Wednesday, March 27, 2013

It's Not Scar Tissue

Three and a half years since I first posted my story, I am seeing more interest and a lot of confirmation that others have been having the same experience as me. I think a quick update will be helpful.

My left, previously frozen, shoulder is completely recovered, and has better range of motion than my right shoulder. I am right-handed, and my right shoulder probably has some damage from many years of tennis, but both sides have excellent range and no limitations whatsoever.

What is Frozen Shoulder? It's not scar tissue, it's much more like a scab. If you keep picking at a scab, it doesn't heal. It's as simple as that!

I know it can be difficult to say no to physiotherapy, because in our culture we always want to "do something." But if you keep thinking "scab not scar," the way will become clear.

Please read on for the whole story, and have a look at the many helpful comments too. Be well!

Sunday, November 8, 2009

Frozen Shoulder Experience and Treatment Options

Hi!  This single post blog is for those who have recently been diagnosed with Frozen Shoulder and are wondering what to do.  I will tell you how the condition affected me, it's progress, the treatment options that were recommended, and the choices I ultimately made about it.  Unless you or a loved one actually has frozen shoulder, I would read no further.  I plan to discuss my experience in detail, and there is no point looking for trouble if you don't have it.

First, I can tell you the whole story in one sentence:  I DID NOTHING for my frozen shoulder, and it got better on its own.  This was contrary to all the medical advice I received, but it turns out I was right, and they were wrong.

Ok, now I'll start at the beginning.

June 2008

I am not a devoted yogi, but once in a while I get the urge to iron out the kinks with some yoga.  After a few months' hiatus I started my usual routine and eventually started to go into Triangle Pose.  I put my right hand down and tried to put my left arm up, but it wouldn't go.  It didn't hurt or anything, it just wouldn't go up.  I thought that was weird, but I switched to the other side and that was ok, so I didn't think any more about it.  I think the same thing happened the next day, but then I lost my interest in yoga again and forgot about it.

August 2008

I am starting to notice some pain in my left shoulder.  It is especially painful doing up the hooks at the back of my bra each morning, and each day it seems to get worse.  It is really excruciating, I have to rest and take some deep breaths each time I do it.  I buy a bunch of front-closing bras and decide to go to the doctor.

At the appointment the doctor asked me to raise my arm to the front and to the side, and I am able to lift it about three quarters of the way up.  He then asked me to touch the centre of my back and I could not get my hand any further than my hip at that point.  "You have a frozen shoulder!" he exclaimed.  He asked me to come back in three weeks to check my progress and talk about treatment.

Of course, I immediately went home and googled "frozen shoulder", as you probably have done too.  I learned that frozen shoulder is caused by adhesions that form in the shoulder joint.  I learned about the three stages of frozen shoulder -- the painful stage, the frozen stage, and the thawing stage.  I learned that some doctors believe it is an autoimmune disorder, and this is my belief as well.  I never injured my shoulder, but I already had an autoimmune disease of the thyroid, and apparently if you have one autoimmune disorder you can be prone to others.  As is typical, it was my non-dominant side that was frozen, i.e. I am right handed, and my left shoulder was frozen.

I learned that there are differing treatment approaches depending on where you live.  The British websites tell you to do nothing, and in about a year it will go away on its own.  At least, that is what they said when I was reading them.  The American websites recommend physiotherapy to maintain some range of movement, and some websites recommend really aggressive physiotherapy, or else your shoulder will be permanently frozen!  There are two surgical treatments.  The caveman surgery involves general anesthetic and a strong doctor who manually forces the joint to move, which sometimes results in a broken arm.  The new 21st century surgery uses an arthroscope to release the shoulder joint.

September 2008

Armed with all this information I went back to the doctor for my next appointment.  Now it seemed like I knew more about it than he did!  I think a lot of doctors hate the internet.  He told me that I was going to need months and months of physiotherapy.  Now, I wanted some physiotherapy, because it seemed like a good idea to at least prevent things from getting worse, but physiotherapy is not covered by Ontario health insurance, and a lot of physiotherapy was going to be very expensive.  We agreed that I would go a few times so I could learn the exercises and then do them on my own at home.

The other treatment my doctor wanted me to get was something he called "needling", which he would do in the office.  This would involve putting an acupuncture needle into my shoulder over and over to loosen the joint.  I hadn't read about this anywhere on the internet.  I was dubious, but I made the appointment for the treatment.

The more I thought about it, the less I liked the idea.  First, I have a strong dislike of needles.  I've had acupuncture, and that was ok, but this sounded like it was going to be a lot deeper.  My shoulder joint was inflamed and sore, and it seemed like sticking needles in it would be very painful.  I kept the appointment, but refused the treatment, and just talked about other issues.  My doctor was annoyed.

At my first physiotherapy appointment the physiotherapist measured my range of motion with various oversized compasses and protractors.  It was not very good, and furthermore taking my arm to the limit and holding it there while she measured was quite painful.  At this point I could lift my arm just over halfway to the front, less than halfway to the side, and anything that involved twisting the arm or reaching to the back was out of the question.

A lot of websites talk about the pain of frozen shoulder.  I found that if I twisted my arm or put my weight on it wrong there would be a really sharp stab of pain in the joint.  I had been in the habit of pushing myself off the sofa, but something about that motion combined with the weight was sudden and excruciating and I quickly learned to use my legs to stand up again!  But unless I did something wrong, it didn't hurt much otherwise.  Sometimes I would take an anti-inflammatory like aspirin or Advil, but not often.

