Trigger Points: Frozen Shoulder: A Trigger Point triggered myofascial Pain Feedback Loop?
Frozen Shoulder may well be the classic clinical presentation of a "myofascial pain
feedback loop" with a strong inflammatory component (see previous page for description and explanation).
Comparison of Standard Physiotherapy with that of Trigger Point Massage…
Two case histories are presented here which, when considered together, highlight
the need to de-activate trigger points before attempting to prescribe frozen
shoulder exercises. (Note - It is not my intention to provide comprehensive
information about frozen shoulder syndrome in this article. References 3,5,
and especially 6, 7, 8, 9 and 10 provide reliable further reading).
Trigger Point Case Study (5): Standard Physiotherapy for a Frozen Shoulder.
Shirley Sahrmann describes a case of frozen shoulder in her classic work:
Movement Impairment Syndromes(5). A summary of the case history is presented here:-
"The patient is a 60-year old woman with a progressive increase in shoulder pain
that started as a mild aching. Over a three seek period she develops pain with
overhead motions and has progressively worsening pain in her shoulder. By the
end of 6 weeks she is having difficulty sleeping because she cannot lie on the
side of her painful shoulder. She attributes her pain to sitting for prolonged
periods working at her computer, during which she leans on her forearm. She also
positions her elbow posteriorly to her shoulder, which places stress on the top
and front of her shoulder. She also believes that her shoulder problem is
exaggerated by the stress on her shoulder that occurs when she walks her dog,
who frequently pulls at the leash in a sudden and forcible manner".
Professor Sahrmann goes on to describe the restriction of motion and slowness
of response to orthodox treatment:-
"Five months after the onset of pain, she has made little progress in range of
motion but is sleeping most of the night and does not have aching in her shoulder
while at rest. She notes that if she repeats her exercises often, her shoulder
becomes more painful; unfortunately performing the exercises does not lead to
improvement in range of motion. Her primary exercise is passive shoulder flexion,
and she attempts to use her arm as much as possible doing daily activities.
She has developed a skin irritation in the axilla from the limited motion,
which she treats with Keri Lotion [Note: could that skin irritation be due
to referred inflammation from a trigger point? - I have experienced the
similar skin irritation in my own body]. Six months after the onset of the
shoulder pain, the pain is only present at the end of the range of motion and
she can tolerate more consistent performance of her exercise program…."
Note: Sahrmann is one of America's most respected physiotherapists, but
recovery for her patient was still a slow affair:- 8 months from the onset
of pain and 5 months after the start of physiotherapy . Compare this with the
case of Bernie, which is quoted below. His shoulder pain was treated with trigger
point massage. His recovery occurred 3-5 months after onset of symptoms and
significant improvement occurred within minutes (not months - minutes) after
trigger point therapeutic massage of his subscapularis muscle:-
Trigger Point Case Study (6): Frozen Shoulder treated by Trigger Point Massage.
Bernie, age forty-eight, had endured pain in his left shoulder for several months.
The problem had begun when he tripped and fell while picking up broken branches
after a storm.. The shoulder ached all the time and woke him repeatedly at night.
He'd stopped even trying to raise his arm and dreaded putting on his shirt in the
morning. He hated the idea of going to the doctor, but the problem wasn't getting any better.
Bernie's wife gave him a gift certificate for a massage and to her great surprise,
he went. The therapist worked on and extremely painful place under his arm and
then showed him how to massage the spot himself. His shoulder was better right
away, which encourage him to continue working on it on his own…. Three months
later, he tested [his shoulder by raising] his arm all the way up. "I'd forgotten
about it," he said. "I don't even think about it any more".
Note: The two cases presented here for comparison do not conclusively prove
that frozen shoulder is a trigger point triggered myofascial pain feedback loop.
They do however suggest a new avenue of enquiry, one which I strongly recommend
you to follow (see refs 6,7,8,9,10).
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Biology of trigger points: frozen shoulder - a trigger point
triggered myofascial pain feedback loop?
© Bruce Thomson, EasyVigour Project
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