Frozen shoulder – a cautionary tale

Ergonomics and Posture for Classical Guitarists, Aches and Pains, Injuries, etc...
Cass Couvelas
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Frozen shoulder – a cautionary tale

Post by Cass Couvelas » Fri Apr 17, 2015 5:45 pm

I've had this complaint once before, 8 years ago, before I took up CG. I know why and how it happened (two distinct 'traumatic' incidents sustained by my left arm). With physiotherapy I got through it.

Since January this year, another bout of it – in my right arm this time – has stealthily crept up on me. It's now reached a point of severely limited movement in my right arm.

I felt sure it must have had something to do with repetitive strain (RSI). For the last 25 or so years I've spent my days in front of a computer, and for about the last six years of that, as soon as work has allowed in the evening, I've segued straight to sitting behind a guitar for as much time as I can manage.

Internet wisdom across all the health sites that I've read indicates a number of possible causes – one of them being female (more women get it than men). All sites will say though that its onset is not fully understood. There is no mention anywhere of RSI as a cause.

I feel very sure indeed that RSI must have been a trigger. A long, slow 'traumatic incident', if such a thing is possible. I realise I've tended to ignore the always wise advice to take regular, proper breaks – but being fit in every other way, I've believed myself exempt. I must say this has certainly served as a very strong wake-up call not to overdo it.

I'm undergoing physiotherapy again, and I'm glad to say that it's not so frozen that I can't play for half and hour or so before I feel appreciable discomfort.

Whether RSI is contributory to frozen shoulder (aka adhesive capsulitis) or not, I really do recommend that people heed that advice and – however fit you think you are – TAKE THOSE BREAKS!!!
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Cass Couvelas
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Re: Frozen shoulder – a cautionary tale

Post by Cass Couvelas » Tue Aug 04, 2015 7:23 pm

Just an update on my experience of this condition, for anyone who feels they might be suffering from something similar.

Frozen shoulder apparently moves inexorably through various phases. The first phase (several months) is painful. I undertook a brief course of physiotherapy during this time, but found I was in a lot more pain than I was expecting and in fact I don't think I should have undertaken it. Apparently that particular phase should be treated with painkillers and not with stretching exercises (NHS website advice). I was too hasty in seeking out the physiotherapy, I think.

However, I seem - as per the textbooks - to have moved through the pain stage and am now in the stiffness stage. I can now go through my physical exercises without severe discomfort, and my shoulder is by degrees releasing itself from its rictus, although my right arm still looks as though it's been screwed on wrongly when I hold it out.

I'm convinced this was brought on by excessive practice sessions with inadequate breaks. I've certainly learned from it.
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pavan

Re: Frozen shoulder – a cautionary tale

Post by pavan » Tue Aug 11, 2015 9:25 pm

I also have a shoulder problem, I play hard and have worked hard. However, my shoulder problem starts in my neck, a nerve or network of nerves. This pressure causes a change reaction of muscular spasms that runs from the right side of my neck. I work to play loose, my latest tension build up is on the outside of forearm and behind my scapula. There is obviously no over night cure or easy fix. It takes me about a half hour of stretching and warm up before I can play and eventually I get too tight and need to quit and spend some stretching time. A good chiro treatment at times will give me a few days relief, but it always comes back.

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Re: Frozen shoulder – a cautionary tale

Post by robinfw » Mon Sep 21, 2015 6:07 am

I have had this problem also.
Sometimes it is better to just quit for a period of time.
Buy an arm sling and put the offending arm to rest for a time.
It does not want to be irritated.
Listen to your body.
When it is able and ready then get into the rehab thing. Slowly.

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Michael.N.
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Re: Frozen shoulder – a cautionary tale

Post by Michael.N. » Mon Sep 21, 2015 8:33 am

pavan wrote:I also have a shoulder problem, I play hard and have worked hard. However, my shoulder problem starts in my neck, a nerve or network of nerves. This pressure causes a change reaction of muscular spasms that runs from the right side of my neck. I work to play loose, my latest tension build up is on the outside of forearm and behind my scapula. There is obviously no over night cure or easy fix. It takes me about a half hour of stretching and warm up before I can play and eventually I get too tight and need to quit and spend some stretching time. A good chiro treatment at times will give me a few days relief, but it always comes back.
I sometimes suffer from numbness in both arms. All caused by tension in the shoulders. I have some rather deep seated muscle knots in that area too. The best method that I have found is a long rest from playing, I'm referring to months. After 3 months rest I'm back to normal. That hardly helps progress with playing technique but I don't lose much either. It takes me about two weeks to get back to my previous level. It's far from ideal though.
Try massaging with a tennis ball before and after any stretching. Also before and after any playing sessions. It only takes 5 minutes. I've found 'wall angels' to be one of the most effective stretches. Also limit playing sessions to less than 20 minutes. I've found this rather regimented approach allows me to play over a longer period of time. Not a cure but it's a big help.
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Jacek A. Rochacki
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Re: Frozen shoulder – a cautionary tale

