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Hit a Wall with Shoulder Capsule Orthopedic Massage
I'm new to this forum ... I'm glad to have found it!
I have been working with a female client (61 yrs old). She suffers from pain all over. May have fibromyalgia (though she's skeptical about that), may have Lymes disease (repeatedly tested negative, but just last week started antibiotics from her doctor anyway ... seems awfully late to be starting on that, but whatever).
She was in great physical shape and very active until two years ago and is still slim today. While on vacation (in Greece?) she suddenly started having strange symptoms, intense pain that inexplicably traveled back and forth between her arms, shoulders and wrists. It seemed the pain moved every few days or couple of weeks back and forth from point to point. At one point it occurred to her to stop taking the cranberry supplements she was on and the pain dissipated. Physical therapy also helped, but she still suffers from "frozen shoulder" type symptoms, noticeably restricted ROM.
1.5 years ago she took a misstep and twisted her knees. An MRI showed osteoarthritis in her right knee and right shoulder. The left knee is similarly achy and stiff. She has had physical therapy on her knees but still suffers some.
Her sternum aches, as does the front of her neck and the back of her legs. She believes she suffers from hypothyroidism (is just starting to see an endocrinologist). She feels like when she is moving she is "ripping" muscle fibers. She's also started suffering from a sleep disorder where she wakes up after two hours and can't go back to sleep.
Naturally, I decided to start tackling her structural issues with pelvic stabilization. We did the battery of hip, ankle/knee, shoulder and cervical spine assessments. She made a lot of progress with the pelvic stabilization over two sessions, so last time she came in we started on the shoulder protocol. That's where I got stuck.
When I did the assessment, the discomfort she described with either pain at the deltoids or deep within the shoulder capsule. She complained of no other discomfort as we assessed. Her abnormal shoulder numbers were:
Flexion (ideally 180˚)
R- 150˚
L- 155˚
Abduction (ideally 180˚)
R- 140˚
L- 45˚
Lateral/External Rotation
R- 70˚
L- 70˚
(close to 80˚ normal)
Horizontal Adduction
R- 130˚
L- 130˚
(close to 140˚ normal)
The following were normal:
Extension
Adduction
Medial/Internal Rotation
Horzontal Abduction
There was bone-on-bone like end feel to her shoulders (as much as I could tell at the low ROM; it was definitely not a normal end-feel).
So anyway, I proceeded to the shoulder protocol, but as soon as I got into the joint capsule work I couldn't abduct her arms beyond about 140˚ without her having pain deep in the shoulder capsule. I did the lateral and medial plunge-rotate-decompress (lateral at the maximum abduction caused a "pinching" sensation, so I would back off), but I could never get past the less-than-ideal abduction.
We did try moving forward to the next step, but that was only painful for her so I abandoned that idea right away.
In frustration I finally told her I couldn't proceed and was sending her home. She knows I am still studying this work and is a really nice woman, willing to work with me. I've done this exact same work on several other clients with good results, so I suspect something else is going on (perhaps the osteoarthritis? Lyme disease?). I told the client I was going to do some more research and see if could determine a way to proceed with the shoulders.
So at this point I'm stymied and am seeking feedback or suggestions. Your thoughts would be appreciated!
I have been working with a female client (61 yrs old). She suffers from pain all over. May have fibromyalgia (though she's skeptical about that), may have Lymes disease (repeatedly tested negative, but just last week started antibiotics from her doctor anyway ... seems awfully late to be starting on that, but whatever).
She was in great physical shape and very active until two years ago and is still slim today. While on vacation (in Greece?) she suddenly started having strange symptoms, intense pain that inexplicably traveled back and forth between her arms, shoulders and wrists. It seemed the pain moved every few days or couple of weeks back and forth from point to point. At one point it occurred to her to stop taking the cranberry supplements she was on and the pain dissipated. Physical therapy also helped, but she still suffers from "frozen shoulder" type symptoms, noticeably restricted ROM.
1.5 years ago she took a misstep and twisted her knees. An MRI showed osteoarthritis in her right knee and right shoulder. The left knee is similarly achy and stiff. She has had physical therapy on her knees but still suffers some.
Her sternum aches, as does the front of her neck and the back of her legs. She believes she suffers from hypothyroidism (is just starting to see an endocrinologist). She feels like when she is moving she is "ripping" muscle fibers. She's also started suffering from a sleep disorder where she wakes up after two hours and can't go back to sleep.
Naturally, I decided to start tackling her structural issues with pelvic stabilization. We did the battery of hip, ankle/knee, shoulder and cervical spine assessments. She made a lot of progress with the pelvic stabilization over two sessions, so last time she came in we started on the shoulder protocol. That's where I got stuck.
