- Hey guys, I hope you're well. Today, we're talking about frozen shoulder and by the end of this video, I hope that you will have
a really good understanding of what frozen shoulder is
and what you can do about it. Now, frozen shoulder is a
very complicated condition. So I'm going to break this video down into different sections. The first, we're going to have an overview of what a frozen shoulder
is and who it affects, then we're going to discuss
a bit about observations and how people move with frozen shoulder, then we'll go into some
anatomy of the shoulder, so that you can understand
exactly what's going on in relation to you and then
we'll look at some stretches and then lastly, I'll just briefly touch on some nutritional and
lifestyle tips as well. Now this could potentially
be a fairly long video. So if you want to skip straight ahead to whatever section most interests you, then I've put the timestamps up just here. So you can just fast forward
to wherever you want. Now, just before we do get started, I just want to say that
if you are in pain, go and get your shoulder
seen to by a doctor or another qualified
healthcare practitioner first, who is able to examine and diagnose you. The last thing you want to
be doing is using YouTube as a platform to diagnose
your own conditions. So, go and get it seen to. So, anyway, without further ado, let's talk about frozen shoulder. So what exactly is a frozen shoulder? Well, as I said earlier, it
is a complicated condition where the mechanisms
behind how it develops are not fully understood, but it's characterized by a
generalized pain in the shoulder and a progressive loss of mobility. So when assessing patients, they often have very nonspecific
pain around the shoulder and they will have difficulties
in moving their arms in all directions, as
I'm showing you here. You would often see patients
compensating in the body in order to improve their reach. So, you'll often find them
shrugging their shoulder or bending their spine as a way to try and get that arm
to move in more range. Frozen shoulder typically affects women more than it does men with about 1.4 women to every one man being
affected by frozen shoulder and typically, you're looking
between the ages of 40 and 65, who are the most commonly affected. Now, there are many different
names for frozen shoulder with adhesive capsulitis being
the most frequently used. However, the medical
profession seem to be moving further and further away
from using that terminology. So, we will just tend to
stick to frozen shoulder, especially for the use of this video. Now you can get two
types of frozen shoulder, primary or secondary. A primary frozen shoulder
is with an unknown cause. It has just developed
with seemingly no reason. A secondary frozen shoulder is when you can usually attribute
it to a certain trauma or surgery or medical condition, most commonly a hyper or hypo thyroidism, high cholesterol or diabetes. Now, regardless of
whether a frozen shoulder is primary or secondary, it
typically follows three phases. The first is called the freezing stage, the second is the frozen and then the third is the thawing phase. So phase one, the freezing phase is also known as the painful stage because typically, this is
the most painful stage of all. It is characterized by
aching generalized pain with progressive loss of
mobility in the joint. Now, this stage can last anywhere between three to eight months and
patients often have difficulties in pinpointing the exact
location of the problem and during this phase, it's
also common for spasms to occur such as in the trapezius or the neck. Pain is often worse at night and patients will often
find that they're woken up throughout the night, especially if they roll over
onto that affected side. They will often also have difficulties in doing certain basic daily movements, such as reaching into the back pocket to try and get their wallet or reaching behind to
try and fasten up a bra or even trying to just
simply brush their hair. It is also possible for pain to radiate away from the shoulder,
such as down the arm or up into the neck and
both passive and active range of motion is lost. So passive is when I as a practitioner might be trying to feel how
much that shoulder can move and active is how much you can move it with your own muscles and the most common
movements that are affected are abduction with external rotation, so for example, brushing your hair or extension with an internal rotation, such as trying to get that
wallet out of your pocket. So, phase two is known as the frozen stage or the adhesive stage
and during this phase, patients will often report
that there's less pain, but there's also a lot
less movement as well. Now, although there's less pain, anytime a patient tries to move their arm into any extremity, they
will definitely feel pain. Now, this phase typically lasts
between four to six months, although I have seen a lot longer. Now lastly is phase three and
this is the recovery phase, also known as the thawing phase. Now this can happen spontaneously and there's no particular
known explanation as to when it happens or why it happens. But this phase can last anywhere
between six to 24 months. There will gradually be an
increase in the range of motion and also, pain will be fairly
minimal during this phase, but there can be periods of
time when pain does increase, but this is only temporarily. So now we have briefly discussed
what frozen shoulder is and how it appears, we're now
going to go and have a look at some of the anatomy of the shoulder and I'm going to explain how the anatomy relates to what's going
on with frozen shoulder. All right, guys, so what we have here are two models of shoulder joints. This is a right shoulder
and this is a left shoulder. So almost as though you were looking at me and we're taking everything
