Since my health and fitness coaching niche are 40 plus year old women, I chose to write about shoulder dysfunction which I’ve been seeing a lot of lately. Myself included.
It’s an inconvenient pain because it prevents you from doing common everyday movements like reaching your arm slightly behind you to put on a coat, hold a blow dryer, and do upper body exercises like a dumbbell chest press. Chronic pain gets in the way of life and is a sign we can’t ignore. Oftentimes, we think it will just go away by itself, and frozen shoulder typically does over time (within 1 to 3 years), but it’s essential to rule out other issues first and get a proper diagnosis before embarking on a treatment plan. There are a variety of methods you can do for a frozen shoulder, both holistically and medically, especially when pain wakes you up at night, and prevents you from functioning normally.
Shoulder Anatomy
The shoulder is a ball and socket joint and moves in a multi-directional way. One of the most common injuries to the shoulder is a rotator cuff injury. The rotator cuff is a group of muscles and tendons that surrounds your shoulder. It holds your upper arm bone (humerus) in place in its socket in your shoulder blade (scapula). I find it helpful to have a visual of what’s going on in any area of the body that you’re working on to heal.
The rotator cuff is made of four shoulder muscles:
- The supraspinatus lets you rotate and lift your arm. It stretches from the top of your scapula to the upper end of your humerus (its head).
- The subscapularis lets you hold your arm outstretched, away from your body. It attaches to the middle of your scapula and stretches to the lower part of your humeral head.
- The infraspinatus helps you rotate your arm. It reaches from the bottom of your scapula and connects to your humerus behind the supraspinatus.
- The teres minor also helps you turn and rotate your arm. It attaches to the outside edge of your scapula and attaches to your humerus beneath the infraspinatus.
How Estrogen Impacts Your Joints
During perimenopause to menopause, hormonal fluctuations are definitely a variable in shoulder dysfunction as well as stress, and lifestyle factors like being sedentary. Shoulder dysfunction typically appears between ages 49 to 62.
Our joints have a lubricant called synovial fluid. It has a viscous consistency and is between each and every joint in your body providing cushioning to prevent bones from rubbing together. One of the many important jobs that estrogen has is to boost the production of synovial fluid. As women enter perimenopause and menopause, their estrogen levels drop and so does synovial fluid. This can increase joint inflammation.
Collagen and Musculoskeletal Health
When we think of collagen, we usually think of our face and how we want good elasticity to maintain a youthful appearance, but this vital protein is also very important for our joints. Collagen is a protein produced by the body that supports all our connective tissues keeping them elastic and strong.
Estrogen also promotes collagen and when there’s less of this hormone, there’s less collagen. As a result, our joints can feel stiff, weak and more prone to pain. Less collagen also means a longer recovery time, as this protein is involved in growth and repair. As you’ll read further down in the section on “nutrition,” I recommend drinking collagen rich bone broth and keeping your blood sugar low to help promote better joint health.
Estrogen Decreases Inflammation
Estrogen is anti-inflammatory and with the onset of perimenopause to menopause, it decreases which makes joint pain more common. If you have other types of low grade inflammation in the body, this can also be a trigger for frozen shoulder. The connective tissue in the body is found in between other tissues everywhere in the body including the nervous system, so pain in one location can be triggered by connecting nerves to another area.
Other Contributing Factors in Shoulder Dysfunction
I was listening to a podcast between two physiotherapists from Ireland on the topic of “The 50 Year Old Shoulder,” and the video length is about 45 minutes and well worth the listening time. Here’s the link. The physiotherapists emphasized how each woman who comes in for treatment is not just a bunch of symptoms; there’s a human being attached to the chronic condition. There needs to be a bio-psycho-social approach that looks at the entire being in a more comprehensive way. Bio-psycho-social means to view a patient beyond their symptoms and include factors that are extrinsic such as environment, sleep, stress, job, diet etc… There are always exceptions, but the standard of care in our modern medical system tends to focus more on the management of symptoms than the cure. To ask a patient about what else is going on in their lives helps the practitioner to better understand what else may be contributing to their present level of pain.
