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Three years ago he
purchased a regular car with a trunk
large enough to hold his table which
replaced the SUV’s he had been driving
for the previous years of his practice.
For a year he had been having difficulty
picking up the table out of the car
trunk. In the last month not only did he
have trouble picking up the table, but
he couldn’t abduct his arm more than 10
degrees. In addition, his arm was waking
him up at night with his shoulder
throbbing in pain.
Gina, a 21-year-old
college student, called me to set up an
appointment after an auto accident in
which she had been rear ended and
diagnosed with a cervical
flexion/extension injury (whiplash).
After three weeks she was also having
low back pain and difficulty raising her
arm. When I evaluated her she had 70%
loss of range of motion in her arm and
shoulder. She expressed concern that the
insurance company would not cover the
shoulder and arm problem because it had
not been x-rayed at the time of the
accident, and her insurance agent said
that the arm problem was probably not
related to the accident or she would
have been in immediate pain.
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Tom, a 37-year-old
accountant/soft ball player, set up a
session for his very painful shoulder.
He had started the spring season after a
three month lay off from soft ball, and
after two games could not throw or bat.
In addition, a chiropractor had told him
he now had a frozen shoulder.
Fortunately, the chiropractor
recommended that he receive massage
therapy for the arm and shoulder in
conjunction with the chiropractic
adjustments. Upon evaluation, his
shoulder was inflamed, and he had
approximately a 10% range of motion.
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All of the above
mentioned clients had a significant
limited range of motion, which is called
a frozen shoulder. However, each one had
a different degree of limitation and
each was brought on by a different set
of circumstances. Jerry, the massage
therapist, had initiated his problem
lifting a massage table out of a trunk,
and continued to repeat the motion after
the problem had started to develop. Gina
had an auto accident causing a cervical
flexion/extension injury as well as an
increased structural collapse which
resulted in an internally rotated right
shoulder, but it was only after using
her arm in daily life activities that a
problem showed up. This was due to the
weakness inherent in the arm and
shoulder when the shoulder is in
internal rotation. Tom’s shoulder
problem was brought on by over activity
on an unconditioned arm while throwing
the soft ball from center field. This
resulted in straining and irritating the
shoulder until it became dysfunctional
and inflamed.
In order to be able to
effectively treat all of the above
clients, it was necessary to evaluate
the structural distortion that each
client had, and to determine whether the
shoulder was internally rotated. I found
that all three had a significant
internal rotation of their problem
shoulders. This in essence left not only
the shoulder, but the entire arm,
severely weakened and susceptible to
strain and injury with light activities.
These clients had used their arms with a
decrease of at least 50% of normal
strength due to the strain pattern, and
consequently had damaged soft tissue. As
the tissue damage was worsening through
regular activities, the inflammation and
swelling was also increasing. This
ultimately led to their frozen shoulder
conditions.
It was apparent that the
internal rotation of the shoulders in
these three clients had to be addressed
in order to effectively treat and
rehabilitate their frozen shoulders.
This required evaluating what muscle
tension and myofascial holding pattern
were responsible for the internal
rotation of the shoulders. The obvious
culprits were the pectoralis groups
along with serratus anterior and
subscapularis. Palpation showed that all
of these muscle groups were very tight
and rigid with very active trigger
points. In addition, the fascia
associated with these muscle groups was
tightened and fibrous indicating that
splinting was taking place further
limiting the range of motion of the
shoulder. The splinting had become part
of the cause of the frozen shoulder by
reinforcing and limiting the range of
motion.
There was other not so
obvious soft tissue that was also
involved. This soft tissue was located
on the inside of the upper arm and
included the biceps brachii,
coracobrachialis, and anterior deltoid
fibers. As with the pectoralis groups
these tissues were tightened, shortened,
and inflamed. The fascia associated with
these muscles was also contributing to
the frozen shoulder by being rigid,
fibrous and shortened.
At this point, it was
also necessary to view the relationship
of the forearm to the upper arm and the
pronation of the hand as contributors to
the internal rotation of the shoulder.
