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“It just started hurting out of the blue and now I can’t move it in certain ways.” The “it” she is referring to is a shoulder. If you knew me you would smile at the words “out of the blue”. You see, for me those words are a challenge. I believe that nothing happens to the body “out of the blue”. The trick is to find out the true cause. This is the part of my job I love.

Why Is It Frozen?

Her symptoms are indicative of a condition known as frozen shoulder, or in the medical world as adhesive capsulitis. Some of the joints in the body are surrounded by a sack called the joint capsule. This sack keeps the lubricating fluid in the joint contained. In adhesive capsulitis the joint capsule gets irritated and inflamed. This results in pain with certain movements, particularly those which stretch the capsule the most. This condition is far more common in women than men, which is a cruel irony given that the most painful and limited movement is putting your arm up behind your back – ladies you know exactly why this movement is important for us and not for men.

The thousand dollar question is, what sets this off in the first place? Sometimes adhesive capsulitis begins after an injury to the shoulder, but in most cases there is no obvious precipitating event. In the medical world the term “idiopathic” is used in these cases. This is a fancy way of saying “we haven’t got a clue”. Personally this irks me. I feel like the fact that the medical world has coined a specific term for “we haven’t got a clue” somehow legitimizes ignorance. It lets us off the hook from continuing to seek answers, and it seems most people have in fact stopped looking.

Why Does This Happen?

I see the word “idiopathic” and my dog with a bone instincts kick in. The more people tell me “we don’t know why” the more motivated I am to dig into the exploration of the why. Seeing as how frozen shoulder is such a common condition and I see cases regularly, I am not satisfied with passive ignorance of what is behind it.

It seems inexplicable to me that a tissue in the body would just randomly become inflamed and irritated one day for no reason.   I just don’t buy it. So here is my theory which, by the way, is supported by the results of treatment.

The shoulder capsule is part of a body-wide matrix of tissue which supports structures and holds them in place. This includes everything from muscles to nerves to organs and everything in between. This system is continuous and uninterrupted, meaning your left ear is directly connected to your right foot. Knowing this, it doesn’t seem far-fetched that tightness in another area of your body could pull on your shoulder capsule and irritate it.

Treatment Requires Looking at the Big Picture, Not Just a Shoulder

This theory is supported by the fact that every single person I have ever seen who had a frozen shoulder also had an upper back that was too bent forward. This pulling down through the upper back results in stress at the shoulder when we try to raise the arm. It’s like a tug of war with the shoulder capsule in the middle. With time eventually the capsule protests and the inflammation screams at us in the form of pain.

The other factor supporting this theory is that I often see people who have had lots of treatment on the shoulder itself with little to no improvement. This is because the problem is not in the shoulder. The problem is the upper back (and in some cases even more distant areas as well) which is pulling down on the shoulder. Treating the upper back and getting it up straighter always improves the shoulder pain instantaneously.

So next time you hear the word “idiopathic” don’t accept it. Keep looking until you find someone that will wrestle the “why” question into submission. Your body knows why, it just needs someone to listen to it.

We see the forest and the trees.

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