away apart from my shoulders. So this is the front of both shoulders and so if we spin them
around, this is the back. Now, we're going to look
at this one here first. This is representing the
rotator cuff muscles. So we've got four muscles,
supraspinatus, infraspinatus, teres minor, and the subscapularis. We're not going to discuss
the muscles themselves. If you want to learn a bit
more about the muscles, go and check out my other video, "Understanding Shoulder
Pain and How To Fix It," where I describe what these muscles do, but what I wanna show you is that, if we take these muscles away and we strip this joint
right back to only the joint, what you can see here is the humerus, so this is your upper arm
bone and this is the scapula. So this is the front and this is the back. If you look over here,
you can see the joint. So the joint is made up of something called a ball and socket joint. The head of the humerus
is known as the ball and then this glenoid fossa, that's what this is called
here, the glenoid fossa is known as the socket. In order to maintain freedom of movement, within every joint is
something called synovial fluid and what this fluid does is it
allows friction free movement between the surfaces of the
two joints or the two bones. But in order to keep this
fluid within the joint, the body needs to keep it there, so it encloses this joint in
something known as a capsule. The capsule is a fibrous sac
that keeps this fluid within. Now this capsule is relatively inelastic but in the shoulders,
it's actually quite loose, so it allows freedom of movement. But if this joint was to gap too much, it will become tighter and tighter, you know, like if you had a piece of cloth and you stretched it and stretched it, there's only so much it will stretch. So that's what happens
in normal shoulders, it prevents excessive gapping. However, in frozen shoulder, it's this that's what causes
the restriction in movement. So let me just show you
now what this capsule looks a bit more like. So if we bring this one over here, here, you've got the scapula
again and the humerus bone. If you just have a look
at the front side here, this is the front side of the capsule. If we spin this around,
you can see the backside of the capsule and it goes all the way around the whole joint. So, this is the underside here. In normal shoulders, it's
this underside portion that's relatively lax,
but in frozen shoulder, it's this that becomes
tightened, it becomes restricted. There are a few things to point out. This here is part of the
muscle of the infraspinatus and then around the
front, this is the muscle that's been cut of the subscapularis. So these two muscles cause
internal and external rotation in your shoulder. So imagine, you've got your
elbow down by your side and you take your hand out,
that's external rotation and if you bring your hand
in, that's internal rotation. So these two muscles here are
responsible for that rotation. If we look at the side, this green blob like thing
here is called a bursa. Now, a bursa is a fluid filled sac and what it does is it
allows freedom of movement between the two structures. It could be between two muscles or between a muscle and
some ligaments, for example. This is the subacromial bursa here. The reason why I pointed that out is because in frozen shoulder, what happens is the
underside of this capsule becomes restricted, it becomes fibrous, it becomes tightened, but also, this subacromial bursa
becomes thickened as well and also, I don't know if you can see, but just in there is a ligament, it is that number eight
ligament just there. This is called the coracohumeral ligament and this also becomes
thickened and fibrous as well. So we have the capsule,
the bursa and the ligament that all become thickened. Now what's also worth mentioning is that the subscapularis muscle, so the front muscle of
this shoulder blade, also seems to become
thickened and tightened. So, it's these four structures
that become tightened in frozen shoulder and that's
what restricts the movements. So speaking of movements,
let's go and have a look at what the movements are like with people who have frozen shoulder, and then we'll go into
some stretches as well. Okay, so in terms of movements,
these are the movements that people struggle with,
with frozen shoulder. We have flection. Now this is a normal range of
flection, from here to here. When people have frozen shoulder, it can often be about as much as this. Then we have abduction, so this is taking the arm away from us and all the way up to the ceiling. People with frozen shoulder can get to usually about 90 degrees, then you start to see
this shoulder hitching up and then they start to bend over. Then we have extension, this
is a normal range of extension. People with frozen shoulder end
up being just to about here. Then we have coupled movements, things such as abduction
and external rotation. So that would be like brushing hair. Now people with frozen shoulder may only be able to get to about here. Then we have extension
and internal rotation. People with frozen shoulder tend to just be able to get to the gluteal fold or even just slightly above, but very rarely any higher than that. So now what we're going
to do is go through all of those ranges of
motions in terms of stretches, I'm going to show you a
few different variations for each movement. Now you don't have to
do every single stretch for each movement, just do the ones that feel the best for you. Okay, so just before we
start any of these stretches, there's just one thing
I want to say to you and that is, from the
research that I have read, people seem to get the most
benefit from stretching, not too much into pain,
so gentle stretching. So, rather than really trying
to force this range of motion, just stretch to where you
