For Frozen Shoulder Manipulation, go to Do I Need Shoulder Manipulation?

Shoulder Surgery is a Last Resort

Not every shoulder injury condition requires surgery.

It's generally understood by doctors and surgeons that surgery will introduce more scar tissue into your shoulder. This added scar tissue will be problematic, requiring PT and often significant treatment post-surgery. If not dealt with properly, your shoulder could end up in worse condition than before the surgery! This is why surgery is only performed as a last resort.

If You Haven't Done So Yet, Get a Proper Diagnosis

A serious shoulder tear is termed as Surgically Necessary (SN) and will require surgery, and in cases of complete tears or detachment, there is really no other option. This is why it is important to get to a physician and find out what is really going on - this is known as getting a proper diagnosis. Getting a proper diagnosis would also determine if your shoulder pain is a side effect from another condition or disease (diabetes or lyme disease are two examples). This is less common but nonetheless, very serious. So yes, it is important to get a proper diagnosis.

If Surgery is Required

Ok, well the good news is that AidMyFrozenShoulder conservative treatments are highly effective for speeding up shoulder post-surgery recovery. To learn more about how to get started with recovery after surgery, click here.

The Good News

Most shoulder injuries are not Surgically Necessary, and will heal on their own. This is why most doctors, physicians and orthopaedic specialists will recommend conservative treatments for non-SN shoulder injuries before considering surgery.

Some Of The Most Effective Conservative Treatment Methods To Avoid Surgery Are:

• Rest - This is important for initial healing to reduce pain, swelling and inflammation in the 'freezing' stage of your frozen shoulder injury. Too much rest can also be harmful to frozen shoulder injuries because joint immobility of the shoulder (from frozen shoulder or some other injury like a rotator cuff tear) can actually cause more stiffening in the shoulder joint. This is why rest should be used when reducing initial pain and swelling, but should not be considered for more long-term conservative treatment.
• Avoid Activities that Caused Your Injury - While resting your shoulder it's also important to avoid all activities that may have caused your injury in the first place and this definitely includes pretty much any type of sport where your upper body is involved. Continuing on with regular activities will not only make your injury worse, but limping to 'work around' your injury will eventually give rise to over-compensation injuries in other areas of your body.
• Use a Cold Compress or Ice Pack - Cold is very effective at reducing pain and inflammation - use at the onset of the injury and during flareups.
• Use a TShellz^® Circulatory Boost Wrap - You can use your own blood flow to maximize your rehabilitation, maintain healthy blood flow to your shoulder, decrease recovery time, and boost overall long-term healing. Promoting blood flow to your shoulder joint capsule will help to minimize the growth of scar tissue, increase flexibility and helping prevent atrophy.
• Physical Therapy - Surgery is usually the last resort. This means doctors or surgeons typically won't perform a surgery until they feel that their patient has put effort into treating their injury with conservative treatment methods. This includes 4 to 6 months of PT. If you haven't experienced any improvement in your condition during that time then surgery may be considered. Agressive PT approaches will focus on forced or manual manipulation of your shoulder joint - this means your physical therapists will be trying to move your shoulder past the point where it 'sticks' or is 'frozen' in place. This can be painful and end up making your injury worse if not done correctly. (reference: 1)
• Stretching - Stretching your frozen shoulder in PT and at home will help you to regain your range of motion much faster than not stretching the shoulder joint at all. Stretching in many ways is the key to overcoming a frozen shoulder injury, and stretching can be made much easier with use of a TShellz Wrap before to warm up the tissue, and a Cold Compress treatment after to prevent any return of swelling and inflammation.

For acute (new or recent) shoulder injuries that have the ability to heal on their own - your doctor may even suggest use of a removable shoulder sling. A removable sling can be very helpful to prepare you for PT sessions and mobility exercises.

However, prolonged use of a removable shoulder brace or long-term rest (restricted movement) without proper exercise or stretching can make your shoulder condition worse. If your shoulder remains completely immobilized and at constant rest, the edges of your soft tissue tear will begin to fill in with scar tissue as part of the healing process. You may also have on-going symptoms of pain, swelling, inflammation, and even poor blood flow circulation.

Conservative Treatments outlined below can be used for all the following puposes:

• Minimize Your Chance of Having Surgery
• If you are having surgery, use these treatments before undergoing surgery (presurgical treatments)
• If you have already had surgery, use these treatments to recovery from surgery at an accelerated pace

Step 1 - Reduce Pain & Swelling with a Cold Compress or Ice Pack

The 1st step for conservative treatment of your frozen shoulder before and after surgery is to reduce swelling to "open up" the area for more blood flow. Anyone in the health-care business knows that your blood supplies the oxygen and much needed nutrients required for your body to heal naturally after surgery. This is why doctors and surgeons recommend cold within the first 72 hours of an injury and following frozen shoulder surgery.

