask WHY these muscles have become weak and in need of exercise?

Trigger points will almost always cause the involved muscle(s) to be weak and easily fatigue. The TrPs will also prohibit the involved muscles from building mass. Given this fact, wouldn't it make more sense to first check the shoulder area for TrPs and if found, remove them? This makes much more sense than spending a lot of time trying to strengthen a muscle that will not strengthen! Not to mention, if TrPs are present, this well intended exercise will cause further stress to the involved muscle and cause other muscles (that do similar work) to become stressed, since they now have to compensate for the muscle that is compromised by trigger points.

The usual diagnosis (and often misdiagnosis) for shoulder issues, is arthritis, rotator tear, adhesive capsulitis (frozen shoulder), bicipital tendinitis and bursitis. Of course there may be true structural damage to the joint, however trigger points are very often the true cause of the pain issue. Unfortunately most health professionals are not familiar with the effects of TrPs nor how to effectively treat them.

The Trigger Point Perspective:

Trigger points will cause involved muscle to be weak and fatigue easily. I have found that about 99% of my clients who suffer from shoulder issues, also have TrPs in the supraspinatus, infraspinatus, teres minor and subscapularus (the SITS muscles) and other scapular muscles. Of course there are other medical causes for muscle weakness and this should be checked by your primary health care provider. 

A muscle that has TrPs, will not build mass. Exercising any muscle that has TrPs, will be a waste of time since the involved muscle(s) will not build mass. And since the primary purpose of the exercise is to strengthen the muscle(s) (i.e. build mass), one has to ask if this exercise protocol should be the 'first approach' for client recovery. I'm sure all rehab specialists and fitness trainers have seen some client's shoulder symptoms exacerbated during/after exercise and stretching routines are employed.

When I talk about procedure for healing a shoulder issue, I have consistently found that a specific Trigger Point protocol must be followed for reliable success. (Please read below "Recommended Trigger Point protocol for rehabilitating shoulder issues:")

 

Shoulder Pain and Range of Motion Issues

There are many muscles involved in the movement and stabilization of your shoulder. And they should all be working in concert to maintain a healthy, pain free shoulder joint.

The supraspinatus, infraspinatus, teres minor and subscapularis, are your rotator cuff muscles. They are the first muscles that should be perused for trigger points when there is a shoulder joint issue.

Then there are the stabilizers; levator scapulae, rhomboids, pectoralis minor, trapezius, and serratus anterior... the list goes on.

So you see, there are a lot of muscle issues that could come into play, which may be causative to shoulder distress!


 

***Trigger points always refer pain in a predictable pattern.***

Therefore, depending on your symptoms, it is not too difficult to find those TrPs that are immediately responsible for your misery. Then we determine where the problem may have got its start. Perhaps an old or recent injury, work related, aggressive workouts, or perhaps improper stretching techniques.

Medical diagnosis for shoulder conditions usually focus on the joint: arthritis, bursitis, tendinitis, rotator cuff injury, adhesive capsulitis, etc. Also, this pain can be blamed on the presumed deterioration of joint cartilage. However, it can be a mistake to automatically assume that the trouble is within the shoulder joint.

Trigger points in nearby muscles are often the real cause of pain. This becomes apparent, when these knots are removed, and the pain goes away!

The fact of the matter is this: If you have trigger points and don't remove them from the involved muscles, you will NOT get lasting relief from your pain or other symptoms - period!

Recommended Trigger Point protocol for rehabilitating shoulder issues:

- Check all related muscles for TrPs, which includes the rotator cuff muscles (SITS), scapular suspension muscles and all muscles that may be an underlying cause to the perpetuation or recurrence of the issue(s).
If TrPs are found - work to remove them. Self-treatment can be effective or see a knowledgeable* Trigger Point bodyworker. During this stage, you should cease exercising and stretching the muscles that have the TrPs. This doesn't mean stop all movement (not healthy for the muscle tissue), but severely limit the strain you place to the involved muscle(s). SITS* muscles are relatively small, considering the work they must carry out every day and consequently highly susceptible to re-affliction if they are exercised or stretched while TrPs are present.

- Keep those involved muscles warm! If you apply ice to the muscles with TrPs, the treatments will fail. The cold will cause muscular contraction and further 'entrench' the TrPs, thereby causing perpetuation of the issue. Only use ice if there is inflammation or swelling... and then only for about 20 minutes. Do not place the ice directly on the skin. Typically, once the swelling/inflammation has subsided, you may then go back to the moist heat.

- Muscle is an organ and like any other organ in the body, when damaged, needs time to heal. Once the TrPs are removed, you must wait at least 2 weeks prior to starting an exercise routine. (Caution - the shoulder issue may feel better, but there still may be TrPs present.) This is crucial to allow the involved muscle to heal and return to normal function. Once the muscle has healed I highly recommend finding a good trainer (preferably one who really knows shoulders) for the next part of your rehab. You must start very gently (shoulder issues are difficult to resolve because SITS muscles are easily re-injured) and slowly build-up the exercise routine. The muscles can now build mass and strengthen the shoulder area.

Note: The same protocol is used for TrPs throughout the body, however some muscles will actually benefit from very mild (preferably passive) stretching during the TrP treatment phase of the rehab. I strongly discourage stretching for shoulder TrP related issues.

*SITS = Supraspinatus, Infraspinatus, Teres Minor and Subscapularus
 

We offer Continuing Education hands-on workshops, for shoulder issues.

Check our Workshop dates/locations

* someone who employs Trigger Point therapy (as their primary treatment protocol) on a daily basis, and has extensively studied the Travell & Simons manuals. 

Our office is closed on weekends and holidays. To book your appointment for treatment, or for more workshop information:
Phone: 250.714.6056                                                           Email: info@triggerpoint.ca             1455 Townsite Rd. Nanaimo, BC V9S 1M9
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