feel a slight discomfort and you can tolerate it and
you could hold that position for time, hold it in that
position and just stay there, so don't push it too hard. So the first stretch we're going to do is a flection stretch, so we're trying to improve
this upward reaching movement. So what you can do is grab a broomstick, sit on a chair and position the broomstick a little bit far away from you. From here, all you need
to do is push your arm out and just feel wherever you
feel that stretch and pause. You could hold that there
for as long as you want and then come back in. So you could make it
dynamic, if you want to, or you just push it out and hold. Obviously the further out you go, the more flection you're
going to get in the shoulder. Now, if this is too easy, what you can do is start with the broomstick farther away and then just lean forward into it. So as I lean forward,
I'm getting more flection through the shoulder. Feel where you feel that stretch just starting to come on and hold. You can use your other
hand here for support or your other elbow for support and hold. I would suggest start
with about 20 seconds and build it up to about a minute. Obviously, if you feel
pain, then just stop. Now, if you want to do
flection on the floor, again, you could do it with a broomstick, you could do it with two
hands and take your arms over as far as they'll go and
pause and hold that there. So you're letting gravity
just pull your arms down towards the floor. It doesn't have to be with a broomstick. You could just do the
affected side, just like this. Now with gravity, that's
gonna put a bit more strain going through the shoulder, so it might be less comfortable for you. So what you could do is get some pillows and position that behind you and so, as you're coming
down into this stretch, you use some support just
to stop you going too far, so it stops you from overstretching. So if I feel a stretch
here, I can hold that and I can stay in that
position for as long as I want, five minutes, 10 minutes,
even up to half an hour. There's no reason why you
can't stay in a position for a long period of time and evidence has shown
that a long stretch, a long duration stretch
with minimal tension is actually very beneficial for
people with frozen shoulder. So, you can also stretch
your shoulder into flection with one of these, a Swiss ball or a gym ball or stability ball. What I would do is put
this ball on top of a table or a desk and that way,
you can stay standing and you can push that ball further away. So what you need to do,
position it towards the end of your desk or table,
put your hand on the ball and just simply roll it
forward, roll the ball forward and what you'll notice is
that as I roll with the ball forward, you can see my shoulder
going through this flection and back to neutral,
flection and back to neutral. So just go to wherever you
feel comfortable, pause, and then roll it back in. Now, if that's too easy and
you want to progress that a little bit more, what you can do is put your hand on
your table or your desk and lean forward just a little bit more and roll the ball forward,
leaning into that, pause, and then bring yourself back up. So you could do this for repetitions. I would do probably about
15 repetitions, hold and just make sure you're
not going into pain. So you don't want to be
stretching and causing pain. Now, if you want to bring your arm into an extension stretch, what you can do is grab your broomstick and position it up against a wall. If you have a ledge like
this, this is brilliant because it's going to help to
stop the broomstick slipping. So what you can do, grab
the end of your broomstick, face the wall and just
gently step forwards and as you step forward, you'll notice that your shoulder
is coming into extension. When you feel the stretch, just pause and just hold that there
for a period of time and then to ease that tension,
you can just step back. Obviously, the further you go, the more intense that
stretch is going to be. So, just go to wherever
you feel comfortable, wherever it's just starting to stretch. So, there's a couple of ways
now that you can do this extension stretch, but in bed. Shuffle right up to the edge and this is the bad shoulder
we're going to stretch here. You could just drop this
shoulder or drop this arm straight off the bed and just let it hang and just keep it there for as
long as you're comfortable to. If you want to increase the
intensity of this stretch, what you can do is just add
a little bit of extra weight, like a can of beans or something, and just hold that in your hand and just let that pull you down. Stay in that position
for as long as you can. So now, we'll move on
to external rotation. You can do this using your broomstick. What I would do is start with my bad arm, bent to 90 degrees from the elbow and then, just grab your
broomstick from here. Now with the good arm, you
can push that arm just out and obviously, the further out you go, the more you're gonna have
to swing it around this way, but just go to wherever you
feel comfortable, pause, and then relieve that tension. So, I'm pushing this way across, push, pause, and then it
relieves that tension. Now, one thing that might happen during this external
rotation exercise is that, you might notice that your
elbow comes away from your body and that's what you do not want to do. So make sure your elbow is
squeezed into your sides as much as you can and what you could do just to make it more challenging is put a rolled up towel just in here. So if I put a rolled up towel, you can put the towel in there
and squeeze that in there and you can do the same
thing, push it outwards. Now there's one more thing you can do for this external rotation. When you are in bed,
