Adhesive Capsulitis

Adhesive Capsulitis a.k.a ‘Frozen Shoulder’ is a condition that effects the health and agility of the shoulder joint. The symptoms include stiffening of the joint, decreased range of motion, searing pain, loss of shoulder function, postural issues and loss of sleep. There are many theories but no known causes for the disorder. 2% of the population seems to be affected and most are women between the ages of 40-60. There are many medical treatments, most of which seem costly and ineffective. The condition seems to mysteriously disappear after 2-3 years, however, there are often residual effects. I, myself, was afflicted with Frozen Shoulder for approximately 6 months until I began and finished the BASI Pilates CTTC. During the 4 month training and the necessary exercise regimen requirement, the symptoms melted away leaving me pain free with approximately 96% of my range of motion returned.

Shoulder Anatomy and Adhesive Capsulitis

The human shoulder is a large, complex joint that attaches the round top portion of the humerus bone to the acromion of the scapula, creating a ball and socket joint. Other important bones that form the shoulder are the clavicle and the coracoid process. Supporting these bones are the muscles and tendons of the rotator cuff that give the shoulder its ability to move in multiple directions. The bursa (a small cushion sac) and labrum (cuff of cartilage) are also vital to the movement and health of the shoulder joint. The ball and socket joint of the shoulder is relatively shallow which gives the shoulder great range of motion and vulnerability to injury.

Diagram and photo of the inflammation

Diagram and photo of the inflammation of the Shoulder capsule due to Adhesive

View of Latissimus Dorsi and Posterior Deltoid thought to play a role in the condition known as “Frozen Shoulder”

Introduction

Adhesive Capsulitis, more colloquially known as “frozen shoulder” is an enigmatic condition that effects the entire shoulder capsule and greatly reduces the mobility and range of motion. It affects approximately 2% of the population, mostly between the ages of 40-60 and seems to occur most commonly in women. There are many theories regarding its cause, pathology and treatment. Common theories include past injuries, diseases or trauma that later become inflamed by an autoimmune disorder which attacks healthy tissue in the capsule. Thickening of connective tissue causes the shoulder capsule to become stiff and therefore less synovial fluid is able to reach the joint (Wiater, “Frozen Shoulder-OrthoInfo”). It has been seen to occur after surgery or prolonged immobilization (Mayo Clinic, “Frozen Shoulder”). Yet another theory includes Diabetes as the source (American Diabetes, “Frozen Shoulder”). However, there are many cases where there were no recognizable causes. Treatment is almost as illusive as the condition itself and includes physical therapy, medication, cortisone injections, massage treatment, hydrodilatation or surgery (Niel-Asher et all…”Frozen Shoulder”). If left without treatment, the condition usually resolves itself in 2-3 years but not without many months of discomfort and immobility.

Case Study: Anastasia Baratta 44

In April 2012, a deep and throbbing pain started in my shoulder. As a 43-year-old woman, I had never experienced this kind of pain before and attributed the issue to ‘side sleeping’ on an overly firm bed was causing pressure-related pain symptoms. At the time, I was teaching mat Pilates a few hours per day and began to notice my mobility decreasing at an alarming rate. In a very short time, my arm wasn’t able to abduct in the coronal plane beyond 70-80 degrees and my lateral rotation was 50% less than its normal range. If I made any sudden movements I would be momentarily taken with an amazing searing pain. The pain would also find its way into my neck and between the shoulder blades in either the lower Trapezoids, Rhomboids or Back Extensors. Eventually, I visited an acupuncturist who diagnosed me with what I now understand to be ‘frozen shoulder.’ At that point in time, I was practicing mat Pilates through www.pilatesanytime.com with mostly BASI instructors–about 4 hours weekly, and while it did not eradicate my condition, I believe that Pilates kept my shoulder from losing all mobility. Fortunately, In September of 2013, I was enrolled in the Body Arts and Science (BASI) Comprehensive Teacher Training Course. During the course of my training, I witnessed my condition nearly disappear.

