Frozen Shoulder & Yoga

In April 2020, I started to experience a diminishing of range of motion in my shoulder that I was well-versed with as I facilitated Anatomy training in multiple rounds of Yoga Teacher Trainings in Chicago. Included in the anatomy training was a module on injuries, and you guessed it... frozen shoulder was one of the conditions I taught burgeoning yoga teachers. It's one thing to teach about an injury or condition, and it's another thing to actually experience it in your own body. 

What is Frozen Shoulder?

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and limited range of motion in the shoulder. The condition occurs when the capsule of connective tissue that surrounds the shoulder joint becomes thickened, inflamed, and tight, limiting the ability of the shoulder to move. This results in pain and stiffness in the shoulder, making it difficult to perform activities such as reaching overhead or behind the back. As the condition progresses, the range of motion in the shoulder may decrease significantly, with some patients experiencing a complete loss of movement in the affected shoulder. Treatment for frozen shoulder typically involves physical therapy, exercise, and in some cases, corticosteroid injections or surgery.

Frozen shoulder typically goes through three distinct stages:

1. The freezing stage: This stage typically lasts between 6 and 12 weeks and is characterized by the onset of pain and stiffness in the shoulder. The shoulder may become increasingly painful and difficult to move, and the range of motion in the joint will start to decrease.
2. The frozen stage: This stage lasts between 4 and 6 months and is characterized by a decrease in pain, but an increase in stiffness and a further reduction in the range of motion in the shoulder. This stage is also known as the "adhesive" stage as the capsule around the joint begins to shrink and thicken.
3. The thawing stage: This stage lasts between 6 months and 2 years and is characterized by a gradual improvement in range of motion and a decrease in stiffness. Pain usually continues to improve during this stage, but it may still be present in some cases. In this stage, passive motion, as well as active motion, should be done in order to regain the range of motion.

The duration of each stage and the overall recovery process can vary from person to person and can depend on several factors such as age, underlying medical conditions, and the severity of the frozen shoulder.

There is some evidence to suggest that menopause may be a risk factor for developing frozen shoulder. Some studies have found that women who have gone through menopause are more likely to develop adhesive capsulitis (frozen shoulder) than men or premenopausal women.

However, it is important to note that the exact relationship between menopause and frozen shoulder is not well understood, and more research is needed to fully understand the connection. Hormonal changes that occur during menopause may play a role in the development of frozen shoulder, but other factors such as underlying medical conditions, injury, and surgery may also contribute.

Additionally, frozen shoulder is generally more common in people who are over the age of 40, so it is possible that the increase in the incidence of frozen shoulder in menopausal women may be due to the higher likelihood of the condition occurring as women age. The exact cause of frozen shoulder is not well understood, but it is more common in women than in men. The reason for this increased incidence in women is not clear, but some researchers believe that it may be related to hormonal changes that occur in the body. Factors such as diabetes, thyroid disease, and other medical conditions that affect the immune system may also increase the risk of developing frozen shoulder.

It is important that if you are experiencing pain and stiffness in your shoulder, and you are menopausal, you should see your healthcare professional for a proper diagnosis and treatment of the condition.

What Factors Contribute to the Development of Frozen Shoulder?

Frozen shoulder is a condition characterized by stiffness and a limited range of motion in the shoulder. Several factors can contribute to the development of the condition and can include:

1. Injury: Trauma or injury to the shoulder, such as a rotator cuff tear, can lead to inflammation and scarring in the shoulder joint, which can contribute to the development of frozen shoulder.

2. Surgery: Frozen shoulder is more common in people who have had surgery on their shoulder, such as a rotator cuff repair or a mastectomy.

3. Underlying medical conditions: People with certain medical conditions, such as diabetes, thyroid disorders, or cardiovascular disease, are at an increased risk of developing frozen shoulder.

4. Age: Frozen shoulder is more common in people who are over the age of 40.

5. Gender: Frozen shoulder is more common in women.

6. Immobilization: Prolonged immobilization of the shoulder, such as in a sling for a long period of time, can increase the risk of developing frozen shoulder.

In most cases, there is no clearly identifiable cause of frozen shoulder. However, there are some classification systems proposed for frozen shoulder, that are based on the underlying cause and clinical characteristics. Some of those systems propose different stages of the condition, like:

• Trauma-related frozen shoulder

• Idiopathic frozen shoulder

• Secondary frozen shoulder

and others are focused on the duration of symptoms or the level of pain intensity.

It is always best to consult with a doctor or physiotherapist to determine which classification of frozen shoulder you have and what the best course of treatment is for your particular case.

Can you Practice Yoga with Frozen Shoulder?