Cold is recommended to reduce pain, swelling and tissue damage. Many doctors, surgeons and physical therapists consider cold to be the gold standard for treatment of inflammation and pain. On-going cold treatments can reduce, or even eliminate, the need for NSAIDs or other medications that can be harmful to your body.

Cold Pack applications are known and trusted by most medical professionals. This is why for years doctors, trainers and other medical professionals have recommended RICE (Rest, Ice, Compression, Elevation) to treat the pain and swelling of fresh injuries, chronic pain, after any re-injury, and especially after surgery.

This is important because once blood vessels are blocked or damaged, they can no longer carry oxygenated blood through the tissue and tissue begin to break-down. Without cold compression, tissue continues to break down as they cannot access the oxygen they need to survive.

By limiting the amount of damage done to your shoulder joint capsule after surgery, you also limit the amount of healing that needs to occur. This is a very important step to heal frozen shoulder injuries faster and with less pain after surgery! This is why you need to treat your shoulder after surgery, when you notice pain / swelling / inflammation, or directly after a re-injury. Applying a Cold Compress right away will stop the damage immediately and unblock your blood vessels to let your body's natural blood flow in to start healing the tissue.

Step 2 - Improve Circulation & Prevent Re-Injury with Circulation Boost

There are a lot of people that think their frozen shoulder is gone after their swelling and inflammation are gone and their joint feels better. They also make the mistake of returning to regular activities too soon without proper time for healing. The truth is that healing takes time and after the swelling is gone your frozen shoulder injury isn't even close to being fully healed.

After the inflammation in and around your shoulder has been reduced, providing extra blood flow and strengthening the tissue around your shoulder is recommended. Believe it or not, the best time for you to focus on avoiding re-injury and strengthening your weakened joint is when the swelling's gone and your injury's started to heal. It's vital that you don't go back to activities too soon because you might bring on a major set-back in your recovery...

• Have you recently re-injured your shoulder by returning to your normal daily activities too quickly?
• How many times in the past have you aggravated your frozen shoulder just trying to perform basic tasks around your house?
• Is your shoulder injury preventing you from work or activities you love to do?

Most people we deal with tell us these scenarios have happened to them many times in the past. The real challenge is how to promote blood flow to your injured shoulder without causing further injury. This goal is even more complicated by the fact that your shoulder is one of your most commonly used joints in everyday life.

Tendonitis, strained muscles, torn ligaments and overall joint pain can often occur at the same time - weakening not only your shoulder joint capsule, but also all of the soft tissue surrounding your shoulder in your weakened joint.

What Happens When You Are Not Using Conservative Treatment Methods (as Outlined Above)

Soft Tissue Injuries of the Shoulder (this also includes the rotator cuff) are all injuries that cannot really be ignored. If you choose to ignore the injury, then this means you will still be be trying to do certain tasks (ie. using a fork, putting on your seat belt, etc) using soft tissue (strained and/or partially torn ligaments & tendons) that is already compromised. This means it will inevitably get worse.

Here is what to expect:
• Since the tissue is still inflamed, lack of proper blood flow will drop your healing rate to a crawl.
• Continually straining the soft tissue (just by doing daily tasks that such as cooking and sleeping on your side) worsens the injury and will introduce more scar tissue.
• Increased scar tissue buildup will tighten the soft tissue in your shoulder, decreasing your already limited flexibility.(reduced range of motion)
  If you suffer from a shoulder injury, this means that when you get out of bed in the morning and try to bathe, shave or wash your hair, it will hurt a LOT - this is due to reduced flexibility in the shoulder.

Since the ligaments/tendons of the shoulder cannot flex as much as they once did, trying to use the shoulder during your simple daily routine just introduces more scar tissue and continuously worsens the injury. As you can see this is a cycle that just gets worse and worse, eventually becoming a chronic (long term) injury. This is the cycle you need to stop or you will probably wind up having surgery once your injury becomes chronic.

What Is The Biggest "Gotcha" When Treating A Shoulder Injury Using Conservative Treatment Methods?

Many of our clients contact us after dealing with persistent & chronic shoulder problems. They have seen physicians and dutifully use cold compresses or ice packs as instructed. Invariably, their shoulder pain nearly disappears after continuous cold treatments, and they get back to performing tasks as they once did before their injury. After some time, the problem reappears and never seems to go away. What we tell them often surprises them, but it is true: you dealt with the pain, but your injury was never healed.

Most people wrongly associate pain with the injury. The real truth is that almost all of the pain really came from the inflammation and swelling. Once the inflammation is gone, do not assume you are fully healed. Now this is not the case for every injury, but for most soft tissue injuries, much of the pain disappears once the swelling is gone. To prevent the injury from coming back (or becoming chronic) you need to heal the underlying injury completely.

