In this video, Dr. Brian is answering common questions on Frozen Shoulder, Shoulder pain, and Active Release Techniques.
Dr. Gervais explains Frozen Shoulder.
Dr. Gervais shares a patient story who came for treatment of his frozen shoulder after 13 years.
Dr Gervais shares another patient story of someone who developed frozen shoulder overnight.
What to do when you experience frozen shoulder.
How common is frozen shoulder and how many cases does Dr. Gervais see.
Can surgeries for frozen shoulder be avoided.
How about people who undergo surgery but don’t see relief? Is that common?
Dr Gervais advice to athletic teenagers and young adults for staying healthy.
Frozen shoulder is one of those things I see quite a bit, inherit with athletes and even stay-at-home moms, just anybody who's had, usually from a shoulder injury. Frozen shoulder is another one of those loose terms, well, what is it? My shoulder is frozen and it won't move.
Could have been from a fall, from falling out like this where in Minnesota winter, on the ice or something, you fell out and everything tore, or you were lifting something heavy that didn't move but your shoulder moved, or just over time the repetitiveness of, out here on the shoulder, this is the backside, the rotator cuff, in those tendons, they tend to wear out over time with misuse and dis repetitive strain they shouldn't, but with use that is non optimal, the kind of mechanics or twisting that is too far or something, you can strain those.
What happens with frozen shoulders?
It's simply an adhesive capsulitis is another term for frozen shoulder, meaning the caps of the shoulder are adhesed, it's frozen. It's a lot different than muscular injuries that we deal with because when you have this ligament, it's a ligament down there, and when it undergoes tightness, it's more of a contracture. It's different cells than a muscle, where you can stretch it open and elongate it.
When I work a frozen shoulder, I have to get way up in there where it depends if it's on the bottom side of the shoulder, or in the upper, or on the top, we look at the area that's more adhesed, and when we do the treatment, we have to hold it for a little bit longer because you're letting these myofibril blasts, it's more of a muscle and ligamentous contraction tissue, you have to hold it longer, to let it kind of release slowly. It's very effective, usually it depends on how long this has been there.
I have an interesting case from a few years ago, I was treating a drummer that tore something in his shoulder and I don't remember what it was, but he developed frozen shoulder. He let it sit for 13 years! Imagine having this trauma, and by the time he came in to see me, he couldn't lift it up. He's like doc look I lifted my arm, he had his whole spine bent, so it looked like he lifted his arm, but he couldn't really move it. There was none of this (shows a moment) he could go out a little bit like this (shows a movement). It was traumatic.
Lifting a couch, the couch didn't move, shoulder gave way, a bunch of stuff tore. The profession as a drummer made it hard for him to work pain free, so he would just kind of lean and do this and that (shows a movement), so he started chewing up other parts of his body, due to this frozen shoulder.
We got in there, and we started working it, and very sore, but we did make positive change with him, and over a few months he saw quite a bit of relief and kept coming in for maintenance. I told him he was good, he says, I want to keep doing it cause it's helping. It was one of those cases where you don't win them all, but that was one that really jumps out, because it's the worst one that I ever saw, and probably some of the best improvement I ever saw too.
In a few months, what kind of range of motion was he able to get back?
He could only, at the beginning come up (shows a movement). If I said, bring your arm out; it was more of this and twisting (shows a movement). You want to have the shoulder move, in the flexion extension, abduction, adduction, external, internal. He could only do flexion, a little bit, and it still hurt. His extension, everything pinched extra, he could not get an external. Combing his hair, it was the left side, but combing the hair, putting the shirt on, I remember putting his jacket on, it was just the most unorthodox style, he'd have to swing it around and try to get it in there. That whipping motion of just getting dressed, would irritate things too. Once we started to teach him, okay here's the range; here's the safe range we're going to work in, let's just try to do our rehab and exercise in there.
