Frozen Shoulder: An Adventure in Pilates Rehab

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One of the great pleasures of being a Pilates instructor is working one-on-one with clients.

I’ve had the honour of preparing my clients for major life events like weddings or the birth of a child, shepherding them through significant change at work or home, and supporting them through illness and injury. An injury—specifically a torn ACL sustained on the soccer pitch back when I was in theatre school—is what first brought me to Pilates as a client, and many of my clients have arrived at the studio via a similar trajectory. I love working with clients from all walks of life, but seeing a client persevere through a challenging injury and coming out the other side is especially rewarding. For the last few months, I’ve been working closely with a client recovering from Frozen Shoulder.

Already a Pilates convert thanks to the Pilates based physio that helped her get moving again after surgery, our client was recovering from a car accident when she was diagnosed with Adhesive capsulitis, also known as frozen shoulder. 

Frozen shoulder is a painful and disabling disorder, a condition thought to be caused by injury or trauma, in which the shoulder capsule—basically all the connective tissue surrounding the glenohumeral joint of the shoulder—becomes inflamed and stiff, greatly restricting motion and causing chronic pain. The normal course of a frozen shoulder has three stages: the "freezing" or painful stage (approximately six weeks to nine months, in which the patient has a slow onset of pain and the shoulder loses motion), the "frozen" or adhesive stage (from four to nine months, marked by a slow improvement in pain), and the "thawing" or recovery stage, (when the shoulder motion returns to normal, from 5 months to 2 years). In the fall, before hydrodilatation (also called arthrographic distension - a procedure performed at the Toronto Rehabilitation Institute) our client returned to Pilates sessions three times a week as part of her treatment plan. This also includes physical and massage therapy, chiropractic, acupuncture and weight training.

We took a holistic approach to her program, focusing on not just the shoulder, but on maintaining her overall mobility and strength. In our early sessions especially, she was in a lot of pain and had limited endurance, so we worked on increasing shoulder range of motion in short bursts, and spent the rest of our time on core strengthening exercises and maintaining mobility in the thoracic spine. Seated Mermaid on the chair, which offers a great stretch into lateral flexion, is a particular favourite, and it’s one of the exercises we use to gauge how she is feeling or progressing on a given day. We also monitor the movement patterns that are either next to impossible or can cause the most discomfort—shoulder abduction (moving the arm away from the body), shoulder flexion beyond 90 degrees (raising the arm above shoulder height), shoulder extension (reaching the arm behind the body), and external rotation of the humerus (rotating the upper arm bone away from the body)—for improvement or change, and use the Pilates repertoire to challenge or increase the strength or flexibility of the shoulder. A real breakthrough moment came when she was able to “tell” her shoulder blade to depress for the first time—I think we both whooped with joy that day!

Statistically, more women are diagnosed with frozen shoulder than men, and most commonly between the ages of 40 and 70. Most frozen shoulders resolve over time without surgery, and the majority of people affected regain about 90% of shoulder range of motion. Recovery is not a predictable straight line, and there can be regression after treatments, but happily our client is making consistent progress, and we have been able to add more resistance, more challenging exercises, and thanks to Pilates’ comprehensive repertoire, if something doesn’t work, we can always try again with a modification, from a different position or on a different piece of equipment. Working with clients during recovery is extremely educational for me as a practitioner, plus I really appreciate getting to know our clients and am always cheered when they walk out the door feeling better than when they walked in. It’s why I love what I do.