Adhesive Capsulitis – aka Frozen Shoulder


Adhesive capsulitis is the medical term for the more commonly used phrase “frozen shoulder.” The capsule of the shoulder thickens and tightens, contributing to pain and loss of motion in the shoulder. There is no known cause for adhesive capsulitis; however, risk factors include diabetes, previous shoulder surgery, and hyperthyroidism. Some statistics show that up to 20% of diabetics may develop adhesive capsulitis compared to only 5% of the general population. The condition is also more prevalent in women around menopause.


The first sign of adhesive capsulitis is often pain. Next is loss of motion and function of the arm. The shoulder may continue to be dysfunctional for several months. It is typically diagnosed by clinical exam, as X-ray and MRI findings are usually insignificant but can help to rule out any other causes of your symptoms.


Adhesive capsulitis of the shoulder can resolve on its own in about a year without treatment however, both conservative and surgical interventions can help to speed your recovery. This condition is most commonly treated with NSAID medication, steroid injections and physical therapy to restore motion. The rehabilitation process is painful and involves aggressive range of motion activities for the shoulder, as well as the therapist moving your shoulder for you. A home program is typically included as well. It is essential for the patient to perform their exercises in PT and at home to restore the movement in their arm.

People with adhesive capsulitis often make a full recovery with no residual effects. Get help from a qualified PT if you suspect you may have the beginnings of adhesive capsulitis to get moving again. Motion is lotion for the joints!


What is the Rotator Cuff?


The rotator cuff consists of four muscles that provide shoulder joint stability and is important for shoulder movement. The four muscles are the supraspinatus, infraspinatus, subscapularis and teres minor. All four of the muscles start on the shoulder blade (scapula) and connect to the head of the upper arm bone (humerus). The shoulder joint is a ball and socket joint which resembles a picture of a golf ball (head of upper arm bone) sitting on a golf tee (shoulder joint). The rotator cuff muscles surround the joint forming a cuff. It is important during shoulder motion to maintain the proper position of the ball in the socket. The rotator cuff muscles assist in lifting the arm out to the side and rotating the shoulder for activities such as opening doors or tucking in the back of your shirt.


There are differing degrees of injury to the rotator cuff. An injury to this area can vary from a strain of one muscle, to a partial tear(s), to a complete tear of one or more muscles. Injury to the rotator cuff can be caused by age-related degenerative changes, muscle imbalances in the shoulder, repetitive overhead motions or trauma. Symptoms of rotator cuff involvement include shoulder joint pain, upper arm pain and functional limitations, such as difficulty lifting arm up overhead or reaching behind your back.


Physical therapy can be extremely beneficial to rehab rotator cuff injuries. During the evaluation, the physical therapist will assess shoulder range of motion and strength and perform special tests to determine the cause of pain. From there, an individualized treatment program will be designed. If rehab is unsuccessful or the muscle is completely torn, surgery may be necessary.


Pain in the Neck?


Chronic neck pain is something that can affect your work and personal life. If you have been suffering with neck pain for greater than 3 months then you would be categorized as having “chronic” neck pain. You don’t need to suffer anymore!


Neck pain can be caused by several different things including muscle spasms, joint restrictions in your neck or upper back, weakness in your neck or shoulder blade muscles, a disc herniation, or arthritis in your neck. Neck pain can also be associated with your posture or work station.


If you are experiencing any of the above issues then you should contact a physical therapist (PT). They will be able to evaluate you by taking you through a series of tests and measures along with functional tests to determine why you are suffering. An evaluation will assess your neck range of motion, your neck, arm, and upper back strength, as well as the mobility of your joints of the neck, upper back, and shoulders. Other functional tests that might be screened are your posture when you are sitting or working at your computer, how your body moves when you reach overhead and when you lift something off the floor. These tests will help the PT determine why you are having your neck pain.


Your PT will then develop an individualized exercise plan to address your areas of weakness and joint restriction. These exercises will help you achieve proper posture (e.g. getting your ear in line with your shoulder and your shoulder in line with your hip) in order to avoid forward head position and rounding of your upper back. The PT will also help to educate you on proper work station set up. Ideally, your wrists are below the elbow, the computer screen is in front of you, feet are flat on the floor and knees are below the hips. (1)


In addition to an exercise routine and education on proper body mechanics, your PT will perform manual therapy on you as well. Manual therapy is when the PT stretches your muscles and assists your joints to move. Research has shown that if your upper back is moving well, this will decrease the strain to the neck muscles and joints, decreasing your neck pain and improving your quality of life. The combination of both exercise and manual therapy can help to reduce your neck pain symptoms, reduce your sick leave from work, reduce the need for pain medication and improve your ability to function at home and at work! (2, 3)


How long have you been suffering with neck pain? What position seems to really cause you the most discomfort?


Iliotibial Band Syndrome – What’s That?

The iliotibial band, also known as the IT band, is a superficial thickening of tissue on the outside of the thigh. It extends from the outside of the pelvis, over the hip and knee, and inserts just below the knee. The IT band is very important in stabilizing the knee. Irritation is often found around the insertion of the band as it rubs on the outside of the knee area and is referred to as iliotibial band syndrome (ITBS). ITBS is a common injury in runners and cyclists due to the repetitive knee range of motion, which can cause excessive rubbing along the knee.

There are many different causes of irritation that can vary from training habits to anatomical abnormalities or muscle imbalances. Running on banked surfaces and/or cycling with a toe in increases the stress to the insertion and make these individuals even more prone to injury. ITBS may also be found in individuals with foot abnormalities, such as high or low arches, that affect the knee position during walking or running. Muscle imbalances, especially weakness in the hip muscles and excessive tightness of the IT band, may also cause friction along the knee area. In addition to knee pain, injury to the IT band can cause hip pain.


As you can see, ITBS can have various mechanisms of injury which can be addressed with physical therapy. On your first visit to physical therapy, the physical therapist evaluates the injury, determines the cause or source of pain and tailors a treatment program specific to the individual. The goal is not only to restore the individual to full function, but to address the primary cause to decrease the risk of future occurrences as well.