Massage techniques
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 this problem.

When 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.

Myofascial 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).

Another goal for the massage therapist is to encourage elongation of the adhered capsular tissues. This is accomplished with various stretching procedures. 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.

Conclusion
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.

References