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The Cold Facts about the Frozen Shoulder

This article was originally published in Positive Health issue 66 – July 2001

In the course of evolution, the shoulder, of all the joints in the body, is the one that has developed the greatest flexibility. According to Bernard G Campbell, “…it seems clear…that the upper arm of modern man carries characters associated with the arm-swinging primates…”.[1]

The shoulder, or glenohumeral joint, allows flexion, extension, abduction and adduction movements. Along its length, the upper arm can also rotate inwards or outwards, movements that should not be confused with supination and pronation of the forearm. The leg can do all that too, but to a lesser degree. Combining flexion, extension, abduction and adduction, the upper limb can produce circumduction – as in shoulder-wheel exercises – something the leg cannot do.

In flexion and abduction, the hanging-down arm can be raised through a range of 180º up to the vertical. It should be noted, however, that the overhead position requires the combined movement of the shoulder joint and the shoulder girdle. And, according to the anatomist Vandervael, only very supple people can attain this. The average person can only achieve a relatively meagre elevation of 120º. To attain the full 180º, a biomechanic subterfuge is necessary, whereby the upper body inclines backwards in order to obtain the missing 60°. In other words, for most people, lifting the arm to the vertical shortens the spine by creating a swayback.

The ability to lift the arm overhead is a very useful physical attribute. With it, you can paint ceilings, comb your hair, put a hat on your head, pick fruit from standard trees, reach for those jars of jam on the upper shelves, hang up pictures, hang from bars, etc.

But, when the body is misused – and it usually is – the versatile and supple shoulder joint is liable to go horribly wrong. Raymond Dart, a Professor of Anatomy, commenting on some research by Col. IS Wright (1945), says: “The conclusion we must draw from these experiments…is that nearly ninety percent of the ‘normal’ young adult American population is malpostured…in respect of their upper extremities and their circulation. They cannot hold up their arms for any length of time without obliterating the circulation in their upper extremities.”[2]

If, after sleeping with your arm hyperabducted (lifted overhead), you wake up with feelings of numbness or tingling in the hand you will know what Dart means by obliteration of the circulation. In medical jargon, you would be told that you are suffering from ‘hyperabduction syndrome’.

Hyperabduction syndrome, though, is nothing compared with other conditions that can affect the shoulder joint. Take, for example, the case of the frozen shoulder, i.e. a painful shoulder that gradually becomes increasingly stiff in all its potential movements, sometimes to the point where no motion is possible. ‘Frozen shoulder’ is an umbrella term that can cover diverse conditions such as adhesive capsulitis, adhesive bursitis, scapulohumeral periarthritis, pericapsulitis, etc. The fact that there are so many labels that might be given to the condition known as frozen shoulder is not a good sign – it’s an admission of uncertainty and hesitation in the face of such a complex pathology. When it comes to causation, origin, tissue involvement, etc, the frozen shoulder is shrouded in mystery.

Consequently, how to avoid developing the cold shoulder, or to defrost it, is still a matter of conjecture.

In textbooks we can read that the common frozen shoulder appears without any apparent cause. If the authors of these books knew how to read and interpret the human form, and to diagnose misuse, they would not write such a thing. Why should the joint designed by evolution to be capable of more movement than any other show such a tendency to stiffness? For a satisfactory answer we have to study the muscles acting on this joint. We then realize that there exists a strong imbalance between the external rotators and the ABDuctors on one hand, and between the internal rotators and ADDuctors on the other. For two (or three, according to some textbooks) external rotators of the arm, there are five internal rotators; for two ABDuctors, there are six ADDuctors. And not only is there a great imbalance in number but also in strength and bulk.

Although this muscular inequality is normal, it can rapidly become abnormal when we indulge in misusing ourselves. Soon, the adductors and internal rotators develop excessive tension or tone. If this state of affairs is unchecked, it does not take long before the opposite muscles start to suffer whenever they are required to do their job. A vicious circle is established that leads to inflammation, tendonitis and/or adhesions in the soft tissues surrounding the shoulder joint (tendons, capsule, bursa). Pain and disability ensue until hardly any movement is possible. The frozen shoulder is not so much frozen as clamped or handcuffed by tight muscles.

The frozen shoulder has a reputation of being able to get better by itself in a year or two. Few are capable or willing to wait this long, especially in our quicksilver mode of living. Besides, this self-recovery is bound to leave sequelae, or compensatory distortions elsewhere. For those who are standing firmly on the shoulders of giants such as Françoise Mézières and FM Alexander, it is relatively easy to ‘thaw’ a frozen shoulder in a fairly short time, without even having to touch it directly (therefore without causing additional pain), provided that the condition is not too advanced. This requires a skilful ‘manipulation’ of muscular tone in order to redistribute it evenly and harmoniously throughout the whole body. But, to shrug off the frozen shoulder successfully, the patient must be ready to put his shoulder to the wheel of misuse and put his back into it as well!

1. Campbell Bernard G. Human Evolution. Aldine Publishing Company. Chicago. IL. 1974.
2. Wright IS. The Attainment of Poise. Human Potential. 3. Autumn 1970.

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