There's no need to go out here (shows a movement) because you're not there yet. We would do that and it would get better, get inflamed a little bit, but better, but as we kept doing it, and it would build on each visit, he got a lot better and was very happy with the improvement. I'm surprised he waited 13 years to come to see you. He didn't know, you know. What if he hadn't waited? I said why would you wait this long? He's like, I didn't know. I'd do some PT (physical therapy), and things like that, I'd get some relief, but I hadn't heard about ART. He did a Google search, led him to my office, and he was like, I want to try this new Active Release Technique (ART) I've never had it. I kind of told him here's what to expect, here's what it'll be, you might be a little bit sore. He says, I've been sore for 13 years, I'm ready to try anything. We stayed on it weekly, for quite a few months and it made a big change for him.
Do you know if he was on pain medication?
No, he didn't want to take that; he was very holistic and did not want to try that. That's great too, because when I'm working, I want to know is the treatment helping? Because if you were to come in, and you took something before your appointment to get numbed up, now I don't know what's the safe range to work in. I always try to have patients come in as natural as you can. If you want to work out before or after that's fine, whatever, but don't skew the results by taking something, because I don't know what your new barrier for pain is going to be. As well as I don't like to know, I mean I like to know if you're doing other treatments, so if you're getting injections or this and that, we kind of stay away from those areas. Because I want to know truly, is what I'm going to do help you or was it your other method of treatment.
One more case study of a nurse that I treated, that developed frozen shoulder overnight with nothing. She had no trauma; no anything, just woke up with it. She wasn't feeling well too, she developed sort of a cold, so there are some cases, where you can develop frozen shoulder that is viral induced. She came in, there was no activity. Couldn't lift it out, couldn't do anything, and that was very interesting because, the whole other side was just fine, and it wasn't so much pain, she just couldn't move it. It happened overnight, so having her try to move it, nothing happened. I started digging around in there elicited a few responses - oh that's really sore, can't move it. I started doing some Active Release techniques on the backside of it and helping her move it, and then we did some banding, and just try to facilitate some things, and after about 30 minutes of working on her, her whole shoulder was moving just fine, like it had never happened. I don't know what that was, but I've read some of the research saying that frozen shoulder can be viral induced, so that was one of those cases where it was just like it turns on a switch.
When someone experiences a frozen shoulder, what should they do immediately and how quickly should they come to see you?
If you have been under care, you would know that I always say if you have something like this, let me know right away, so we can knock it out. But if you're new, this is new to you, I would get somebody to look at it right away to see what it was. If there was trauma, you usually would want to do imaging, to see is there a labral tear, is there a fracture, is there some sort of x-ray findings, that could be why it shut off.
Your body knows, hey let's not move it, if it's hurting. Let's stabilize by just keeping it still. If there's no trauma, and you want to get it, you know, it's best to get it assessed. Your provider, you know, whoever helps you with movement therapy, you know PT or me. Just get it assessed, to make sure there's nothing wrong. The sooner you get on something, then, the quicker you knock it out. If you let, things just brew up, tighten up for no reason, it just costs you a lot of time, money, and effort in the long run if you don't address it quicker. That makes a lot of sense.
Do you see a lot of cases with frozen shoulder?
I do, you know, early on in my career, I saw a couple of really bad ones, that was kind of humbling, like, wow, the drummer for instance, came in and I was able to help him, but I've seen a few over the years, where some had, one of them had to have a total shoulder, just because there was so much that was going on in there, that we never resolved. That was another one that I saw, that had a total shoulder replacement but I would say, I see probably one a month, on average, and it's usually from overuse, where you do have an injury,and things tighten up, where the rotator cuff tendon up here (refers to a picture), you'll get some fraying or you'll get some, really nasty adhesions, where it's not allowing it to move. Or deep below that, you can get some impingement, or the labral is tearing so by default, you're going to get a frozen shoulder because you don't want to move it in that range, it hurts. It could be a whole array of different things going on, so there are different diagnostic tests, and orthopedic tests, that we can do to see what is the tissue that's in question.