Post by Jacek A. Rochacki » Mon Sep 21, 2015 9:46 am

I suffer from similar problems - pains in hands, arms, shoulders and legs and I am under constant medical care of good specialist, phd in medicine. Diagnosis is sciatica and sciatica shoulder, these pains in arms, (often also in legs - then it is “ordinary” sciatica) are caused by changes in my spine what often happens in older age. These changes cause discs applying unwanted pressure on nerves what causes pain. The cure in my case is performing regular exercises.

in case of sciatica - the so called McKenzie Method
https://en.wikipedia.org/wiki/McKenzie_method
in case of sciatica shoulder - also set of exercises prescribed by specialist

My point is: the pains are caused by changes in my spine, disks apply pressure on nerves.
I believe that all this is well explained here
http://www.totalhealth.co.uk/clinical-e ... rachialgia
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Stephen Kenyon
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Re: Frozen shoulder – a cautionary tale

Post by Stephen Kenyon » Wed Jan 13, 2016 10:49 pm

I've gone down with this as well now, left shoulder. In fact it started being noticeable last August. While there is no standard explanation for how it develops, in my case I too suspect that it was intensive if not challenging practice without proper warm-ups/downs (preparing some fairly easy Bach to play in front of colleagues at a conference ...).
Progressively over the autumn I found it harder to raise the left arm to playing position. By end of the year I just can't.
The first stage was to have a cortizone injection right into the joint. This sometimes does the trick just fine. All it did was mean the arm started hurting rather - unless that's coincidence.
Today I got to speak to a specialist and I have been put down for the manipulation treatment. This means being put under and they manipulate the joint to free it up. One osteopath warned me this treatment could cause tearing; the specialist said the only known danger was the arm breaking (!) Its probably going to happen in about 3 months time.
Apparently its most unusual for both shoulders to go at the same time; so maybe the ominous signs in the right shoulder are either my imagination, or referred pain from the left. I've been doing everyday several 'windmills' with the right arm to keep it moving. I asked the specialist if that exercise might have prevented the other side from going in the first place; he didn't seem to think it would.
Fortunately I've not had any commitments in the diary relating to classical guitar - and none are going in until this is sorted. Playing with the neck horizontal is not affected so my 'other styles' are not in trouble.
Apart from guitar restrictions the biggest issue is that sudden movements can be incredibly painful; I'm no tough guy, but this is the sort of pain that you don't just grit your teeth and carry on. Yesterday was breezy and my hat blew off - automatically I raised my hand to try to grab it - big mistake! This sensitivity can repeatedly wake one up over the course of the night - so I'm even more bleary than usual.
I don't know what cautionary fruit can be taken from this, other than avoiding misuse - at any age but certainly once you get to 40+. Always warm up and down, take breaks and listen closely to what the body is saying - sometimes it whispers and we ignore it until it raises its voice.
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Re: Frozen shoulder – a cautionary tale

Post by Cincy2 » Thu Jan 14, 2016 6:23 pm

I've got severe arthritis, bone spurs and cartilage loss in both shoulders. It's my own fault. Years of heavy weightlifting, overtraining, lack of stretching. Whatever the cause, I am on a road that eventually leads to severe pain and disability. To prolong the useful time left, I use a combination of exercise, massage and chiropractic care. I still lift weights 3 times a week but only do shoulder or chest exercises that don't hurt and move me within my restricted range of motion. My doctor can't believe I have the muscle tone and strength that I do. I also get a very deep tissue massage once a month that works all of those shoulder muscles to keep them free of adhesions and enhance the circulation. Finally, there are a lot of nerves in the spine that branch to shoulders so I also go to the chiropractor once a month to find and fix incipient problems. I can't say for sure this regimen is the cure for any of you but for me it keeps me healthy, happy and active.

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Cass Couvelas
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Re: Frozen shoulder – a cautionary tale

Post by Cass Couvelas » Wed Jan 20, 2016 7:07 pm

Stephen Kenyon wrote:I've gone down with this as well now, left shoulder. In fact it started being noticeable last August. While there is no standard explanation for how it develops, in my case I too suspect that it was intensive if not challenging practice without proper warm-ups/downs (preparing some fairly easy Bach to play in front of colleagues at a conference ...).
Progressively over the autumn I found it harder to raise the left arm to playing position. By end of the year I just can't.

Apart from guitar restrictions the biggest issue is that sudden movements can be incredibly painful; I'm no tough guy, but this is the sort of pain that you don't just grit your teeth and carry on. Yesterday was breezy and my hat blew off - automatically I raised my hand to try to grab it - big mistake! This sensitivity can repeatedly wake one up over the course of the night - so I'm even more bleary than usual.
Stephen, I'm sorry to hear this. Your experience sounds very like mine.