The following is a list of the “bio-psycho-social” factors to consider with chronic pain/frozen shoulder:
Sleep: Pain wakes you up and can keep you awake making it difficult to function during the day. When you’re able to sleep, your body can more easily repair and heal itself. With more fatigue, movement is also more difficult. Chronic sleep deprivation also leads to elevated levels of cortisol. Chronically elevated levels of cortisol increases insulin which is a fat storage hormone. As you can see, one thing that’s off can set off a chain reaction, so you need to trace things back to the root cause.
Weight gain: There’s clear evidence that women who are overweight and menopausal are more prone to joint problems. The extra weight creates mobility problems.
Stress: Menopause can be a time of more stress, especially, if you’re dealing with mood swings, depression, anxiety, hot flashes and/or brain fog at the physical level. Additional stressors can come from one’s job, finances, environment, relationships etc… Chronic and/or acute stress creates more muscle tension and that can exacerbate any existing shoulder dysfunction.
Additional Potential Causes:
- Diabetes,
- Hypo or Hyper Thyroid Condition
- Scar Tissue/Adhesions in the shoulder area from an old injury
- Pre-existing injury
Symptoms of Frozen Shoulder
It usually happens on one side of the body and mobility is limited. There are certain positions that you can’t comfortably do and pain is often worse at night. You can’t sleep on the affected side, overhead movements where the arm is externally rotated are often difficult, and exercise can be uncomfortable. The pain typically lasts from 1 to 3 years. This was my case during the menopause transition. It can clear up on its own but there are a variety of interventions you can try from a holistic approach to surgery. 
Non-Invasive Treatment Options
Physical Therapy
This approach uses mobilization, stretching and strengthening exercises that address the joint capsule. The goal is to progressively load the joint with more resistance over time. Compliance on the part of the patient is critical because what you do at home makes a difference in your recovery. Most PT is once or maybe twice a week, so do your homework exercises! I totally understand that pain makes you tense up and other muscles will come into play to guard the area so you have to go slow and trust the process.
When I was dealing with shoulder pain several years ago, I was unable to do a single pushup or use 8 pounds for a dumbbell chest press. It was upsetting, frustrating and depressing because prior to that, I enjoyed rigorous strength training workouts. However, my mindset was positive and I believed it would get better in time with slow and steady progress. It did. Another method to consider when you get to the point of using weights is eccentric lifts. Eccentric is the lowering phase of weight training and there’s less of demand on the joint. It’s another technique that helps build strength while rehabbing your shoulder.
Nutrition
There’s absolutely plenty of evidence that eating foods that are whole and unprocessed diet can make a difference in recovery. The less done to a food, the better. Instead of drinking orange juice, eat an orange. Eliminate or substantially decrease foods that raise your blood sugar. Foods such as wheat based pasta, breads, alcohol, fruit juice, dry boxed cereals, energy bars, dried fruit etc… Learn to read food labels. Sugar has different names such as maltose and dextrose (if it ends in “ose,” it’s likely a sugar derivative. Elevated blood sugar is connected to inflammation in the body. If you have digestive issues, heal your gut. When your digestion is optimal, you can better absorb all the nutrients in your food. Try bone broth which is a wonderful nutrient dense broth that helps with gut repair. Here’s a link to my facebook page post for making bone broth in an instant pot. This is one of the easiest recipes I’ve found. Make sure to use marrow bones or 3 pieces of oxtail will work which yields a collagen rich broth. Ideally, bones from a grass fed and grass finished cow. You can also buy it (homemade is always better!). Bone broth is rich with collagen, minerals, probiotics, and electrolytes. If you buy it, I recommend Kettle and Fire. They have traditional beef flavor, as well as other flavors you may like. I’m not a coffee drinker, so that’s my morning beverage.
