Should you practice yoga with a frozen shoulder?
Guest post by Mike Munro, PT
Frozen shoulder is technically called adhesive capsulitis. The question of whether you should practice yoga with a frozen shoulder is not so simple to answer. Where you are in the stages of frozen shoulder matter a great deal! Please, before self-diagnosing, much less trying to deal with it, make sure you get a proper diagnosis and a professional opinion.
Anatomy of the shoulder
- The shoulder joint is a ball and socket joint.
- Three bones come together to make the shoulder girdle: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone).
- The ball is the round head of the humerus which fits into the socket created by the scapula.
- The shoulder capsule surrounds the shoulder joint where the bones come together.
Some things are common to frozen shoulder that are not found in other conditions. If you really have this condition and have not been misdiagnosed, then the condition should behave quite consistently in the following ways:
Active movement is stiff and/or painful in most directions and so is passive movement. This contrasts with a tendon tear of the rotator cuff, for example, which may have limited active movement yet passive limitations are much less. It is important to have a clear diagnosis and you may need a physical therapist assessment to determine this.
The phases of freezing, frozen, and thawing are the hallmark pattern of frozen shoulder. It starts off sore, and not as stiff, often aching at rest and then gradually the pain lessens as the second phase sets in. The second phase is marked by decreases range of movement in all or most directions, yet the pain is now mostly produced at end range and is not as acute with less pain at rest. The final phase sees a lessening of all pain and the range of movement gradually comes back. This whole process is somewhat resistant to treatment effecting a more rapid recovery, so treatment is more focused on managing the process and optimizing recovery rather than a cure.
Studies have shown that the duration of the whole process varied from 1 year to three and a half years (McKenzie 2000.)
Possible risk factors may include:
- Parkinson’s disease
- Cardiac disease
- Immobilization of the shoulder for some period of time due to surgery or injury
- Previously had a stroke
- Heart disease
- Cervical disk disease
- Open heart surgery
Good news and bad news
The good news about frozen shoulder is that it gets better on its own. There is some evidence that exercise at the right stage can improve function, yet most people will recover even without regular therapy.
I tell people that I can help them with recovery yet reassure them that slowly but surely it will get better on its own as well. Most people will agree to doing some exercises to help optimize recovery and try to get function back sooner and will hopefully with greater strength as the condition resolves.
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Staying as active as you can is important so keep moving. For people practicing yoga you may have to do more standing and floor poses with the arm in modified positions temporarily, such as warrior 2 with a hand on a hip. In general, keep your body moving: walking, hiking, modified gym routines, whatever you can manage.
Physical therapy for each stage according to MDT
(Mechanical Diagnosis and Therapy, aka the McKenzie Method.)
1. At first, all but painless movement is avoided. One option is pendular exercises, where you wave the arm dangling like an empty coat sleeve. Avoid active movements that cause pain, as they will more likely cause unnecessary bouts of increased pain. The pendular exercises may help decrease the constant ache that comes with the first phase. NSAIDs are often recommended but you have to weigh the costs and benefits. There are increased risks of GI problems with NSAIDs, which can be quite serious. And, the benefit is only some temporary relief in a condition that will naturally resolve.
2. The condition improves even without treatment. Yet most people like to do something pro-active. This phase is where that becomes more available. You can move into available range even if it produces some end range pain as long as there is no increase in pain afterwards. Still it will take time and it is often not until stage three that any noticeable improvement starts to show up.
3. This stage is usually the most responsive to exercise. McKenzie recommends working at internal rotation of the shoulder (hand behind the back positions), before external rotation (eg. arm elevated with elbow out to the side: goddess arms). this is because working the external rotation first will often be more aggravating. Once the internal rotation has improved then progress to working external rotation and elevation from there. Specific guidelines for exercise during the second and third phases of frozen shoulder can be found on pages 46 and 78 in the self-management book “Treat Your Own Shoulder” by Robin McKenzie.
Frozen shoulder and yoga
What this means for frozen shoulder and yoga practice is simply “patience”. You can modify your practice so as to not aggravate the condition in the first phase. Try to include more movement where possible in the second phase. Then start to explore more range and stretching with the shoulder in the final phase. You simply have to modify. Do what you can and avoid aggravating the shoulder until is it ready. This may mean your practice does not include regular sun salutes during the first phase and second phase. You can gradually re-introduce them during the final phase with whatever range of movement you have available. If you are following the MDT (McKenzie) approach, an emphasis on the hand behind the back variations will be more productive than working the arm overhead. This is specifically during the second and third phases of the condition.
McKenzie, May. The Human Extremities. Mechanical Diagnosis and Therapy. Spinal Publications. New Zealand, 2000.
McKenzie. Treat Your Own Shoulder. Spinal Publications. New Zealand, 2009.