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Frozen Shoulder Part 2

by Baxter

Anatomical Studies of the Shoulder by Leonardo da Vinci

For those of you out there who might have missed Nina’s original post on frozen shoulder from a while back (see Yoga and Menopause: Frozen Shoulder), I’d highly recommend it. And while Nina rightly points out a correlation between menopause and adhesive capsulitis (that’s its fancy name), it turns out that men fall victim to this conditions as well. In fact, I developed a case of it in my left shoulder over the fall and early winter months of 2015-16!

Some interesting statistics on and features of frozen shoulder: 

• It usually affects those over 40 years of age, with the peak period being between 40-70 year of age. 
• 70% of cases are women and 30 percent are men. 
• The jury is still out on what causes frozen shoulder. Although there is a connection between menopausal changes in women and the development of frozen shoulder, the other leading contenders are that it is an inflammation problem, an autoimmune problem, or simply a stiffening of the joint capsule problem (a process called fibrosis). 
• Since it does not always show up in isolation, it can be accompanied by other causes of shoulder pain, such as bursitis or rotator cuff injuries, making diagnosis and treatment tricky. 
• According to the Mayo Clinic, you are at higher risk of getting it if you have diabetes, heart disease, Parkinson’s disease, thyroid conditions, or a recent trauma that immobilizes your arm such a fracture or stroke.

When I started getting pain and limited range of motion in my left shoulder and arm last fall, I was not sure what was going on. It came on gradually and I did not have any of the risk factors I had read about, but I had tweaked my shoulder 15 years ago while climbing and had some chronic stiffness that my yoga usually worked out nicely. And then there were two events in September. First, I was swinging on a low trapeze bar for about two minutes, after which I noticed that my shoulder was not so happy with me. And, second, two weeks later I took a trip to an indoor sky-diving place, where a total of four minutes in the wind tunnel with the arms in bird-wing position made my shoulder even more unhappy. I recently came across research that connects direct or indirect trauma to the shoulder joint as a common cause of secondary frozen shoulder, which could explain my case.

When I finally got into to see the orthopedic specialist in late January of this year, initially I was offered a couple of steroid injections to cover both rotator cuff injury and frozen shoulder. At that point I asked for an MRI, since my physical exam could not confirm either diagnosis (it’s good to keep in mind that history and exam don’t always tell you what is going on for sure). And the MRI showed a healthy rotator cuff and definite frozen shoulder, so I only really needed one injection! That very same day, I got into to see an amazing physical therapist, who gave me a set of exercises to begin immediately. From a Yoga for Healthy Aging perspective, I was delighted to discover that some of the exercises were dynamic movements (similar to Arms Overhead Pose), done in sets of 10 repetitions, and others were static movements, held between 2-5 minutes. When I asked about the longer holds, my physical therapist mentioned that the joint capsule, made up of thick connective tissue, requires longer holds to loosen, similar to the timing we’ve discussed for stretching fascia here on the blog.

Now, I had read the studies that the average time for recovery of range of motion was 1-2 years and that really did not fit into my plans, so I asked the physical therapist if he had ever had a patient who recovered faster. He said, yes, one person who had actually taken his advice to do the physical therapist exercises hourly during the day had seen a rapid recovery in just a few weeks! (He pointed out that most patients only do them infrequently.) That was all the incentive I needed, and I started my practice immediately that day. After all, abhyasa (yogic practice) is not all that different (see Practice)!

One of the challenges of rehabbing frozen shoulder is that you actually have to move into far enough into stretch that it is painful. This is in contrast to physical therapy for rotator cuff injuries, where you would not go to the point of pain. I found that my ability to focus on my breath while holding painful stretches for 2-5 minutes was invaluable in staying the course without over triggering my sympathetic nervous system. And although I did not do them every hour, I often got 3-4 sessions in every day for the next few months. By April, my pain-free range of motion in that left shoulder was back to normal, and my physical therapist bid me farewell, with the important reminder to keep an eye on my right shoulder, as 25% of those with frozen shoulder will get a case of it showing up in the opposite shoulder in the 2 years that follow (Nina had this happen).

My takeaways:

1. If stiffness and pain persist in your shoulder, get it checked out by a specialist to get a solid diagnosis.
2. Try to see the best physical therapist you can in your community—it can make a difference.
3. Apply your yogic practice skills and your yoga tools to your rehab. (I was doing all the yoga poses I could do, although with left arm modified, along with my physical therapy exercises, and I believe it helped!).

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Some Information About Concealed Carry Training

By Paulette Mason

The world of the modern generation is, in more ways than one, better than what the previous generations had years back. The people of today had more stuff, stuff which were way better than those people had previously. Modern society also had things easier. Most tasks can be done by simple push of buttons, but years ago, old folks had to do hard manual labor from sun up until sundown.

But of course, no society is ever perfect. If they had a hard time making money back then, at least they had a more trouble free life. People were easily content and knew how to share. The people of the modern times did not only have top deal with pressures at work, they also had to stay clear of the streets where hundreds of crimes happen so casually that culprits just walk away as calmly as they could from the crime scene. These dangerous times compel one to learn self defense, such as wi concealed carry training.

Carrying a concealed weapon or CCW extends to refer to any private individual who is given the permission to carry weapons in areas where there are many people. The said weapon can be a handgun or a similar device, and it can be concealed somewhere beneath articles of clothing, or could be some place in close proximity. CCW permits do not always refer to guns and other fatal stuff, because they can include pepper spray and the like, especially when carried in great amounts.

Generally, these permits fall under four basic categories, in accordance to individual state regulations. The first one is classified as unrestricted. A jurisdiction that has an unrestricted stand on concealed carry means that there are no permit requirements for one to have a hidden weapon on him or her. Some states even allow open carry of a handgun even without permit.

Shall issue states are those areas who allow for the ownership of such obscure things only when one is granted a special license to be able to do so. Applicants do not even have to explain thoroughly why they needed the license, all they had to do is to submit the needed requirements. The granting council shall then issue the license if the applicant has complied to everything on their list.

May issue jurisdictions require applicants to prove that they need to have the permit due to a good cause. Often, non specific reasons are not allowed, so one has to be as detailed as possible as to why he or she needed the CCW permit. Until then, the police or the sheriff may grant permission by the time they deem it safe for a certain applicant to be given one.

There are also some states that does not allow any private citizen to carry an obscured weapon in public areas. No issue refers to the iron clad stand that no permits nor licenses should be issued nor recognized in such states. Illinois was the last no issue state, and with its move to legalize the said permission last July 2013, no state is considered as no issue all over the country.

The states who have just upturned their no issue category on the CCW are now accepting applications from its citizens. Wisconsin, for example, accepts only applicants that are of legal age and are residents of the said state for quite some time. They also had to submit some sort of proof that they have undergone training.

Such trainings include the hunter education program which is issued by the Department of Natural Resources. Similar programs from other states can also be recognized. One can also take courses given by certified instructors specified by the granting authority.

About the Author:

Find an overview of the advantages you get when you complete WI concealed carry training and more information about a reputable training provider at http://www.sheepdogfirearmstraining.com now.

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