What Hongkongers can do about frozen shoulders: exercises, why we get them and tips on avoidance
Frozen shoulders are painful, frustrating and still much of a mystery to the medical profession. We spoke to two specialists on what treatments exist and how to best prevent the problem in the first place
When Wong Huey-maen first experienced pain in her left shoulder five years ago, she dismissed the soreness as a muscle ache and hardly gave it a second thought. But it soon worsened. Within months, she could no longer carry heavy weights. Even simple movements, such as cleaning the table or reaching for something on a high shelf, could trigger a sharp pain in her shoulder.
Looking for a solution, Wong, now 50, has been to nine acupuncture sessions, taken Chinese herbal medicine and seen two osteopaths. She even tried out alternative medicine such as bioresonance therapy, where electromagnetic waves are used to treat physical ailments. But to her disappointment, nothing seemed to work. “At most, they provide temporary relief. So instead I just have to avoid certain movements, which can be extremely troublesome,” Wong says.
Physicians have diagnosed her condition as “fifties shoulder” or “frozen shoulder”. Both terms are commonly used to describe conditions involving shoulder pain, the third most common musculoskeletal complaint after neck and back pain. However, like many others, Wong is still struggling to understand what her condition is and how to treat the pain.
Physiotherapist Malcolm Minns, from Byrne, Hickman and Partners physiotherapy clinic, says “frozen shoulder” is often used incorrectly as a catch-all term for people with shoulder pain. “‘Fifty-year-old shoulder’ is also a nonsense term that is neither a diagnosis nor a description of a problem,” he adds. “Nobody is diagnosed with ‘middle-aged back’ or ‘70-year-old knees’.”
Frozen shoulder, also known as adhesive capsulitis, occurs when the soft tissues or muscles around the shoulder joint become inflamed and scar tissue develops. It is often confused with other conditions such as degenerative changes in the rotator cuff, which is a group of muscles and tendons that surround the shoulder joint and keep the head of the upper arm bone securely within the shoulder’s shallow socket. In the case of a true frozen shoulder, however, the biggest distinction is the loss of passive range of motion.
“The shoulder is literally adhered. It’s stuck,” Minns says.
Wong’s physicians are hardly to blame for failing to resolve the pain. Aside from knowing that frozen shoulders are more common in women and those with diabetes, the diagnosis, pathology, causes and most effective treatments for the condition are still unclear.
According to chiropractor Antonio Wong Chun-wah, some medical practitioners have suggested that poor posture is a potential cause.
“People are constantly craning their necks to look down at their phones,” he says. “This puts a lot of pressure on the spinal cord, especially the cervical vertebrae, where the nerves are connected to the shoulders. This can therefore increase the tension in the shoulder muscles.”
There are many approaches to treating the condition. Though surgery is rarely required, the most common procedure is manipulation under anaesthesia to stretch the shoulder capsule – though this comes with the risk of injuring the rotator cuff. Traditional Chinese medicine practitioners often use a combination of herbal medicine and acupuncture to reduce inflammation in the muscles, while physiotherapists might use shock wave therapy or electromagnetic stimulation to stretch the capsule and improve mobility in the joint. The process, however, can be excruciating.
None of these methods offer the perfect cure. A frozen shoulder – which goes through three phases: freezing, frozen and thawing – must run its course and treatments can only help speed up the process.
Minns believes the key to both preventive care and recovery is exercise. “Most other things may help in the short term or provide a little bit of symptomatic relief. But an active exercise programme is the most effective treatment in the long term,” he says.
“People like to be passive recipients – ‘Treat me, make my pain go away.’ It doesn’t work like that. Having something done to you isn’t intrinsically changing anything in your shoulders. People need to be actively involved.”
Wong Huey-maen has come to realise a similar thing. She had always been puzzled about why she developed shoulder pain, given she is a clerk and rarely does any heavy lifting. “Surely my shoulders would not suffer from overuse,” she says. “And Chinese doctors always say the same thing: your muscles are inflamed, you need to rest. But slowly I’ve learned that underuse of muscles can also be a problem, and that regular exercise is necessary and can help the body heal.”
Knowing the correct exercises is important as the wrong ones may further aggravate the pain. Minns recommends resistance training to improve the rotator cuff’s strength and stability, such as lateral raises and bent over rows.
For lateral raises, keep your back straight, brace your core, and slowly lift lightweight dumbbells out to the side until your arms are parallel with the floor, elbows slightly bent. Then lower them back down. Aim for 10 to 12 repetitions.
To do a bent over row with a resistance band, stand with your feet shoulder-width apart. Bend your knees and lean forward from the waist, holding the resistance band taut with straight arms. Then pull your elbows up behind you, bringing the band close to your chest. Pause before slowly lowering the band.
For those with more acute pain, Antonio Wong suggests the finger walk – stand with your face to the wall, about an arm’s length away, then walk your fingers up the wall as high as you can.