Also consider removing gluten from your diet. There’s two types of proteins in wheat: gliadin and glutenin. Gliadin can be problematic and increase inflammation. Try taking out gluten for 30 days and see if that brings down inflammation. It can also help with weight loss and improve low thyroid conditions. A large percentage of the United States population has leaky gut which is when the small intestine has small openings in the lining that allow food particles to enter into the blood stream. Food that gets into the blood stream is foreign and not supposed to be there so the body believes its under attack. This is how auto-immune conditions develop. The cause of leaky gut can be due to many factors but it’s often due to eating foods that are irritating to the gut like gluten. There’s a lining in the small intestine called “cilia.” It’s like the fine fibers of a shag carpet and they form “tight junctions.” Gluten is an irritant and can open these junctions allowing food particles to escape through. Removing irritating foods like gluten, gives the intestinal lining a chance to repair itself.
Homeopathy:
I’ve often reached for the least invasive choices when it comes to treating myself and I find homeopathy to be gentle and effective. It does take longer because it’s allowing the body to heal on its own time rather than something more invasive like drugs or surgery.
Tissue salts are one of my go to options for a variety of ailments. Tissue salts are a collection of 12 homeopathically prepared minerals and mineral salts. They are the fundamental building blocks of every cell in the human body. There are many good books – I like “Tissue Salts for Healthy Living by Margaret Roberts- out there to learn about homeopathy or you can make an appointment to see a clinically trained homeopath who can do a proper evaluation.
During the last century with the advent of industrialization, our soil has been depleted of many essential minerals and most packaged food contains chemicals and preservatives that are foreign to the human body. It’s no wonder chronic disease plagues a good percentage of the population. One of the main reasons is due to mineral deficiencies which are essential cofactors for many biochemical processes in the body to make things run smoothly and well.
The combination of the following tissue salts: calcium phosphate, potassium chloride, sodium phosphate and sodium sulfate from the company Schuessler Tissue Salts can be used to address your shoulder inflammation. The 4 tissue salts together are called Comb M-Rheumatism. :
- Calc phos (Calcium phosphate)
- Kali mur (Potassium chloride)
- Nat phos (Sodium phosphate)
- Nat sulph (Sodium sulfate)
Magnesium:
Did you know that you can have a buildup of calcium in your joints which can cause pain? Taking a good magnesium supplement like magnesium glycinate (Note: glycine is an amino acid and helps with anxiety, has a calming effect, promotes better sleep and aids digestion) helps to remove excess calcium along with lessening inflammation in the body because it relaxes the muscles. Magnesium is both an essential mineral and electrolyte. It’s involved in the regulation of cellular stress and activity. In other words, it really helps take the edge off! I recommend Pure Encapsulations Magnesium Glycinate.
Carbon 60:
Carbon 60 is a supplement that has incredible antioxidant properties and is what you call an electron donor. Inflammation in the body is oxidative stress or free radical damage and carbon 60 can help reduce inflammation dramatically. Let’s unpack this, so you have a better understanding of how powerful this antioxidant is.
The human body is composed of solid matter. When we break solid matter down we have microscopic particles called atoms. Everything in the universe is composed of these compounds called atoms. If you recall from high school science, an atom is the smallest amount of a chemical compound. Atoms contain smaller components inside them called subatomic particles. These subatomic particles are: protons, neutrons and electrons. When the body is repeatedly exposed to toxins on a daily basis from stressors such as a poor diet, emotional stress, your job, finances, lack of sleep, electric smog, chemicals from personal care products and that you use to clean your home, you create instability in many of those atoms inside your body. This is called free radical damage.
Free radicals are oxygen-containing molecules that are highly reactive and unstable. They’re formed when molecules or atoms gain or lose electrons.This results in an unpaired electron that can easily react with other molecules.These unpaired electrons don’t like being alone, so they search the body for an electron to pair with. This is what can sometimes cause the damage that free radicals are often associated with.
Nature designed us perfectly and for everything to be in harmony and balance. The more years we are on the planet, the more exposure we have to free radical damage. Making lifestyle changes makes a difference in preventing, decreasing or eliminating inflammation and chronic disease. This is where an anti-oxidant like carbon 60 comes to the rescue. The structure of carbon 60 contains 60 carbon atoms and it donates electrons anywhere in the body that’s needed, without creating any instability in itself. It’s the gift that keeps on giving. Most people notice a difference between 2 to 4 weeks once they start taking carbon 60.