It was obvious that the entire arm down
to the pronated hand were all either
supporting or helping to cause the
internal rotation of the shoulder. In
addition, upon kinesiological testing
the strain pattern that existed in the
shoulder manifested all the way through
the hand. The muscles of the forearm and
the hand were also contracted and in a
strain pattern with inflammation and
weakness. The clients were not aware of
what had been happening in their arms or
hands because the most severe pain was
in the shoulder. The muscles used in
pronation were the ones I found that
were the shortest and most distressed.
The fascia was similar to what I had
found in the shoulder and upper arm. It
was fibrous and shortened, and splinting
was found even in the hand and forearm
which contributed to the limited range
of motion of the shoulder.
After addressing the
specific musculature involved with the
frozen shoulders, it was now important
to bring the rest of the body into
structural balance to support the
remobilization and rehabilitation of the
shoulder. Each client had fallen into a
structural collapse through different
life activities, yet this collapse
appeared to be the major player in the
development of their frozen shoulders
due to the internal rotation of the
shoulders.
Now for the therapeutic
challenges. All three clients had
swelling and inflammation in the tissue
that needed to be treated to
rehabilitate the shoulder. This swelling
and inflammation were two of the
principle reasons for the degree of pain
that each client was experiencing. Each
client also had tightened, fibrous
fascia that was pulling the arm into
internal rotation and splinting the area
which greatly contributed to the lack of
range of motion. Finally, each client
had significant adhesions that had
developed from being in the strain
pattern while using the arm. Some of
these adhesions were deep and were
compressing nerves next to bony
prominences resulting in significant
pain when their arms were moved. The
tightened fascia was also in and around
the muscle fibers which added to the
limitation of range of motion.
The protocol I designed
to treat these shoulders would first and
foremost release the internal rotation
of the shoulder and arm; 2nd reduce
swelling and inflammation and the
associated pain; 3rd release the
myofascial holding pattern that was
helping to lock the internal rotation
and restrict the range of motion; 4th
lengthen the fascial and muscle fibers
that had become shortened and contracted
locking the shoulder into internal
rotation and restricting its range of
motion; and 5th release the adhesions
and scar tissue that had formed which
were compressing nerves and restricting
the range of motion of the shoulder and
arm.
Gina, the college
student, was having significant pain
from whiplash in her neck and low back.
So, the first treatments addressed the
structural collapse of the spine. Even
though I was not working directly with
the soft tissue of her shoulder, there
was some improvement. The reason her
shoulder went so far into internal
rotation was the distortion in her spine
from her auto accident. After six
sessions focusing on the head, neck and
shoulder and low back to balance the
spine, I was able to start concentrating
on her shoulder. In the initial sessions
it was necessary to spend most of the
time releasing the fluid, ischemia and
inflammation from the shoulder and arm.
Then I was able to work the 3-step
approach by 1st releasing fluids and
toxins, 2nd releasing the myofascial
holding pattern with directed myofascial
unwinding strokes and 3rd concentrating
on individual fibers and adhesions. She
quickly experienced relief of some of
the symptoms and an improved range of
motion. After five more sessions she was
pain free with full range of motion.
Jerry, the massage
therapist, had arm and shoulder problems
longer than the rest of the group.
Unlike Gina, the structural collapse of
his spine was not significant enough to
cause pain, so I was able to work with
his shoulder from the first session. The
3-step approach worked extremely well
with Jerry. However, I could not treat
some of the deepest adhesions and scar
tissue in the shoulder until the sixth
session because of the degree of
myofascial holding and shortened fibers
that had accumulated as the problem was
developing. After full range of motion
had been reestablished, he chose to have
me release the distortion in his body
that had supported and actually caused
his shoulder problem. In addition, he
devised a different way to retrieve his
table from the trunk of his car without
twisting or straining his shoulder.
Jerry was fully rehabilitated when his
overall body structure was balanced and
strong enough so that his daily
activities did not pull him into a
structural distortion.
Tom, the accountant, did
not have the degree of structural
collapse of the spine that Gina had so I
was able to work from the first session
on his shoulder and arm. As with Gina,
the 3-step approach was very effective
and allowed me to release the fluids and
inflammation, the myofascial holding
pattern, and the adhesions, scar tissue
and shortened fibers in his shoulder and
arm. After four sessions, Tom was pain
free and started to slowly strengthen
the arm for soft ball.
Don
McCann, founder Structural Energetic
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