If you have questions, call our office at 1-866-237-9608 (toll free continental US).

Why Your Shoulder Injury Does Not Heal Easily

If our body is designed to heal our own injuries, why does it take so long to heal?

When we have an injured ligament, muscle, tendon or bursa, this means the tissue is damaged. Your body responds to this damage with healing right away. During this healing process the injured tissue spasms. These spasms are contractions, and are meant to hold the tissue still to prevent any further injury.

Swelling and inflammation is your body's way of:
• Creating localized pain to tell you something is wrong there and to stop moving it, and
• Sending blood to the area to start healing. Healing at this point will also expand the blood vessels in the injured tissue - they enlarge and swell causing you pain. This pain is a signal for you to lessen activity that would put anymore undue stress on your shoulder.

However, there is are significant problem with swelling and inflammation with regard to healing rate. Once soft tissue (such as your supraspinatus tendon) is inflamed, blood-flow is restricted. The body heals itself by sending nutrients through the blood to the injured tissue, and if the injured tissue is swollen, the blood-flow is greatly decreased.

Decreased blood-flow to injured tissue, prevents the damaged tissue from healing as fast as it would if the area wasn't swollen.

The other issue is that swelling is also very painful. With many conditions such as the common supraspinatus tendinosis, once you get rid of the inflammation, a lot of the pain will disappear as well.

Once the Pain is Gone, We Think Our Soft Tissue Injury is Healed.

So we start using it more and more for common tasks, and then "boom" we get a sharp pain and then it starts all over. When this happens, the injury was never fully healed - and now it is worse! More scar tissue grows in the new tissue micro-tears and well, lets talk about scar tissue.

Scar Tissue - We Need It For Kick-Starting Tissue Tear Repair
But After That It is Nasty Stuff

Tendons, ligaments, muscle and other soft tissue in the shoulder are all meant to be soft and flexible, ready to work and move extreme forces in everyday activities. When I say extreme force, I mean try to imagine the amount of force that your arm puts on your shoulder, even when you are just trying to lift your own arm, let alone something heavy.

Scar tissue grows in damaged tissue when it tries to heal; little tiny band-aids that overlap each other to bind tiny tissue tears together. With this added scar tissue, muscles & tendons & ligaments become rigid, less flexible and unable to handle the forces that it once could. If you're suffering with scar tissue now you may feel the effects with stiffness, tightness, weakness and tiredness in your shoulder.

Scar tissue can form fast to bring together the edges of a tear, but working fast doesn't mean that the job's done right. When scar tissue forms it doesn't come together as neatly as regular (healthy) tissue would. Scar tissue fibers will lay down over top of your tear in a cluttered, messy and jumbled up way.

On-going issues with scar tissue can result in soft tissue tears and increase chances of strain to nearby tendons or ligaments (as they are now handling higher forces due to overcompensation).

Scar tissue is one of the MAIN reasons why a chronic shoulder injury has not healed and your Range of Motion (ROM) is reduced from what it once was.

Scar tissue will form fast to deal with a soft tissue shoulder injury, and this scar tissue will attach to EVERYTHING in the area, including the surrounding healthy tissue as well. This can result in a fusing together of the soft tissue in your shoulder that shouldn't be fused together, and this will cause extreme pain when you move your shoulder - it is literally ripping scar tissue. This is why PT is often painful - the therapist stretches the joint, forcing the scar tissue bonds to break so you can regain your range of motion.

Scar tissue is a major problem especially when it comes to a shoulder injury - causing your injury to become chronic, and taking months or even YEARS to completely heal!

You can quickly minimize scar tissue growth and reduce risk of re-injury to your shoulder muscles/tendons/ligaments by increasing blood flow to that area and increasing the elasticity of soft tissue in the area. Treating yourself with the Shoulder TShellz Wrap is the easiest and most effective way to accelerate your recovery, increase soft tissue elasticity and deal with stubborn scar tissue.

When applied before activity or work, the TShellz Wrap will also relax and lengthen your soft tissue to help improve your range of motion and prevent atrophy (tissue wasting & shortening) of your injured shoulder.

Overall, continued treatment with a TShellz Wrap will maintain good health in your soft tissue and significantly reduce your risk of re-injury.

• Once the swelling is gone (usually after applying cold compression to the injury over 24 to 72 hr period).
• BEFORE getting out of bed in the morning. BEFORE going to bed at night.
• BEFORE exercise, workouts or activity of any kind to increase elasticity of shoulder tendons, ligaments and muscles and decrease the chance of re-injury.
• AFTER surgery (once the skin wound has healed over) to increase post-surgery healing rate and minimize scar tissue growth at the surgery location.
• Anytime BEFORE you feel you might undertake activity that will put significant strain on the injury area.