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The Cure for Frozen Shoulder That No One Talks About

By Sara Calabro

Frozen shoulder, also known as adhesive capsulitis, isn’t as official as it sounds. Frozen shoulder just refers to shoulder pain that leads to restricted range of motion. It is a catch-all diagnosis for shoulder pain and immobility for which the underlying cause is unknown.

Janet Travell, the author of Myofascial Pain and Dysfunction: The Trigger Point Manual, speaking of the medical literature on frozen shoulder, says, “When so many authors agree that the cause of a disease is enigmatic, there is good reason to expect that a major etiologic factor is being overlooked.”

This major factor, according to Travell, is trigger points in the subscapularis muscle. Acupuncture can eliminate these trigger points, wiping out frozen shoulder for good and offering people an alternative to the common—yet usually only temporarily effective—protocol of pain killers, cortisone shots, and surgery.

Olympic swimmers who are dazzling us with their performances this week: Take heed! Freestyle swimming is one of the most common causes of subscapularis trigger points.

The Signature Pain-Referral Pattern of Subscapularis Trigger Points

The subscapularis is one of the four muscles that comprise the rotator cuff. It attaches to the inner surface of the scapula and to the front of the humerus bone. Its primary responsibility is to hold the humerus in place during arm movements, preventing displacement. It also helps internally rotate the head of the humerus.

Trigger points are sensitive nodules in the musculature that cause referred pain. In the subscapularis muscle, they produce a signature pain-referral pattern. Pain concentrates on the back of the deltoid muscle. From there, it can extend onto the back, over the scapula, and/or down the back side of the upper arm. Pain usually skips the forearm but appears again as a band around the wrist (see picture at right).

Early-stage subscapularis trigger points normally don’t prevent people from reaching up. However, reaching backward—as if you were getting ready to throw a ball—tends to be painful. This is why frozen shoulder and adhesive capsulitis are sometimes referred to as pitcher’s arm.

Another tell-tale sign of early-stage subscapularis trigger points is wrist pain that concentrates on the back of the wrist, sometimes making it uncomfortable to wear a watch.

Common Causes of Shoulder Pain from Trigger Points in the Subscapularis

Is it sounding like your shoulder pain might be coming from trigger points in the subscapularis muscle? Here are some common ways in which these trigger points get activated:

Overdoing it at activities that require medial rotation of the arm. Examples include freestyle swimming and throwing a baseball.

Forceful overhead lifting while adducting the arm (bringing it closer to your body). An example is the kettleball swing exercise, where you use outstretched arms to raise the kettleball from between the legs.

Sudden stress placed on the shoulder muscles due to a humerus fracture or shoulder-joint tear, or breaking a fall.

Once a trigger point is activated—in the subscapularis or any muscle—it’s commonly perpetuated or exaggerated by everyday movements. Sleeping on one’s side or having slumped-forward posture can make subscapularis trigger points worse.

Cures for Subscap-Related Shoulder Pain

Once you’ve identified subscapularis trigger points as the source of your shoulder pain and immobility, there are several steps you can take to reduce them.

Get acupuncture.

Trigger points in the subscapularis can be released by inserting acupuncture needles directly into the muscle.

While extremely effective at eliminating shoulder pain, having these trigger points needled can be uncomfortable due to the location of the subscapularis. To access the muscle, the acupuncturist needs to palpate somewhat forcefully inside the underarm (see picture at right).

Another acupuncture technique for addressing pain from trigger points includes needling away from the actual pain site, choosing points along the acupuncture meridians that transverse the painful part of the body.

For example, the Small Intestine meridian runs directly along the signature pain-referral pattern for subscapularis trigger points. An acupuncturist might choose to needle an acupuncture point on the Small Intestine meridian that’s farther down the body.

Small Intestine 3, for example, is an acupuncture point on the side of the hand (see picture at left) that’s frequently used to alleviate shoulder and upper back pain around the scapula. You can massage this point yourself to help reduce pain in that area.

Adjust your posture.

Something else you can do yourself to reduce subscapularis-related shoulder pain is adjust your posture—while awake and sleeping.

During waking hours, try and avoid the slumped-forward posture that so many of us have unfortunately developed as a result of sustained computer use. This postion forces the arms into a medially rotated position, which perpetuates trigger points in the subscapularis.