you can use towels again to limit the amount you're going out into this external rotation. So, you can stack up a
load of towels or cushions and you can use that to
stop you going too far. Now, as you can see, I've
got a weight here in my hand. So that's just going to
add to the resistance, just add to the amount
of downward pressure, keep it there and hold and you can hold this for
as long as bearable really, up to half an hour or 45 minutes. So the last stretch or
mobility exercise that I'm going to show you is
something called a pendulum swing. Now, you could do this
with a small can of beans or you could do this
with a small dumbbell, if you have them at home. I've got four kilo dumbbell here, but that might be a bit
too heavy for some of you. So, kind of a four pound
dumbbell should be fine, or a two kilos dumbbell. So, what you're going
to do is find something that you can put some weight through, so something you can
hold onto for stability, bend forward and let your arm just hang. Now, the first thing you
want to try and do here is just to relax all of the
muscles in your shoulder. So you're trying to let
that joint just sort of gap, just to let that shoulder just have a bit of traction going through it. Then from here, using your
body, I'm exaggerating slightly, but using your body,
allow your arm to swing. What you don't want to
be doing is staying rigid and doing it with just your arm muscles, because you're trying to move the joint and not strengthen the muscles. So, use your body to
just let the arm swing and just focus on trying to
keep that shoulder relaxed, trying not to use your shoulder muscles to move the weight and
just do that for a period of a minute or so, or 10 to 15 repetitions and then, so I'm going
forwards and backwards. So what you can then do is take
your feet into a wide stance and shift your body from side to side. So now, we're getting
this sort of abduction and adduction movement
and you're using your body just to get that swing
going through the shoulder, keep the shoulder relaxed and then what you can do
is you can use your body to start making some circles. So, you could do 10 in one direction and then, you can do 10
in the other direction. This shouldn't cause you any pain. Obviously, if it does, then just stop, but it should feel like
there's a bit of a pull going through your shoulder and it's a nice way of just
getting a bit more circulation of fluid around the shoulder joint, so it should feel quite nice. All right, guys, so we've
done a whole load of stretches and I hope that you've
been able to follow along and they all make sense. Give them all a try. Now, there are some stretches there that you might be able
to do for repetitions. You could start with 10, you
can build it up to 20 or 30 or however many you like, as long as it doesn't cause you any pain or start to inflame anything. There are some exercises that you might need to just hold a position for, in which case, you can hold for either as long as you're able
to stabilize yourself or for example, if it's an
exercise where you're lying down, then you can potentially hold a stretch for up to 45 minutes, as
long as you're stretching, not into any pain and you're
able to tolerate that stretch for that amount of time. Now, some of you might be wondering, should you stretch into pain? And the short answer is no,
do not stretch into pain. Let's say you're scaling
at one to 10 out of pain, with 10 being the most, only go into about one or
two out of 10 for pain, so it's very, very minor pain and then also, some of
you might be wondering, how often should you do this? I would say, you could do
this every day if you wanted, you could do up to two
to three times a day. Now, obviously it depends on
which stretches you're doing and how long they're going to take and how much time you have available. Pick and choose these as many as you like and do them as often as you like, but obviously, keep them
within doable limits. What I will say is that,
the more you do this, the more consistent you
are with these stretches, the greater you can expect to see results. Now, just one other point, what
I mentioned earlier is that frozen shoulder is more common in people with high cholesterol, diabetes as well. So, it's worth just considering that maybe some dietary
interventions could help you. If you are diabetic or you've
got high blood sugar levels or your cholesterol levels
are slightly too high, then why don't you use
this as an opportunity to start improving your diet. If you can manage to get
your blood sugar levels down, then potentially, who knows, potentially it might help to speed up your recovery. A couple of other things,
make sure you're going to bed at a decent time, between
10:00 p.m and 2:00 p.m is when your body is best
suited for physical repair. Now, if you're going to
bed around at 12:00 a.m, one o'clock in the morning,
11:30 at night, whatever it is, then you're missing out on valuable time that's going to help you
to physically repair. Also, I would just say as
a general lifestyle factor, make sure you're drinking plenty of water, getting a good amount of regular exercise and just staying as fit
and healthy as you can, because the healthier you
are, the better your body is going to be able to
fix its own problems. So guys, I hope you found
that video helpful today. I am sure it's a fairly long video, so I hope you stuck
right through to the end. If you found it helpful,
give it a thumbs up. If you want to see more
content similar to this, then press the subscribe button. If you know anyone else
with a shoulder problem, like you or a frozen shoulder, then share this video with them and if you have any comments
or you have any questions, please stick them in the
comments section below and I will see you guys in the next video. So, stay safe and take
care and goodbye from me. (futuristic sounds)
