Mrs M, a 62 year old retired housewife, initially presented with a long history of right shoulder pain and major movement restrictions diagnosed as a frozen shoulder. She had had a hydrodilatation to improve the range without any further advice. She also had neck stiffness and significant movement restrictions of her left shoulder following a previous frozen shoulder.
Mrs M. main goals: (self rated as 10/10 being pain free and full function)
To reach overhead e.g. hanging clothes, reaching in high cupboard (3/10)
To carry bags without pain (6/10)
To do weight bearing activity e.g. Pilates exercises (5/10)
We performed a systematic assessment of Mrs M’s musculoskeletal system and found the following imbalances:
- Neurodynamic tension in both upper limbs
- Severely restricted shoulder movement bilaterally (Flexion, Abduction, External Rotation)
- Tight posterior shoulder capsule bilaterally
- Muscles guarding around both shoulders and right side of the neck (scalenes, upper trapezius)
- Stiff neck (C6-7) and thoracic (T1-2, T9-10) segments
- Over-activation of upper trapezius with active shoulder movements
Through a clinical reasoning approach, we worked out together that Mrs M’s right shoulder external rotation was a good test to measure changes in her condition. Through a process of treatment trials and reassessment, we found the biggest and quickest change in this test occurred with a release of her neck (C6-7). It increased her right shoulder movement by more than 50% and even improved her left shoulder by 30%. When re-testing the main dysfunctions in her body, most of them had improved (decreased muscle tension around shoulder, increased hamstring flexibility, increased thoracic and neck movements).
Following the reassessment, we were confident that we had found the main driver of her shoulder problems. With more treatment of her neck, the shoulder mobility got to 90% and it only needed a few minutes of local work on each shoulder to get back to full range.
Mrs M. achieved all her goals and even more. In the week that followed the treatments, she found out her neck was a lot freer allowing her to reverse the car easily, her hamstrings were less tight so it was easy to do some Pilates exercises that she was struggling with.
To make sure she doesn’t overload her neck area again, I gave her postural exercises and attended a Pilates reformer session with her to make sure she was doing the exercises appropriately. I also discussed Mrs M’s condition with her Pilates instructor and strategies to prevent recurrence of her problem
This case demonstrates that even if there is a diagnosis of local problems where the pain is, other areas in the body can affect the overall condition and without a thorough assessment, we can’t be sure we are treating the main driver of the condition to get the best result.
If you would like to learn more about the neuroscience behind the approach we used with Mrs M, please click here.
