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Frozen shoulder: are your exercises targeting on the frozen part?

Do you suffer from a  frozen shoulder?

Have you tried performing shoulder exercises to improve the mobility but still experience pain even after all the effort?

Do you notice in the mirror that you could lift your arm higher but at the same time your shoulder movement looks strange?

If you have answered yes to the above questions, continue to read on and find out what could have happened here?

Let’s start by having a quick revision of the construction of the shoulder joints...

The shoulder joint is formed by a ball (humeral head) and a socket (glenoid fossa), and this is why this joint is also called GH (gleno-humeral) joint. The ball represents one of the ends of the arm bone (namely humerus), and the socket is well located on the outside border of the shoulder blade (namely scapula).

The scapula is attached to the spine and rib cage by muscles and the connection is called ST (scapulo-thoracic) joint. Arm lifting is achieved by a combination of the lifting of the arm bone, and upward turning of the scapula (which is clockwise turning for the left scapula, and counter-clockwise turning for right scapula). In another word, the lifting is achieved by the combination of GH joint and ST joint. With a full shoulder lifting of 180 degrees, the GH joint contributes about 2/3 to the total movement (about 120 degrees) and the ST joint contributes for the remaining 1/3 of the movement (about 60 degrees).

In frozen shoulder, the joint that is frozen is the GH joint, while the ST joint remains “unfrozen”. Since we know that the two joints move together to achieve arm elevation, it’s not hard to conclude that if the GH does not move enough, the ST move extra! This is where the movement problem starts. The shoulder blade usually moves extra in the following a few ways: it elevates extra, it tilts forward extra, it upward rotates extra, or the combination of those extras.

This is why...

When the arm raises (either to the front or from the side), the shoulder shrugs excessively; the hand attempts to reach behind the back, the shoulder tilts forward excessively. The results of these movements are that the relative position between the scapula and arm bone is disrupted, causing the tendon of the rotator cuff to be irritated or compressed. This can be found as one type of secondary impingements of the rotator cuff.

The bring home message here is that during frozen shoulder rehabilitation exercises, it is important not only to focus on how high you arm is rising, but also to look at which joint is contributing to the movement.

What's next?

The followings are some recommendations to help you perform your shoulder movements more effectively.

Shoulder movements
Common movement errors
Recommendations
Forward lifting or sideway lifting
  • Excessive shoulder shrugging or  hitching
  • Head tilting to the affected side

  • Keep shoulder down and keep head in the middle
  • Perform exercises in lying or, with affected hand holding to door knob / side of table, perform squatting movement to passively raise arm
Hand behind back
  • Excessive forward tilting of shoulder

  • Unaffected hand to help push shoulder backwards during exercise
  • Perform exercise in face down lying, with a towel roll underneath the affected shoulder

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