When standing, try hooking your thumbs into your belt or pants to prevent your arms from touching your sides. And when you’re at your desk, remember to frequently move your arms—a simple movement of reaching the arm up and behind the head will do it—to help keep the subscapularis muscle stretched.

Sleep with a pillow.

At bedtime, grab an extra pillow. If you’re sleeping on the painful side, place the pillow between your elbow and side of the body. Again, this abducts the arm away from the body, which stretches the subscapularis muscle. If you sleep on the pain-free side, put the pillow in front of you so that the painful arm can rest on it (pretend you’re hugging the pillow).

Do the doorway stretch.

A final self-care technique for reducing subscapularis trigger points is the doorway stretch. Stand in a doorway and place both hands on either side of the door, at about shoulder height. Lean forward to give a nice passive stretch to the subscapularis.

If your shoulder pain is coming from trigger points in the subscapularis muscle, no amount of pain killers, cortisone shots nor surgeries is going to solve the problem. Those treatments have their place, but why not try the less invasive path first?

Photo by Sara Calabro
Trigger-point images from Myofascial Pain and Dysfunction: The Trigger Point Manual
Acupuncture point infographic from A Manual of Acupuncture

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Comments

Naomi Frank
Reply

Yup…. this treatment was pretty life-changing about 15 yrs ago when I began my studies in Chinese medicine!

Alma Myers, LAc
Reply

I’ve seen quite a bit of Frozen Shoulder; about 40-80% increased range of motion just after the first treatment and often before a needle is used. Acupuncture helps this release to hold and continues to heal, increase circulation, and relief pain or discomfort. Thanks for another great article Sara!

Anita Lang-Bakar, L.Ac.
Reply

Good article, but I’d like to add one thing worth noting:

People with Diabetes are 2-4 times more likely to develop adhesive capsulitis than the general population. It affects about 20% of Diabetics.
(A few other Endocrine & auto-immune conditions can also be the cause)

Sara
Reply

Thanks for pointing this out, Anita. Important to know.

Sara

Brenda Lehrer
Reply

I had frozen shoulder for about a year before entering acupuncture school and a supervisor recommended taking Remmi Femin or black cohosh as she said it’s often an hormonal issue. The combination of acupuncture and herbs did the trick and within a few months I was pain free. I learned that women typically have left shoulder issues during menopause also. Terrific article Sara as usual.

Sara
Reply

Hey Brenda. Interesting about the left shoulder during menopause. Thanks for sharing.

Sara

Dave
Reply

Or you could apply low intensity laser therapy to all the acupoints and trigger points – no pain involved.

Maruti Shanbhag
Reply

One more effective point for the frozen shoulder is ST-38. One can use two needles at this point and go for a powerful stimulation. The range of motion of shoulder joint improves dramatically.

[...] effectively relieve pain. For example, a point on the lower leg, Stomach 38, is a go-to point for frozen shoulder. One that’s located on the hand, between the thumb and index finger, can work wonders for low [...]

adele
Reply

thanks .

Adel
Reply

Or you could to subscapularis broom stick stretches, helps a lot. Also do infraspinatus stretches too that helps in circumduction of arm.

Hannah
Reply

Adhesive capsulitis is not an all-encompassing term for shoulder pain. It is a term for capsule inflammation which results in scarring and reduced external rotation. It is a specific condition with a specific pathophysiology. It is a tricky to treat condition but definitely in the early pain phases acupuncture is helpful.

Sandra
Reply

I am a 51 year old menopausal woman currently suffering my second go with frozen shoulder. In 2012, it was my right side and I was in PT for 9 months. This time, it’s the left side. The pain this time is 10 times worse that it was on the right side. I have near constant muscle spasms that I am taking Robaxin for along with Percoset for pain. The only time the pain truly subsides is when I am soaking in my tub. I haven’t been able to find any article or blog on WebMD recommending accupuncture for frozen shoulder, but will definitely ask my doctor about it.

Emma
Reply

I am a big fan of Janet Travell’s work, and Whitfield Reaves current teaching for integrated traditional acupuncture and modern orthopaedics. Would love to hear tried and tested methods for releasing the subscapularis that doesn’t involve needling through the axilla! Many thanks

Lily
Reply

I have frozen shoulder problem with right shoulder. Not much pain anymore (i have been suffering 4-5 months by now) but rotation problem affects my life pretty bad. Doing excersises but it does not get better. thanks for advice, will try accupuncture too

Will
Reply

Great article! It describes my condition perfectly. Can you recommend an acupuncturist who follows this protocol for frozen shoulder in the Boston MA area? Thanks!