Are there any surgeries in your opinion, that happen today, or these days, that can be avoided if people come to you first? What is your experience with use of surgeries to treat some of these issues?
I do think that a lot of the surgeries in this area are over prescribed so to speak, just because your body can repair on its own too, and there are new procedures with PRP and stem-cell, that I work with other providers, to do that in conjunction with what I'm doing. I've had patients to go in there, and they do exploratory surgery, because the MRI was not conclusive, so they'll get in there and see like there's nothing wrong with this tissue.
You can have issues where it's just so chronic, where your body just shuts it down. It needs just to be stimulated and rehab with neuromuscular education, manual therapy, PRP, different things to regenerate some of this tissue,because what happens, is I keep looking back here at this tendon (points to a picture), there's this common insertion tendon up here where these muscles attach, and you can get full resection of one of those, and some of the elements might be intact, so you can help that tissue regenerate with some of these stem cells, and PRP procedures, and at the same time myself included, with the other provider. I'm doing manual therapy around that tissue, they're doing the work in there, and it's just kind of a win-win without having to do any more damage so to speak.
Anytime you have a surgery, there's a benefit to it, but there's also, you have side effects. You cut the tissue, and right away your body has to start scarring to heal that tissue, that they have to get to. Try to avoid it, at all costs. That's my thought.
For people that have undergone surgery and are not seeing relief from it, we see that a lot, with different cases, shoulder, or back, you know, surgery was recommended, there was hope given, then the surgery happens and the relief hasn't happen. Do you see a lot of cases of that?
That happens more often than not. With ART being not as well-known as kind of mainstream, other treatments, I had a gentleman in here on Monday that had, they cleaned up some calcification, tendonitis stuff in his shoulder, I've been doing ART and he is like, I wish I would have found you sooner, because this is, so much better just with getting that motion and that movement back, because when you go in there and you clean that up, or you have a spur, they'll shave it off, it'll be good for a few years, but it comes right back because body's response to stress is, it's gonna put down bone. You can shave off the bone, but if you don't reduce that stress that's adding to it, it's gonna come right back. I've heard that a lot of times, where it'd be nice you know, someday, my goal is to have people try ART and these services first off, and then go with a surgical route. It's you know, least invasive, there you know the cost, and the rehab time, and lost time from work, and lost time from having fun, and doing what you want to do. It's just more in your favor.
What is your advice to teenagers that are active in sports and young adults because, maintaining our skeletal system and our nervous system and have it continue to function normally, it's so important, it's core to staying healthy. What is your advice to the younger generation?
That comes up a lot right now, just because of the media and what's going on in the news, is sports specific for these children, and you know I have two children of my own, and we try to just have a variety. To play what's going on during that season. If you're playing baseball year-round, or hockey year-round, as you are skeletally maturing, that's a lot of stress for anybody. Our age, kids, whatever, but as you're growing, and you start to have repetitive strain injuries or let's say compression fractures, or anything that can happen to the osteo structures in a skeleton, you're gonna have that issue, and then you have to build on it from there, as you continue to grow. It's just a lot of demand for young kids to keep up with that, playing hockey 12 months a year or baseball 12 months a year. It's best I believe, to have a variety of sports, where you're in court, always having varied movements, different change, where you're not always going this direction, but maybe this direction (points in different directions) or back, you know different. Building the brain to - you know, map out new movements, and learning new things, is more beneficial than playing the same thing over and over. So, variety is good, variety is key, that is good, wonderful advice, very helpful.
Dr. Brian Gervais, DC, CCSP, ART® expert, specializes in full body Active Release Techniques (ART®).
ART® is a patented, state-of-the-art soft tissue system/movement-based massage technique. According to Dr. Gervais, headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, and tennis elbow are just a few of the many conditions that can be resolved quickly and permanently with ART®, massage, and proper nutrition.
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