In approximately 3 months of training, I experienced my shoulder ‘thawing’ or regaining much mobility. By the time of completion, the course of my recovery was about 90%. In this paper, I will describe how BASI and its Block system healed a debilitating condition known as Adhesive Capsulitis. The BASI Block System contains the important components of strengthening and stretching with alignment based movement, which allowed me to rapidly and stretching with alignment based movement, which allowed me to rapidly and progressively improve the mobility and health of my shoulder through a whole body system of exercises.

Conditioning Program

Since frozen shoulder is essentially a weakened joint with resulting inflammation, the strengthening aspect of the following exercises (laid out in the Block system form) were paramount to the restoration of the joint. Another important component for increasing range of motion is stretching. Stretching is beneficial for overall conditioning and amazing for releasing and elongating the entire shoulder both anteriorly and posteriorly.

Warm-up
The Pelvic Curl – strengthens the entire core (and to some degree the extremities) through the co-contraction of the back extensors and transverses abdominus including the rear deltoid for stabilization of shoulders. It also gave a lot of relief through the stretching of the spine and all the muscles, tendons and connective tissue involved in the exercise.
Supine Twist – stabilizes shoulders, stretches back and strengthens core.

Chest lift

Chest lift with rotation

Foot Work
The Wunda Chair – demands the co-contraction of the abdominals and back extensors. This requires the entire torso, including the shoulder girdle to stabilize and elongate. Only some of the optional arm positions were possible at first.

Abdominal Work
Cadillac Mini Roll Ups and Mini-Roll-Ups Oblique – both exercises strengthen the abdominals while utilizing sustained shoulder stabilization.
Roll-Up Bottom Loaded – helped to strengthen shoulder throughout a range of motion.

Hip Work
Frog / Walking / Bicycles – require stabilization of torso and shoulder girdle.

Spinal Articulation
Tower Prep / Tower – There was immediate relief and increased mobility of shoulder through any spinal articulation exercise. This seemed due to the positioning of the shoulder and the added pressure of the push-through bar and the deep stretch of the spinal extensors, Latissimus Dorsi and Posterior Deltoid.

Stretches
Ladder Barrel – Shoulder Stretch 1&2 were challenging but beneficial as a sustained
chest opener and shoulder stretch.

Full Body Integration
Down Stretch / Long Stretch – strengthening through shoulder stabilization and
precise rotation of the shoulder flexors and extensors.

Arm Work
Arms Sitting Series – due to the necessity of stabilization and overall strengthening of the shoulder girdle these are obvious exercises for most shoulder health considerations.
**Arms Kneeling Series, Rowing Series and the Side Arms Kneeling Series were too demanding on the joint at first but within 3 months there was the ability to do most of the exercises with slight modifications.

Leg Work
Leg Work was important for all over body condition but did not seem to directly effect or relate to this condition.

Lateral Flexion and Rotation
Mermaid – this was a pleasant exercise for upper back and shoulder to stretch while remaining stable.

Back Extension
Pulling Straps 1/2 opened up the front body and strengthened the back in manner that was supportive and elongating for the shoulder.

Conclusion

In conclusion, Adhesive Capularsis is a debilitating and painful condition that can cause loss of sleep, time and work for individuals afflicted by it. Little is known about the actual causes, and consequently, treatments are often invasive and potentially ineffective. What is known is that the condition usually mysteriously disappears after approximately 2-3 years. The most common non-invasive treatment recommendation is physical therapy at considerable cost. The importance of movement that reinforces proper posture and alignment can not be over emphasized. BASI Pilates and its Block system take the individual through a comprehensive network of exercises that focus on posture, proper functional movement and optimal body alignment. These exercises reduce the probability of injury an promote healing in multiple systems of the the human body of which the joints and the associated tissues are obviously a part.

I have found through my own experience that the BASI system of Pilates has been quite effective at treating this issue in a relatively short period of time. Throughout my research, I found a few people and places that offered Pilates as method of recovery from frozen shoulder but none that were specific about the process or exercises used. Through consistent and systematic practice of BASI Pilates, the symptoms of this enigmatic issue can thaw away, leaving the afflicted person free to move again. I am impressed and grateful to the BASI system for relieving me of this very painful condition.

For Bibliography http://www.basipilates.com/lib/file/adhesive-capsulitis.pdf