Yes, the extreme pain from an ill-considered movement can certainly catch you out! I remember once I held out my hand to shake hands with someone without thinking. They were somewhat taken aback the way I yelped and winced! I found I had to constantly be aware of the most mundane and common of movements – like shrugging off a jacket, or reaching into a cupboard – and take them extremely slowly and carefully.

However, just as the NHS site says, the pain phase does come to an end after several months (this can vary in length; for me it was about 8 months). It's hard to believe it when you're in the middle of it, with no apparent means of handling it other than painkillers (physiotherapy during that stage is NOT a good idea – it's far too painful and actually not recommended by the NHS), and with no end in sight.

I am through that phase now. It's now just a question of working towards the return of as full a range of movement as possible through exercises.

You might find that in three months' time you've reached a stage where you won't feel the need to undergo the manipulation. I do hope that's the case for you. In the meantime, I wish you well.
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Stephen Kenyon
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Re: Frozen shoulder – a cautionary tale

Post by Stephen Kenyon » Wed Jan 20, 2016 10:18 pm

Cass Couvelas wrote:....Stephen, I'm sorry to hear this. Your experience sounds very like mine. ...
Thanks Cass for your thoughts 8)
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Michael.N.
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Re: Frozen shoulder – a cautionary tale

Post by Michael.N. » Wed Jan 20, 2016 10:56 pm

Not sure I like the sound of that manipulation treatment. I've suffered a lot with shoulder/back issues (not frozen shoulder), largely of my own making and ignoring poor posture, especially when playing. Having said that I've noted that quite a few friends have suffered with either frozen shoulder or shoulder bursitis and they don't play musical instruments. They have all reached that age when things start to go wrong though. I'm pretty sure that the best thing that I've done was to do the physical exercises related to the back and shoulders. I now do them daily, without miss. It's far better than the pain.
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Re: Frozen shoulder – a cautionary tale

Post by simonm » Wed Jan 20, 2016 11:50 pm

I haven't suffered from this, but my immediate feeling is that a few acupuncture sessions certainly could not make it worse. That would be my first port of call as my gp here happens to be an acupuncturist as is the wife of a friend (but in another location). I wonder would other remedies such as hot water bottles, or the opposite cold compresses do some good.

I had a quick look at some Germany sites just now. Massage, physiotherapy, acupuncture, warmth/cold are all possible avenues to explore. If the sites I looked at are correct, frozen should generally, but not always, goes away by itself in 1 to 3 years.

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Re: Frozen shoulder – a cautionary tale

Post by gitaarmaps » Wed Mar 09, 2016 10:48 pm

Around Xmas 2014, I was diagnosed with "frozen shoulder" on my left side.
It was quite painful and serious, I couldn't use my left arm for almost nothing any more.
I've always thought that my intensive guitar playing in the few months before that, especailly combined with a probably poor posture, have contributed to the development of that frozen shoulder. (I always played with a footstool until then)

The specialised doctor had advised me a series of 30 fysiotherapy-treatments, which I started to do. The first 5 or so were extremely painful.
No wonder that some people just stop with those kind of "treatments" ...!
Anyway, I continued until I had done 25 sessions. After that (+/- 15 weeks later), my arm was almost back to normal ( I would say to about 90% of flexibility as before the frozen shoulder)

After that, I've never used a footstool anymore, and now I play only with a guitar support like Ergoplay or Gitano.(and I've just ordered a Barnett guitar support :) )

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Re: Frozen shoulder – a cautionary tale

Post by keithwwk » Wed Mar 09, 2016 11:43 pm

Michael.N. wrote:Not sure I like the sound of that manipulation treatment. I've suffered a lot with shoulder/back issues (not frozen shoulder), largely of my own making and ignoring poor posture, especially when playing. Having said that I've noted that quite a few friends have suffered with either frozen shoulder or shoulder bursitis and they don't play musical instruments. They have all reached that age when things start to go wrong though. I'm pretty sure that the best thing that I've done was to do the physical exercises related to the back and shoulders. I now do them daily, without miss. It's far better than the pain.
I agree. Majority, the older the less movement and exercise. Do these exercises regularly and consistently do really help!
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Re: Frozen shoulder – a cautionary tale

Post by Stephen Kenyon » Wed Mar 09, 2016 11:54 pm

Aha, was wondering whether to post back along here.

A couple of weeks after my contribution in January I went along to a physiotherapist a colleague recommended. It was one session, mostly discussing the situation and warning me against expensive therapy options, and about 10 minutes of direct manipulation of the shoulder surrounds, which was extremely close to as painful as was bearable. This was Tuesday.

Saturday I was applying shampoo (increasingly referred to as "air-care") and suddenly noticed the affected arm lifted higher than before. It has continued to make small but noticeable improvements. The physio had recommended some exercises but these had hardly started because the email that was going to detail them had gone straight into not even the spam folder but the trash. I did get a pulley exercise from the chap, and have used that. His warning was to expect many weeks of 10 minutes pain everyday to fix this, and it looks like for once I've got lucky. Perhaps it was just the time for it to move.
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