"You know, I think I have that proposal here in the car. I’ll look for it and call you back.” Johanna pulled her gray Suburban over to the side of the road and parked. Her briefcase was in the back seat. She turned and reached back to grab it and suddenly there it was again. A sharp pain in her shoulder. "What is this?" she thought to herself. She reached again but the pain stopped her like a road barrier. Johanna climbed out of the truck and opened the back door to get her briefcase. As she rummaged through the papers looking for the proposal, she noticed a steady pounding in her shoulder as if she had a headache. “I’m going to have to get this checked out. Something’s not right.”
Johanna sat patiently in Dr. James’ waiting room reading a Style magazine. But she had no clue what she had read. All she could think about was her shoulder. In the two weeks that passed from the time she called for an appointment, her shoulder had worsened. She could not brush her hair, snap her bra, and could barely lift her arm up to put on a shirt. She was worried. The pain and loss of motion had steadily increased and she had no idea how the whole thing got started. “Maybe it’s a tumor or some disease. What if it is? Will I ever be normal again?” The questions kept coming flying into her mind one after another.
“Johanna? Dr. James will see you now.”
Johanna stood up and felt the wave of pain ride through her shoulder. She put on her best smile and followed the nurse to an examination room.
Dr. James asked her several questions, moved her arm in ways it did not want to move and muttered to himself . “You have a frozen shoulder. I’ll write you a prescription for the pain and get you on some good muscle relaxers. I also am sending you to see a physical therapist. Here is a list of therapists. Pick one that would be convenient for you.” And out the door went Dr. James.
Johanna felt queasy. “What is a frozen shoulder? What do I do for it? How did I get it? When will it go away or will it go away? What is a physical therapist?” she thought. Johanna got dressed slowly and left Dr. James’ office with more questions than answers.
Johanna looked through the phone book and called one of the therapists Dr. James had given her. She made an appointment for the next day.
“What we’ll do is stretch your shoulder, gently, and do some mobilizations along with some heat and ultrsound to relax the muscles and tissues in your shoulder. You should feel better after a few weeks,” said Holly the therapist..
“About how long will it take for my arm to move like it used to?” asked Johanna.
“That’s hard to say. You should ask your doctor too. Might be a couple of months.”
“What about the pain at night? Why do I hurt so bad at night?” asked Johanna.
“Well, it could be your cutting off some blood flow or it might be that muscles are too tight and are cramping,” said the therapist.
Johanna laid down on a table. Holly gently lifted her arm. She had moved it about 70 degrees when Johanna suddenly grabbed her arm and shouted, “Oh! My! Please stop! It really hurts!” Holly froze. She attempted to lift the arm a bit further but Johanna was in too much pain. She slowly lowered the arm and said “You hurt too much for me to move your arm so we’ll use some ultrasound to help your pain and then I will do some joint mobilizations. But don’t worry. I won’t move your arm again today.”
Johanna worked with Holly two or three times each week. Every few weeks, Holly measured Johanna’s motion but little changed. After six months, the pain had subsided to a dull, tolerable level. Johanna’s shoulder was stiff. It was so stiff. Holly had tried a number of things to help her. Then the day Johanna secretly feared arrived.
“Johanna, we are not making much progress and your insurance company requires me to show progress in order for you to continue with your therapy. I think we’ll just need to teach you how to work on this at home,” said Holly.
Johanna was nervous and scared. She had a very stiff shoulder and the one person who had tried the hardest to help her was giving up on her. Johanna could not imagine how she would ever be any better than today. Holly showed Johanna how to use a cane to stretch her shoulder and showed her several other stretches to do.
“You’ll need to do these for 10-15 times each day 4 or 5 days each week. After a few more weeks, you should feel better,” said Holly.
Johanna did the exercises each day. After three months had passed, her shoulder only hurt when she stretched it and maybe her motion was better. It was hard to tell. Brushing her hair was a fight but she could do it and dressing was easier now. It had been nearly nine months since she first noticed the pain while reaching for her bag in the car. Life moved on and Johanna adapted. She gave up some of things she loved like tennis and swimming. She settled but she wondered. “Is this the way it needs to be? Is there something else I can do? Will I always be like this?”
How could have Johanna’s journey been different? First, neither Dr. James nor Holly told Johanna what to expect. Anxiety falls as knowledge rises. Johanna needs to know the disease may last from 9 months to 24 months. She needs to now what’s around the corner. She will hurt and lose motion but the pain will subside. If at the end of the disease process she still does not have enough motion, she may need either a manipulation under anesthesia or a capsule expansion procedure but more importantly the options exist. She needs a lifeline for her concerns and fears. The disease is tough to fight on your own. Johanna needs structure. A regular appointment every three weeks to talk, get advise, encouragement and when indicated a change in her healing movements. Adhesive capsulitis follows one of the laws of the Universe - for every action there is an equal and opposite reaction. Push hard and it pushes back with equal vigor. Light, easy motion to start coaxing it into recovery.
Shortening the natural cycle of adhesive capsulitis is unlikely but you can make the journey far more enjoyable and win a client for life.
Make today count.
Doug Kelsey
Author. Teacher. Therapist.
