& Address: Frozen
by Whitney Lowe
Techniques that encourage relaxation of the muscles surrounding
the shoulder girdle are a mainstay for massage approaches. Simple
techniques, such as effleurage and broad cross-fiber sweeping
strokes, are useful. Because the muscles often become fibrous
and shortened due to the limited range of motion in the shoulder,
restoring their proper movement is an important aspect of addressing
muscles are unable to move through their full range of motion,
restoring proper movement can be challenging. In this case, active
engagement techniques work well. The image to the left shows an
active engagement method for the pectoralis major, which often
becomes restricted in adhesive capsulitis. The client is instructed
to hold an isometric contraction (horizontal adduction) in the
pectoralis major and then slowly let it go. As the client releases
the contraction, the practitioner performs a longitudinal stripping
technique on the pectoralis major fibers.
trigger points in muscles such as the subscapularis may also play
a role in the perpetuation of capsular adhesion.
These trigger points can be treated with static compression methods
or compression with active movement (Right Figure). During compression
with active movement, the practitioner maintains pressure on the
trigger point while the client moves through as much of the range
of motion as possible (internal and external shoulder rotation).
goal for the massage therapist is to encourage elongation of the
adhered capsular tissues. This is accomplished with various stretching
However, do not expect results to come quickly. In addition to
- or in conjunction with - massage techniques, stretching methods
should emphasize the motions of external rotation and abduction,
and will get the best results when performed slowly to stretch
the adhered tissues. For example, with a passive stretch in lateral
rotation, the client is taken just to the point where discomfort
starts and then held there (see Left Figure). While in this position,
the client is encouraged to breathe deeply and relax the shoulder
as much as possible. After holding the stretch for 20 seconds
or more, the client is slowly brought back to the neutral position.
The procedure can be repeated several times.
Adhesive capsulitis can be debilitating and cause long-term
impairment. Proper treatment can mean the difference between a
several-months-long disability or one of several years. Even with
therapeutic results, this condition may require a long rehabilitation.
As a result, the client may get depressed about the lack of improvement
in his/her condition. Positive statements regarding even small
amounts of improvement will go a long way toward encouraging active
participation in the rehabilitation process. This is also where
your knowledge of the condition will be highly valuable, as your
clients attempt to learn more about their own bodies and what
they can do to return to optimum health.