One thing you quickly realize about frozen shoulder, aside from how many people are struggling, is how ridiculously uninformed the medical community is on it.
I heard from women who shuttled from specialist to specialist, each siloed in their area of expertise and not able to see any part of the bigger picture.
One woman I messaged with ended up at an orthopedic surgeon for her frozen shoulder, getting a cortisone shot after being told it would help with mobility for 12 months. A month later the frozen shoulder returned – and she was offered only exploratory surgery. Did the doctor not doing the faintest bit of research? No, because she found the link to thyroid dysfunction all on her own.
“For years I thought I was working out wrong or sleeping wrong,” she told me. “It had to be something I was doing wrong, right?”
As a result of her own research, and tests she later had, she found out her thyroid-stimulating hormone (TSH) levels were far outside the optimal range – and is now on thyroid medication. When she found more research on how nutrition and low stomach acid can contribute to hypothyroidism, she changed her diet accordingly.
No wonder women are frustrated: there is literally zero consensus on how to treat frozen shoulder.
A research article published in the Journal of Sports Medicine this past October reflected the confusion in the medical community about frozen shoulder.
When surveyed, 140+ specialists found thyroid screening “unnecessary” and couldn’t agree on whether to test for diabetes in patients who presented with frozen shoulder. There wasn’t even a consensus on what to call it, or what physical therapy to use, how to properly diagnose it and even what complications might arise from one approach, which is called “movement under anesthesia”. A 10-year systematic review of literature published in the Journal of Pain Research in August was also inconclusive: although it pegged thyroid and diabetes as risk factors and cited the “non-dominant” shoulder as falling most prey, no treatment emerged as preferable, only a call for future randomized controlled trials.
Another woman I spoke with spent two years searching for help. She found it in a cortisone shot combined with physical therapy. Another interesting perspective that came up from women and practitioners was that there is an emotional element to all this, too.
“My 55 yr old sister is suffering from shoulder issues… she’s just back from a visit with an osteopath and he said it’s so common for women our age but also that 9/10 cases he sees are linked to grief,” wrote one woman.
One practitioner recommended switching to a less inflammatory diet, reducing stress and working on unprocessed trauma.
“I’ve started to work with a trauma therapist and sending my clients to her having great results,” she said. “Body issues like stomach and shoulders can be trapped trauma.”
As for what works, cortisone shots and physio came up over and over again, along with hormone therapy and acupuncture. And then this: “Just moving it, ignoring the pain, gave me back my shoulder. Surprisingly fast, actually. Just do it. Grandma never got shots, massage, yoga! She just got on with it.”
One thing no one mentions: dry needling. No one ever mentions dry needling, which is like acupuncture but involves putting the needles right into the muscle. It’s painful and uncomfortable, but it’s also my holy grail for pain relief. (I’m going to write about this much more in another Substack because this one is becoming epic.)
Low and behold when I searched for it, I found out there is a clinical trial ongoing at Duke University right now involving 100 patients, with results due next year. The lead researcher is Derek Clewley, assistant professor and core faculty in the Doctor of Physical Therapy division. Derek is clearly as obsessed with frozen shoulder as I am rapidly becoming, because he also published a case report in the Journal of Orthopedic Sports Physical Therapy in 2014 on a 54-year-old women who experienced rapid improvement after just two sessions.
And just to show you the divide, my favorite YouTube physiotherapists Bob and Brad (really, these guys are awesome and their neck stretches are *chef’s kiss*) say the only thing that is certain about frozen shoulder is that it takes forever to get better. It can’t be healed quickly, and if it can, they say in unison, “it wasn’t frozen shoulder”.
I love hearing from people who are taking radical responsibility for their own health in this way. Trust women to pull together their own solutions while the medical community takes years to catch up to the reality on the ground.
And if you don’t have frozen shoulder, all this noise about it might be a good excuse to take some preventative measures:
• Those of us who are able to use our shoulders should be, and that includes strength training multiple times per week. Prehab.
• Take a closer look at your thyroid. It is involved in so many issues these days, that I’m considering a visit to a naturopath or a functional MD. In the functional/naturopathic/integrative world, “Normal” is not optimal.
• Face up to and address any metabolic issues, including the pervasive insulin resistance.
• Move. There is no reason to be immobile.
• Take steps to deal with those suppressed emotions, adverse childhood experiences and whatever else you are trying not to think about. Or it will deal with you.
• Try dry needling: you better believe I’m tracking down Derek Clewley from Duke for the podcast, but aside from that, from my personal experience, some expert dry needling is pure magic. Painful, uncomfortable magic.
In conclusion: This is a developing story and I’m going to keep on it. But another developing story is that we seem to be in need of a new, yellow-alert-style category for menopause symptoms called “signal symptoms”. These are things that should be taken seriously, signaling that we might have bigger health fish to fry. Take frequent hot flashes, which a lot of people like to joke about, but can be a signal for issues that put women at greater risk for heart disease down the road. If there is a list like that, then frozen shoulder, with its links to thyroid, metabolic health and more, should really also be on it.
The more I learn about this, the more I realize that midlife is the time to investigate and address all of these things, following the clues when we can, changing our ways and adopting better habits, before they start wreaking havoc on our health down the road — when something like frozen shoulder might be the least of our worries.
Have a frozen shoulder story? Please hit reply or share in the comments. AMx
With my background as a physician (internist) and massage therapist, I can tell you that most primary care docs are woefully unprepared to care for musculoskeletal complaints since most of their training is hospital-based. It is frequently difficult to determine the cause of a frozen shoulder unless there was a discreet traumatic event.
Everyone's body ages at a different rate dependent on hydration, smoking, and other medical conditions. Each person has different sensitivities to pain and how much psychological overlay there is. Strength training is important BUT especially with a menopausal shoulder, slow movement, holding the position, slow return to the original position, fewer reps, not overloading, and perhaps limiting the range of the upward movement are important to avoid shredding tendons, especially the supraspinatus. A sports trainer who is affiliated with physical therapists and has a focus on working with older folks can be helpful in guiding technique and modifying exercises to avoid irritation and discomfort.
Massage therapists and physical therapists trained in manual therapy learn frictioning techniques that break up scar tissue that is limiting the movement of ligaments (and in the case of the shoulder, tendons) responsible for the "freezing" of a joint. Both neuromuscular therapists (specially trained massage therapists) and those PTs , DOs, and MDs trained in dry needling work on "trigger points" within muscles that cause pain when they are inflamed.
That said, inexperienced massage therapists need many continuing education courses focusing on medical orthopedic massage techniques such as frictioning and neuromuscular therapy. Even physical therapists who are young and inexperienced do not understand that the older body or that of a smoker or diabetic takes much more time to heal and needs less intensity of exercises. And they all need to listen to the patient to avoid overdoing a treatment or exercise.
Great article. Thanks. I’ve had three frozen shoulders. I first I saw medical dr wanted to use cortisol shot but I kept searching. I finally found great relief with Tuina- chinese acupressure. Acupuncture nor massage helped the same way. I keep it mobile with iyengar yoga therapy but tuina is the best.