Top 3 Surprises About Acupuncture | AcuTake
Reply

[…] true that acupuncture can work wonders on pain conditions—for everything from low back pain and shoulder pain to migraines and TMJ, acupuncture is on […]

Pete Doyle
Reply

Don’t forget local trigger point release in subscapularis! Pretty simple with the right needle length, angle and technique. Love the black cohosh tip as peri-menopausal issues can trigger this.

Pete Doyle
Reply

In general the 4th rotator cuff player (subscapularis) is neglected by most PT’s, LAc’s, and OrthoMD’s. Simple stuff.

MG
Reply

Needling ST 37 (a classic point for shoulder problems) works wonders also. when combined with subscapularis work.

Will Cooper
Reply

This treatment strategy would be more credible if you mentioned some case studies from your own practice — as such it reads more like theory.

Jeanne
Reply

Still, very few people talk about the liver lymph pathways that are connected to the right shoulder. Three years frozen with lots of PT, ART, Acupuncture, etc., and the thing that truly helped me the most was seeing a lymphatic practitioner who helped me clear my liver. Instant changes in ROM. Instant. Then the rebuilding happens, which includes trigger point work!

Pete Doyle
Reply

Jeanne- Can you tell us more or contact me?

Kristi
Reply

Sorry to say this Sara, but you did not do your homework here. Your click-bait headline is completely misleading. There is NO known cure for frozen shoulder/adhesive capsulitis. None. And, you have insulted everyone who has suffered from this horrible, misunderstood disease, and are misleading those who have been newly diagnosed and are looking for accurate help. Isn’t as official as it sounds? Is a brain tumor official? by saying it “Frozen shoulder just refers to shoulder pain that leads to restricted range of motion. It is a catch-all diagnosis for shoulder pain and immobility for which the underlying cause is unknown.” This is totally innaccurate (ask any orthopedic surgeon) and is like saying lung cancer is a catch all phrase for people who have breathing issues. It’s simply false. Frozen shoulder is an actual disease where the tissues and muscles in and around the shoulder joint literally fuse together – sometimes overnight, leaving the arm physically impossible to move (not due to pain, although it’s tremendously painful, but because it’s literally locked in place and if you try to move it, the tissues tear like you were tearing off your ear. Get it?). The cause for this very specific condition is unknown to the medical community, but they suspect it’s autoimmune. Thankfully, it mysteriously resolves on it’s own sometime between 1 and 3 years, but unfortunately, that time for FS patients is like being stabbed repeatedly with a knife in the shoulder 24/7 for months on end. It’s that painful. Acupuncture can be helpful to relieve a bit of the pain, yes, and to help a person be able to loosen things up a tiny bit faster, perhaps, but it is certainly not a cure for this disease. As someone who has studied FS for years, suffered and recovered from it, and runs a support group for FS patients, I recommend that you remove or revise this inaccurate article and headline if you truly want to be of service. Thank you.

Toni
Reply

The answer for me was Ortho-Bionomy http://www.ortho-bionomy.org.au/what-is-ortho-bionomy/. I had pain in my shoulder that gradually got worse. Thinking it would get better I put off doing anything. Eventually it was obvious I needed to do something. I went to a physio who sent me for an MRI for an accurate diagnosis. Torn rotator cuff, torn cartilage and frozen shoulder. Then to a top Sydney shoulder specialist who said despite the diagnosis the frozen shoulder was the primary cause of my pain and restricted movement. Told me to stop all physio exercise and it would be 18 months. He gave me a referral for a cortisone injection and another for an injection called hydrodilatation which blows up the shoulder joint with fluid supposedly speeding recovery. I found out my brother-in-law (who I thought was only a nurse) could help. So on my lounge during a family function he gently moved my arm around explaining that he was doing Ortho-Bionomy. I was sceptical but it felt better afterwards and I had more movement. The following day wasn’t as good but was slightly better than before. It improved a little day by day so 2 weeks later I went for another treatment and from that moment it got better to the point of full recovery over the next few weeks. He told me I may need another couple of treatments and gave me the name of a practitioner closer to where I live. No need – it is cured. The 18 month recovery took 3 months from the time I was diagnosed and weeks from my first Ortho-Bionomy treatment. I told you my story because I know how painful this condition is and 18 months is a long time to put up with this. Hope this helps.

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