resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
Getting Athletes Back in the Game: Low-Level Laser Therapy for Sports Injuries
Sports injury rehabilitation is all about getting back in the game quickly and with optimal health. A relatively new tool for the treatment of sports injuries is finding global success, and it is doing so in a fast, efficient way.
Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Talking to Skeptical MDs: "Just the Facts, Ma'am"
The first lesson in public speaking is to know your audience. This is particularly applicable when talking to skeptical medical doctors about chiropractic. You have to understand where they are coming from and speak the language they understand.
Healing With Simple, Healthy Food
When it comes to your health, there is no better way to take control and create positive outcomes than by focusing on diet and lifestyle. As chiropractors, you know the power that regular self-care has for your patients.
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
Primary Lateral Sclerosis: A Condition With a Chiropractic Connection
Primary lateral sclerosis (PLS) is a slowly progressive, adult degenerative disease of the upper motor neurons characterized by progressive spasticity or stiffness. It is a clinical diagnosis that has been avoided because it is (largely) a diagnosis of exclusion.
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
Super Bowl Chiropractor
With opening night of the 2014 National Football League season only a month away, what better time to talk to Dr. Jim Kurtz, team chiropractor for the defending Super Bowl champion Seattle Seahawks?
Post-Concussion Patient Care: Relevance of the Chiropractic Adjustment
There is a widespread understanding within the profession of the general guidelines for care of the concussion patient. These include guidelines for physical and cognitive rest, return to normal activities and so forth.
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Medical Qigong for the Heart: Part II
Chinese Medicine is rich in commentary regarding the emotions and how they affect our qi.
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
Advice for Young Doctors
When I began practice, I was just shy of my 25th birthday. I was young and I looked it. I had been told this would be a problem when starting a practice – and it was. Older patients often paused when they entered for care.
Looking Back: Abstracts From Chiropractic History
D.D. Palmer's Technique for the Posterior Apical Prominence; An Early Attempt to Achieve Consensus on Subluxation; Chiropractic Subject Headings: Past, Present and Future; Mabel Palmer: A History of Chiropractic That Almost Wasn't.
Offline Marketing Techniques: Opportunities to Help Grow Your Business
In a world becoming increasingly dominated by connected devices, when we think of marketing, we often think of online and social media marketing. Considerable attention is given to Facebook and Twitter, as well as CPC [cost-per-click] advertising.
The Gluteal-Knee Connection
The underlying causes of knee pain and dysfunction are rarely isolated to the knee. The knee is a relatively stable joint with limited intrinsic ability to adapt to aberrant motion.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
F4CP: New Campaign to Promote Chiropractic as a Career
The F4CP has announced a "targeted cooperative campaign" that will engage doctors of chiropractic and chiropractic students, as well as chiropractic colleges, chiropractic media, state associations and vendors, to encourage DCs to recommend a chiropractic career to patients, family and friends.
Not Another Typical Drug Company Lawsuit
It's becoming more common to see drug manufacturers negotiate "false claims" settlements for millions and billions of dollars.1-2 Most of these settlements have to do with violations in the marketing of the drugs they produce and sell.
May, 2003, Vol. 03, Issue 05
Adhesive Capsulitis: Freezing, Frozen, Thawing Shoulders
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
My last column on reflex sympathetic dystrophy syndrome (RSDS) seemed to hit a chord. It seems many of us work with clients who live with chronic pain - clients who feel they have limited options in the mainstream medical community.While massage is unlikely to be a curative for this frustrating and potentially debilitating disorder, it is clear we have some benefits to offer. The following is an excerpt from a letter I received from Cynthia van der Smissen, RMT, who achieved some success in treating a client with this condition:
As the title promised, this month's column is about another painful and frustrating condition, but one that has a much brighter outlook than RSDS: adhesive capsulitis, sometimes called "frozen shoulder."
Adhesive Capsulitis: What Is It?
Adhesive capsulitis is the currently accepted term for one of several disorders grouped under the umbrella heading "frozen shoulder." This group includes any combination of shoulder conditions that contribute to reduced range of motion (ROM) at the glenohumeral joint, including arthritis; bone spurs; bursitis; rotator-cuff tears; and impingement syndrome. These problems occasionally lead to secondary adhesive capsulitis, but require different types of intervention for complete resolution.
Adhesive capsulitis is an idiopathic (of unknown cause or origin) problem with a peculiar and unique presentation. It typically has a long, slow, painful onset ("freezing"), followed by a period during which pain is reduced, but function is severely restricted ("frozen"), and finally, a period during which all pain subsides and function is fully or nearly fully restored ("thawing"). The entire process can take anywhere from a few months to well over a year.
Adhesive capsulitis can afflict anyone at any age, but it is seen most frequently among women in their 50s. Some researchers suggest that it affects as much as 2 percent to 3 percent of the population at some point, and somewhere between 10 percent and 15 percent of those patients may have it bilaterally.
Etiology, Signs and Symptoms
Because the shoulder joint has less supporting connective tissue than most joints in the body, it has unparalleled mobility and a huge normal range of motion. Even the capsular ligament that links the humeral head to the glenoid fossa is looser than most joint capsules. This increases mobility, but it leaves the shoulder vulnerable to a number of injuries other joints typically don't face, because they're better protected.