Sleeping is the other big challenge with frozen shoulder.  I switch around between sleeping on my stomach and sleeping on my side, and I found I couldn't sleep with my shoulder to the back at all.  I learned to sleep just on my side with my arm down and to the front.  If you sleep on your back you will probably have no problem.  For a couple of weeks I would wake up in the night after rolling into the wrong position, but my body adapted pretty quickly.

October 2008

The physiotherapist gave me a set of exercises.  One group involved holding a broom handle with both hands and using the good arm to push the frozen arm into a wider range of motion.  She also recommended using your body to swing the frozen arm forward and back and side to side.  She wanted me to buy this pulley system that you attach to the top of your door so you can use the good arm to pull up the frozen arm.

I went home and I faithfully did my exercises, morning and evening, although I put off buying the pulley.  I found that my shoulder became a lot more painful, and I had to keep up with the anti-inflammatories all day.  My range of motion was getting worse too.  This went on all month, and then for some reason one day I didn't do the exercises.  The next day my shoulder felt a lot better.  I mentioned this to my physiotherapist, and she suggested that I might be doing the exercises too vigorously.  I tried cutting back, but it quickly became clear:  there was significantly less pain if I just left my shoulder alone.  I decided to believe the British websites.  I stopped doing the exercises and cancelled the rest of my physiotherapy appointments.

November 2008

When I stopped doing the exercises my range of motion stopped getting worse, but it did not get any better.  Living with frozen shoulder is awkward, but I came up with different strategies to cope.  Driving was one area of adjustment.  I was not able to move my left arm up over the top of the steering wheel when turning, so I learned to scooch along the bottom of the wheel.  Fortunately I was always able to dress myself, the internet talks about people who can't do up their own buttons, but I retained enough range of motion to dress and wash my face.

Washing my hair was trickier, I couldn't reach that high but I found that if I bent over it was ok.  Drying my back was the most annoying thing.  Finally I realized that I could just put on a terry cloth robe and that would absorb the water on my back before I dressed.

So I adapted.  Except for yoga maybe, I don't think I was prevented from doing anything I normally do because of my shoulder.  If you are into sports, or working out, or have a physical job, then you might have to make changes for a while, but remember, it is only temporary.

January 2009

Early in January I suddenly realized that the pain in my shoulder was gone, even if I tried to twist it.  I had entered Stage Two, the Frozen Stage.  I really believe that when I stopped exercising I gave the inflammation in my shoulder a chance to die down, so I was able to progress to the second stage fairly quickly.  My range of motion was not improved at all, but I felt a lot better now that I was in no danger of moving it the wrong way and getting that really sharp pain.

My physiotherapist called also in early January to see if she should close my file or if I wanted to come back.  I told her how my shoulder was doing and that I hadn't been doing the exercises.  She was very concerned that if I didn't do the exercises my shoulder wouldn't get better.  She suggested that I should get the "caveman" procedure done soon, because the longer I waited the tighter my shoulder would get.  She admitted that a broken arm had happened occasionally with that procedure.  She didn't know if the arthroscopic surgery, was available in our part of Canada.  I told her that I would do some yoga, and she was satisfied with that.

I think I tried once to do a simple yoga routine, but it was really impossible.  So, I continued to do nothing.

February 2009

No improvement in my range of motion.

March 2009

No improvement in my range of motion.

April 2009

I had not been testing my shoulder regularly, but one day I wanted a bowl from the top shelf in the cupboard and I just reached up with my left hand and grabbed it.  It was like my body knew I could do it before I did.  From then on there was just slow and steady improvement in my range of motion.  I did nothing to help it along, no exercise of any kind.  It was Stage Three, the Thawing Stage, and it just thawed out on its own.  By September I had 95% of my range of motion back.

November 2009

As I write this I have my full range of motion back.  I can do up a back-closing bra, which even in September I still couldn't do.  I am going to stick with the new ones, though, they actually fit better.  I can do Triangle Pose, although it is uncomfortable.  It is not sore in the joint, it is the muscles that seem both tight and weak, but I guess after so long that is to be expected.  Not being able to do yoga for so long has given me a new desire and appreciation for it!  I am really looking forward to a regular yoga routine.

In summary, I guess you can see that frozen shoulder is a slow process -- about a year and a half in my case.  But the outcome is perfect, and I didn't have to spend hundreds or thousands of dollars on painful treatments.  I just waited it out.  And I think it's important to say that I didn't worry or stress about it, and contribute to the inflammation that way.  Also, in September 2008 I started taking a variety of good quality supplements, a multivitamin, omega3, glucosamine and MSM, coQ10 mainly, not for my shoulder specifically, just for health.  They may have helped too.

Doctors say they don't know much about frozen shoulder, but based on my experience here is what I think is happening in there.  For some reason your immune system starts attacking the lining of your shoulder joint, and this causes it to become inflamed.  It is the inflammation that causes the adhesions to form, as I experienced when the exercise inflamed my shoulder even more and my range of motion grew smaller.  Once you are through the first Painful Stage the inflammation has subsided and no new adhesions are being formed, although the old ones remain.  Over time the adhesions start to break down, I think through a combination of gentle daily motion and the healing of the tissue inside your shoulder.

I hope this has helped you as you weigh your options.  This is one of the websites that helped me with my decisions, although it has been revised to be more pessimistic than when I read it in 2008: