Frozen shoulder could easily be the most difficult complaint we treat in our clinic. Perhaps along with the worst cases of back pain that have been left for far too long before seeking treatment. So if it’s that stubborn, the first question is, ‘can frozen shoulder be treated’?. And the answer is yes. One of the good pieces of news about frozen shoulder treatment is that, more or less, every case self-resolves eventually. The question is, how long are we willing to wait for your frozen shoulder to resolve itself, and how much can we speed up the process. So if we acknowledge that frozen shoulder can be treated successfully, then the next thing most people want to know is how long it’s going to take. As you may have guessed, this leads to the proverbial piece of string factor. Thankfully, there is a little more certainty about the treatment needed for frozen shoulder when compared to the length of a piece of string, because there is undoubtedly far less variation.

Frozen Shoulder and Treatment

Frozen shoulders that receive treatment tend to resolve on average about 90% faster than their untreated frozen shoulder counterparts. Almost all frozen shoulders will resolve within two years, even if they don’t receive treatment. Most people being frozen shoulder don’t get any proper rehab in the first year or so, due to a lack of options at the DHB level. In a typical frozen shoulder scenario the patient who has no treatment may find that in the first year of their onset of frozen shoulder, they may only experience a 10% improvement. Then later, when they do finally find a treatment that works for them, they can make another 50% improvement in a couple of months and then move up to about an 80% improvement in another couple of months—leaving them the remaining 20% to work through over six months. In total, there’s a 10% average improvement in the first year with no treatment, followed by a further 90% improvement in the second year with treatment. Of course, if they had found the successful treatment in the first year, the whole process would have taken half as long, or even 10% as long as the entire process with no treatment.

Cupping therapy involves placing cups on the skin to create suction. This suction increases blood circulation to the area where the cups are placed. This may relieve muscle tension, improving overall blood flow and promoting cell repair. It may also help form new connective tissues and create new blood vessels in the tissue. Cupping therapy is an ancient, holistic method for treating various illnesses, diseases, and conditions, including hip pain, shoulder pain and low back pain. While the exact origin of cupping therapy remains controversial, its use has been documented in Egyptian and Chinese medical practices dating back as early as 1,550 B.C. While cupping therapy has fallen in and out of favour throughout the centuries, it’s currently making a resurgence thanks to prominent athletes and health-conscious celebrities sporting the distinctive red circular cupping marks (not bruises!). 

While there are multiple techniques and methods involved in cupping therapy, here at Featherston Street Pain Clinic, we specifically focus on ‘dry’ cupping created using negative pressure suction. Our practitioners use an apparatus to create a gentle suction that draws your skin upward into the cup. (Your skin is not broken at any time in the process.)

What Does Cupping Therapy Feel Like?

As suction is directly applied to the skin, there’s an initial tightness sensation as the skin is drawn into the cup; the feeling passes quickly as your practitioner moves on to place the next cup. As the practitioner repeats the suction process, they will check to ensure the cups aren’t too intense. 

While traditionally, heat was used to create a vacuum, we use a suctioning apparatus that draws the air out of the cup. As time passes, your body will begin to acclimate to the feeling of the cups. The amount of cups required is dependent on the area of complaint. When being introduced to cupping therapy for low back pain, fewer cups with less pressure will be used. The cups will be placed for 5-20 minutes; afterwards, the practitioner will release the pressure in the cup, which often gives a calming, relaxing effect. Depending on the type and severity of your low back pain, a singular cup may be used with the practitioner gliding it across your skin, commonly known as ‘running cupping’. Running cupping has been shown to locally and systemically remove toxins by stimulating the immune response by dispersing uric acid, a natural waste product from the digestion of certain foods. 

We tend to attribute it to sore muscles or stiff joints when we experience low back pain, neck pain, or shoulder pain. However, many chronic back pain symptoms are caused by a thin casing of connective tissue surrounding and holding every organ, blood vessel, bone, nerve fibre and muscle in place: the fascia. While receiving little attention in the modern western world, fascia plays a critical role in every movement you make. 

Like ligaments and tendons, fascia is primarily composed of elastin and collagen, making it flexible and stretchy when the body moves. Interestingly, fascia also contains pain receptors and mechanoreceptors, which detect stretching or changes in pressure within the body. For this reason, some scientists consider the body’s fascia to be one giant sensory organ! Healthy fascia has a smooth and slippery texture and can shift its consistency between a gel-like state and a more fluid one when needed. However, when unhealthy, fascia can become sticky, clumpy, tight, and flaky when unhealthy. It forms restrictions, adhesions and distortions, causing various problems, including chronic back pain.

What is Fascia?

Have you eaten chicken breast or lamb shoulder recently? Notice that clear-like film that covers it? That’s fascia. At the same time, it looks like one sheet of tissue, but in reality, it’s made of multiple layers of liquid called hyaluron, intertwining all the muscle fibres. This provides the internal structure of the body, rather than it being just the skeleton that holds the body up, the facia and connecting soft tissue that keeps the skeleton upright also. The fascial tissue has so many nerve endings it’s almost as sensitive as skin. The fascial tissue is designed to stretch as you move. However, when the fascia is stressed, it tightens up. If the fascia dries up and tightens around the muscle fibre, it can impact mobility and cause painful knots to develop.

Pain is complex – it’s a huge topic – but the good news is that some general rules form a sound basis for navigating your way out of most aches and pains in the longer term. Let’s get started.

Rule 1 – If there is no significant medical issue, assume there is a weakness.

If all your scans and blood tests have come back clear, you probably have some weakness in your area of pain. You won’t be too surprised when I tell you a significant part of the solution will likely be strength work. The only note of caution is that if the tissues are inflamed, they may not respond to strength work without a bit of treatment beforehand.

Working on pain is a bit like working on dental issues; sometimes, you need to get through the treatment side of things before you go away and work on the big picture. Pain relief methods are an essential step towards being able to strengthen your weakened painful areas without risking making them worse. But once that is done the majority of pains relate to some need for increased strength and muscle support. 

Rule 2 – Be willing to think outside the box.

If you have been doing the same treatments with the same providers for a long time and aren’t seeing progress, be willing to try out new things. Doctors are great (mine saved my life once), but only a tiny part of their training relates to pain management. Physios are great, but sometimes there is more to pain relief than exercise prescription. Chiropractors are great, but not all pain comes from the joints. Osteopaths are great, but not all pains will respond to a gentle approach. Flexibility and open-mindedness are essential qualities when it comes to working with stubborn pain issues.

Sciatica refers to radiation pain or paresthesia (pins and needles) down the pathway of the sciatic nerve from the lower back, through the hips and down the leg. Sciatica affects 10% to 40% of the population, typically around 40 years old or above. In most circumstances, sciatica only impacts one side of the body. Sciatica usually occurs due to a lumbar herniated disc (90%). Often, a particular event or injury does not cause sciatica—instead, it tends to develop over time. Sciatica is common in specific types of occupational work that are physically strenuous, such as machine operators or truck drivers—specifically, people who often bend their spine forward or sideways.