The short answer is yes. I practiced yoga the entire 2+ years of having this condition. The real question is how. Practicing yoga with a frozen shoulder can be challenging, as it typically causes stiffness and pain in the shoulder joint. However, with a gradual, mindful approach, it is possible to safely practice yoga with a frozen shoulder. Here are a few tips:

1. Start slowly: Avoid pushing yourself too hard too soon. Start with a few gentle stretches to warm up the shoulder and ease into more complex movements.
2. Focus on range of motion: Yoga poses that focus on increasing range of motion in the shoulder joint can help to improve flexibility and reduce stiffness.
3. Avoid pain: If a pose causes pain, stop immediately and either modify the pose or skip it altogether.
4. Use props: Use props such as straps, blocks, or blankets to support the shoulder and reduce the need to use the affected arm.
5. Use your other hand: If you want to raise your affected arm overhead, use your other hand to hold onto your wrist or hand to help the arm up. Continuing to move your shoulder through as much range of motion as you can helps to break up the thickening that’s developing in the joint. 
6. Learn to breathe through the pain: Deep breathing can help you relax and manage pain during yoga practice.
7. Listen to your body: Pay close attention to how your body feels during each pose, and make adjustments as needed.
8. Avoid high intensity: stay away from any high-intensity yoga, like power yoga or vinyasa that requires a lot of upper body movements.

Remember to consult with a doctor before starting any exercise routine, especially if you have a pre-existing condition. A yoga instructor can also help you come up with modifications and poses that will be the most beneficial for you and can show you how to perform poses safely, avoiding any further injuries. If you can find a yoga teacher who has experienced frozen shoulder, even better!

What are the Best Exercises for Frozen Shoulder? 

Exercise can help to improve range of motion and reduce pain in the shoulder. Here are a few exercises that may be helpful for people with frozen shoulder:

1. Pendulum exercises: Stand with your affected arm hanging straight down and use your other arm to gently move the affected arm in a small circle. Gradually increase the size of the circle as the shoulder becomes more flexible.
2. Isometric exercises: Sit or stand with your back against a wall, and press the back of your affected hand into the wall. Hold the contraction for 5-10 seconds, and then relax. Repeat several times.
3. Passive range-of-motion exercises: these exercises use assistance from a therapist or another person to move your arm through a full range of motion. These can include gentle shoulder stretches, rotations, and circumduction exercises.
4. Active range-of-motion exercises: these exercises are done by the patient independently and they can include shoulder stretches and rotations done with small weights or a resistance band.
5. Strengthening exercises: Once the shoulder has improved with range of motion exercises, some light strengthening exercises may be added. These can include shoulder presses and rowing exercises using light weights or resistance bands. 

*It is important to note that these exercises be done gradually. Being mindful about how you progress through these exercises will either help you progress or if you push too hard, or too fast will cause you to regress and possibly endure more pain.

The above exercises should be done under the supervision of a physical therapist or doctor to ensure that they are safe and effective for your particular condition.

It's also vital to listen to your body and avoid any exercise that causes pain. Gradually increase the intensity and frequency of your exercise routine as your shoulder improves.

Using Kinesiology Tape with Frozen Shoulder

Kinesiology tape is a type of elastic therapeutic tape that is often used to help with musculoskeletal injuries, including frozen shoulder.

It is thought to work by providing a mechanical lift to the skin, which can help to reduce pain and inflammation in the affected area. Additionally, the tape is believed to provide a small amount of compression to the soft tissues, which may help to improve circulation and promote healing.

It can be used to help in the following ways:

1. Pain management: Rock tape can help to reduce pain and inflammation in the shoulder joint, which can make it easier to perform exercises and other daily activities.
2. Support and stability: The tape can provide support and stability to the shoulder joint, which can help to prevent further injury and promote healing.
3. Improving range of motion: It can also be used to create a mild amount of tension and assist with a specific range of motion in the affected shoulder, which can help to improve flexibility and reduce stiffness.
4. Feedback mechanism: when applied properly the tape can provide a form of proprioception (feedback) to the patient and the therapist allowing them to understand better the patient’s limitations and progress.

It's important to note that it is best to consult with a physical therapist or doctor before using rock tape, as they can show you how to properly apply the tape and ensure that it is safe and effective for your particular condition. They can also guide you in determining how much tension to apply, how to apply it, and for how long to keep it on. It's also important to note that Rock taping is not a standalone treatment for Frozen Shoulder, it should be used in conjunction with other treatments such as physical therapy and medication.

If you, or someone you know, is experiencing frozen shoulder (or a rapid decrease in the range of motion in your shoulder joint) it's important that you visit a qualified health professional to get a diagnosis and rule out any other shoulder injuries. This is hugely important as your treatment will vary based on your diagnosis. 

Have you ever experienced frozen shoulder? Leave a comment and share your story! 

Resources: 

1. Knoph, Karl Dr., Heal Your Frozen Shoulder: An At-Home Rehab Program to End Pain and Regain Range of Motion
2. Anderson, Bob, Stretching

You can purchase these resources in my Amazon shop.  

These resources helped me through the stages of frozen shoulder but, again, it is important to note that this is an injury that takes a good amount of time to resolve.