When I did the assessment, the discomfort she described with either pain at the deltoids or deep within the shoulder capsule. She complained of no other discomfort as we assessed. Her abnormal shoulder numbers were:
Flexion (ideally 180˚)
R- 150˚
L- 155˚
Abduction (ideally 180˚)
R- 140˚
L- 45˚
Lateral/External Rotation
R- 70˚
L- 70˚
(close to 80˚ normal)
Horizontal Adduction
R- 130˚
L- 130˚
(close to 140˚ normal)
The following were normal:
Extension
Adduction
Medial/Internal Rotation
Horzontal Abduction
There was bone-on-bone like end feel to her shoulders (as much as I could tell at the low ROM; it was definitely not a normal end-feel).
So anyway, I proceeded to the shoulder protocol, but as soon as I got into the joint capsule work I couldn't abduct her arms beyond about 140˚ without her having pain deep in the shoulder capsule. I did the lateral and medial plunge-rotate-decompress (lateral at the maximum abduction caused a "pinching" sensation, so I would back off), but I could never get past the less-than-ideal abduction.
We did try moving forward to the next step, but that was only painful for her so I abandoned that idea right away.
In frustration I finally told her I couldn't proceed and was sending her home. She knows I am still studying this work and is a really nice woman, willing to work with me. I've done this exact same work on several other clients with good results, so I suspect something else is going on (perhaps the osteoarthritis? Lyme disease?). I told the client I was going to do some more research and see if could determine a way to proceed with the shoulders.
So at this point I'm stymied and am seeking feedback or suggestions. Your thoughts would be appreciated!
Views: 53
Replies to This Discussion
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Permalink Reply by Desmond Diaz on
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im not sure this helps or that you haven't tried, but i have had an influx of shoulder patients (young and old) with limited restrictions like you are discussing. i have tried somethings that had some success with my current patients:
Acupuncture to help with the pain management in the shoulder. If no access to that, a useful product is an ETPS(electro therapeutic Point Stimulator) from acumed. It uses small micro currents of DC current electricity on acu puncture point to help relieve pain and reduce tonicity in the tissues.. very cool stuff to help with the shoulder without being invasive. The back pain and shoulder pain protocols consecutively should help.
after that, maybe some upper trap, levator, deltoid, pec major and minor, rhomboid/scapular releases, to help free up and major tissue restrictions, followed up with some active engagement stripping to loosen it further.
additionally you can (within pain threshold of the patient) apply light traction to the upper limb while jostling or distracting the arm..after a few repeated motions while still pulled, try to increase the range up to pain limit.
and repeat in the motions necessary. also use ice to help calm any soreness down or inflammation.
if you have any experience with kinesio taping, see if that can help as well -
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Permalink Reply by Ray Mingo on
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Hi Marlene
First of all I would like to say I admire you for taking on some of the most difficult clients and your wellingness to seek knowledge for the benifit of your clients. These experience will only make you more knowledgable about conditions and how to deal with them and other health care professionals will seek you out for your experience and expertises. I
encourage you not to become frustrated.
(quote)
She was in great physical shape and very active until two years ago and is still slim today. While on vacation (in Greece?) she suddenly started having strange symptoms, intense pain that inexplicably traveled back and forth between her arms, shoulders and wrists. It seemed the pain moved every few days or couple of weeks back and forth from point to point. At one point it occurred to her to stop taking the cranberry supplements she was on and the pain dissipated. Physical therapy also helped, but she still suffers from "frozen shoulder" type symptoms, noticeably restricted ROM.
The symtoms she's experiencing may not be a problem found in the shoulders but rather may be a problem found in the neck. That's right the neck! In the neck are muscles called scalenes. There are three of them on each side of the neck (anterior, medial and postior scalenes) which are attached to the side of the neck at one end and at the other end they are attached to the 1st and 2ed ribs. The brachial plexus and subclavian artery pass between these muscles. These muscles are extremly challenged in physically active individuals. They are respitory muscles.
Trigger points as well as scar tissue can develop in these muscles which can affect the brachial plexus and subclavian artery smothering nerves and arteries causing pain and numbness in the shoulders down the arms into the hands affecting strength and ROM. When these muscles become tight and restricted they can pull on bone trapping nerve and artery between bony structure affecting strength and ROM as well.
These muscles often goes unnotice as the culprid for shoulder problems causing some to pound away on the shoulders. Trying to increase ROM of the shoulder may make symtoms worse especially flexion, abd, horizontal adduction and external rotation which will place more presure in the brachial plexus and subclavian artery.
Try therapy on the scalene muscles freeing up tight restrictions elimination of trigger point and scar tissues with the addition of PNF stretching. Training and experience is important when dealing with the scalene muscles because of the brachial plexus and subclavian artery; you can do more harm if you press on these structures. Training to deal with these muscles should be sought out and a good knowledge muscular skeletal anatomy.
Study Erik Daltons' Myoskeletal Alignment Techniques and also Facilitated Stretching by Robert E. McAtee & Jeff Charland.
I wish you well in your pursuit to wellness,
Ray -
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