Carbon 60 is taken as a liquid supplement and you want to start off with 1/2 tsp for the first week and slowly increase the dosage up to 1 tbs if you are over 45 years old. The older you are, the more free radical damage you likely have. It’s safe for children and pets as well, but give them a smaller dosage. It’s by far one of my favorite supplements. It’s a bit on the pricey side but well worth it. Here is a link to the carbon 60 I use. I am an affiliate so I receive a small compensation for referrals. The company is called Carbon 60 Purple Power. Carbon 60 won the Nobel prize in science for its discovery. Here is a study to learn more about carbon 60.
Frequency Specific Microcurrent Therapy-FSM:
FSM has been around since the early 20th century, it just hasn’t received as much attention as it deserves. FSM treats nerve and muscle pain using specific frequencies and micro-ampere current to treat nerve and muscle pain. Specific frequencies are given for the patient’s particular issue. The number of treatments needed for recovery and pain relief depend on each individual case. In the book, “The Resonance Effect,” by Dr. Carolyn McMakin, she describes cases that cleared up in as little as 3 sessions to others that needed 12 visits. There are similarities to electrostimulation and electrical muscle stimulation. In my research for this article, I found an Osteopath who has a clinic in NYC that offers FSM: PhWellness.
Surgery, as A Last Resort
If you have tried everything that’s non invasive, then surgery may be the best option. Always get two to three opinions before doing surgery. There’s a procedure called manipulation under anesthesia where the tight shoulder joint capsule is stretched and torn with manipulation. It’s a time-efficient procedure and relatively easy to perform, resulting in rapid restoration of the range of motion of the shoulder joint and reduces the symptoms of frozen shoulder. When I read the description and the word “stretched and torn,” for the procedure, I nearly fell off my chair!
Arthroscopic shoulder surgery involves the use of an arthroscope, which is a thin tube containing a light and a camera. A surgeon uses this to see within your shoulder joint. The surgeon makes tiny incisions through any areas where there is tight restriction to restore the complete function of the joint.
Maintaining Healthy Shoulder Joints
When any of my trainees come to me with shoulder pain, we always work through it and come up with a plan of action. That may include seeing an orthopedic doctor so we know what part of the shoulder is the issue and which exercises to do and what not to do. Use common sense when it comes to movements that cause pain. If it hurts, don’t do it.
However, a frozen shoulder doesn’t mean to do nothing. You can work with a physical therapist or a knowledgable fitness specialist, who will give you a shoulder protocol routine to help increase mobility and blood flow to the area. It can take anywhere from several weeks to months, to see improvement
I’ll never forget a strength and conditioning coach I had worked with when I had a bad rollerblading accident and fell on the ground with my arm stretched out. His advice was “Make sure to use your arm, after you’ve done all the icing you need because your joint will become stiff and you can develop scar tissue.” Scar tissue is basically a protein made from collagen that forms when we cut ourselves. However, with an internal joint injury, the body may develop excess scar tissue that becomes an adhesion. Most of the time, the scar does its job and brings the edges of the skin, muscles, ligaments, tendons, and sheaths together without a problem. At other times, the body overreacts and develops too many healing cells. Adhesions occur when scar tissue attaches to the healthy tissues and organs around the wound. They can be painful and limit movement. I bring up adhesions and scar tissue because your frozen shoulder could also be an old injury that never bothered you until your 40’s or 50’s and movement helps to break up old scar tissue and improve normal range of motion.
Exercises You Can Do For Frozen Shoulder
The following images are exercises you can do to improve your shoulder mobility, if you’re dealing with frozen shoulder. I would start with 4 exercises and slowly add on until you can do all ten. If you’re thinking of going to a physical therapist, print out the photos and show them to your PT or orthopedic doctor. Ask what he/she thinks about them.
Wishing you a full recovery and that you keep your shoulders healthy and strong!