Stage I: Freezing
When the process of adhesive capsulitis starts, the joint capsule begins to adhere to the humeral head. Sometimes, this process is secondary to another injury that limits shoulder use, but it also can occur without any discernable trauma or trigger. This time frame, during which the adhesions between the humerus and the capsular ligament progress and worsen, is the first of three stages, sometimes referred to as the "freezing" stage. The first stage of frozen shoulder can last for two to four months, and is acutely painful in both active and passive movements of the shoulder. Typically, range of motion is lost in medial rotation first, but may progress to all directions.
Stage II: Frozen
The second or "frozen" stage of adhesive capsulitis lasts anywhere from four months to a year. During this time, the joint capsule thickens and essentially glues itself to the humeral head - particularly the anterior portion. Although range of motion is severely limited during this time, much of the pain usually subsides.
Stage III: Thawing
Perhaps the most mysterious thing about adhesive capsulitis is that after many months of severely limited movement in the shoulder, and progressive formation of connective tissue adhesions between the joint capsule and humeral head, the condition begins to resolve spontaneously. The joint capsule becomes free, pain is eradicated and movement is restored. This process may take a long time; a year or more is not unusual. If completely untreated, it is likely that range of motion at the shoulder joint may not be fully re-established, but the percentage of lost function (again, this is usually in internal rotation) is often not significant enough to warrant further interference. The goal of many treatment options is to ensure that when the adhesions begin to melt, the fullest possible range of motion is recovered.
At this time, no single factor has been identified as a direct cause of adhesive capsulitis. Certain statistical relationships have been traced, however, that raise interesting questions. People with diabetes have a higher risk of developing this problem than the general population. The same is true for people with chronic fatigue syndrome; people recovering from heart attacks or strokes; and people with hypo- or hyperthyroidism. Adhesive capsulitis has been investigated as an autoimmune disorder; however, while some immune cell abnormalities occasionally have been observed, this does not seem to be a universal situation. If there is a single reliable causative factor for adhesive capsulitis, it has yet to be identified.
Generally, adhesive capsulitis is diagnosed based on patient history and clinical tests. The end-feel of the joint is firm, but not as hard as joints with a bony end-feel. Its pattern of progression is predictable enough that it can be identified without a specific blood marker or diagnostic test. X-rays and MRIs may be conducted to rule out other possible scenarios (bone spurs, osteoarthritis, tumors, tuberculosis, etc.), but they are not diagnostic for frozen shoulder. Arthrograms (tests in which a contrast medium is injected into the joint space), give useful information; not only do they show where adhesions may have developed, they also reveal how much fluid the affected joint can accommodate. A healthy shoulder will accept 20-30 mL of dye for an arthrogram; a shoulder with adhesive capsulitis will only be able to take in 5-10mL.
The results of various treatment options for adhesive capsulitis are not exactly cause for celebration. Studies of various interventions show that while they may be successful at restoring full, or nearly full, range of motion, they may not shorten the process. Indeed, overly aggressive physical therapy and exercise, while being painful, also increase inflammation and prolong the freezing or frozen stages. Interventions for adhesive capsulitis typically start with NSAIDs or other anti-inflammatories, then progress to home exercises, physical therapy and perhaps surgery. Cortisone injections may be prescribed to limit inflammation, and allow for the possibility of manipulation under anesthesia to detach adhesive material. This treatment can improve range of motion if successful, but the possible complications are serious: fracture of the humerus; rupture of the joint capsule or subscapularis muscle; and neurovascular or cartilage injury. Surgery to mechanically separate adhesions also can improve ROM, but carries the risks associated with surgery, and significant postsurgical pain.
Can Massage Help?
As always, this is where things get interesting. Nothing in the literature suggests massage can directly affect any of the tissues in which pathological changes are taking place. After all, we can't friction the inside of a joint capsule to reduce adhesions. Furthermore, passive stretching, while important to reduce the risk of permanent loss of ROM, is painful and may exacerbate symptoms if overdone.
So, if you have a client in any stage of adhesive capsulitis, what are your options? A few readers sent me some interesting suggestions. All of them deal with the secondary restrictive effects of adhesive capsulitis, but that makes sense, since muscular restriction reinforces joint restriction, leading to the vicious "use it or lose it" cycle of immobilization.
Kathleen Beruman of Bar Harbor, Maine, wrote the following about working with a client diagnosed with adhesive capsulitis and chronic fatigue syndrome:
Terry Solomon of Los Angeles, Calif. contributed these suggestions:
While neither of these stories can function as a fully performed research project, they do point out the fact that just because the "common wisdom" about frozen shoulder predicts pain and limitation for one year or more, doesn't necessarily mean that's what a client has to endure. Thoughtful, educated, sensitive, imaginative massage therapists are finding ways to "break the rules" with intractable disorders all the time. If you're one of them, I hope you'll share your story with the rest of us.
The topic for my next column is again your choice. Would you like to read about severe acute respiratory syndrome (SARS) - the "new flu" that is spreading rapidly in Asia and somewhat more slowly in the U.S.; various types of depression; or something entirely different? Let me know what's on your table, so we can share it with everyone.
Until then, blessings,
Ruth Werner, LMP, NCTMB
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.