Thawing a Frozen Shoulder
Chances are good that at least once in your yoga teaching career, you'll encounter a student with a frozen shoulder. In fact, chances are even better that you'll encounter many more than one, since so many of the so-called baby boomers, now middle-aged, are practicing yoga. Your student with this condition will report a stiff and painful shoulder and will probably be unable to do, or will at least have difficulty with, certain poses: those with the arms overhead, held out to the sides in standing poses, or bearing weight in Sun Salutations. Given this much pain and limitation, your student should already have seen a health care provider, and the knowledge gained from that evaluation and diagnosis will help you help your student continue to practice yoga.
Ironically, a diagnosis of frozen shoulder actually describes a hot, painful, and inflamed joint, which is technically called adhesive capsulitis. Breaking down the words can help you understand the condition: -itis means inflamed, so you know that the fibrous capsule that surrounds the shoulder joint is swollen, hot, and painful. Adhesive refers to adhesions, which is scar tissue that forms between the folds of the capsule. If you stitched the folds of a tablecloth, you wouldn't be able to open the cloth up to its full size. Similarly, with adhesive capsulitis, the adhesions won't allow the joint capsule to open fully. The tightened capsule limits the full movement of the shoulder into flexion, abduction, and rotation.
Causes and Effects
A frozen shoulder may occur due to a health problem that causes general immobilization—after an abdominal surgery, say, or during immobilization of the shoulder itself due to guarding and pain after an injury. The lack of movement, plus any inflammation due to injury, allows the adhesions to form between the folds of the joint capsule. Not uncommonly, a frozen shoulder may set in with no known cause, although the condition is common in women between the ages of 40 and 60, so hormonal changes may be a factor. Whether there was a previous shoulder injury or not, the frozen shoulder itself is quite painful, which makes shoulder movement difficult, causes more adhesions to form, and thus the condition becomes a vicious circle that can go on for months.
Fortunately, there are ways to break out of this circle. Unfortunately, the process of healing is slow even under the best of circumstances. Many physicians prescribe anti-inflammatory medications, but ice or acupuncture can also help relieve pain and inflammation. Healing can also be hastened by massage and ultrasound. Yoga, of course, is a wonderful tool to help restore the shoulder's strength, flexibility, and function—but only if it's performed thoughtfully and with patience for the long haul.
First, as you or your student look at building or rebuilding a yoga practice after an injury, it's important to be honest and present with how you deal with pain. It's rarely appropriate, while working with an injured joint, to "push through the pain" unless you are under the guidance of a trained professional. Instead, work at the point where you have significant sensation of stretch, or even discomfort—if you don't push a little into the scary place, you won't make any progress—but not so far into discomfort that you generate resistance in your body or mind. Holding the breath is a sure sign of resistance, as is the tightening and guarding of muscles trying to protect themselves from injury during an overaggressive stretch.
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