Ask The Expert: Why is Frozen Shoulder So Common in Women Aged 40-60?
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So what's the deal with frozen shoulder? While many of us may not be familiar with it, frozen shoulder is a condition that can impact a significant number of women, especially those in midlife. This painful and restrictive condition can make everyday activities a challenge, affecting not just physical health but overall quality of life.
To help us better understand this condition, we spoke to Alison Linn, a seasoned osteopath with over 34 years of experience, who is well-versed in a variety of treatments. Her emphasis is on self-management education, empowering her patients to take an active role in their recovery.
Here, we explore the causes, symptoms, and effective treatments for frozen shoulder, and why it is particularly common in women aged 40-60.
What is a frozen shoulder and the underlying causes?
The mechanism behind frozen shoulder, also known as adhesive capsulitis, is still poorly understood even today. However, we do know that the vast majority of sufferers are women aged 40-60+. It is strongly associated with hormonal changes, such as those seen in menopause. This is because, in women, muscle tone is linked with estrogen, and menopause is associated with generalised inflammation called inflammaging. Additionally, IVF interventions, diabetes, cancer, and hypothyroidism can provoke this condition. Therefore, it's always a good idea to get your bloods checked to rule out any underlying pathology behind the frozen shoulder.
A frozen shoulder can also be associated with trauma to the shoulder. In most cases, it will resolve with or without intervention within 18 months, although that is a long time to wait.
Despite being so painful and debilitating, very little shows up on scans other than a bit of calcification and bone thinning—tissue tears can show on scans too, but these are, in the main, often not responsible for the pain.
What are the common symptoms of frozen shoulder?
Movement is restricted and painful, whether you move your arm yourself or someone else does it for you. This is particularly noticeable with the most basic of movements such as reaching for your hair, reaching for the kettle, and reaching into a back pocket. There is also a loss of strength, and the skin can become very sensitive. Pain tends to worsen at night, especially if you try to lie on the affected side.
Frozen shoulder is usually one-sided, but in rare cases, it can affect both sides simultaneously. Sometimes, there is little or no pain, just a loss of freedom of movement.
There are other shoulder conditions, but a healthcare professional will be able to assess and diagnose frozen shoulder accurately.
Interestingly, some individuals exhibit a full range of movement when under general anesthesia, even though they are painfully and severely restricted when conscious.
What are the stages of a frozen shoulder, and how long do they typically last?
There are three phases of a frozen shoulder, although not everyone goes through each phase.
- Freezing Phase: This is the initial phase, where movements become painfully restricted.
- Frozen Phase: In this phase, the pain may lessen, but the shoulder becomes locked up, significantly limiting movement.
- Thawing Phase: The final phase involves an improvement in movement and a reduction in pain.
These phases typically span on average 12-18 months, but for some, they can be as long as two years or more.
How can a frozen shoulder be treated or 'unfrozen'?
Based on the data, several treatments have shown efficacy:
- Shoulder Hydrodilation: This procedure involves injecting fluid into the joint to expand and stretch the shoulder capsule.
- Shockwave Therapy: Uses sound waves to stimulate healing and reduce pain.
- Platelet-Rich Plasma (PRP) Therapy: Involves injecting a concentration of a patient's own platelets to accelerate the healing of injured tendons, ligaments, muscles, and joints.
- Anti-inflammatory Medications: Help to reduce pain and inflammation.
Other treatments with good evidence include:
- Acupuncture / Traditional Chinese Medicine (TCM): These can help reduce pain and improve function.
- Exercise Therapy: Targeted exercises can help restore movement and strength.
- Manual Therapy: Techniques used by physiotherapists and osteopaths to improve shoulder mobility.
- Prescription Herbs: Certain herbs have good evidence behind them to support healing and reduce inflammation.
- Cortisone Injections: While effective in reducing inflammation and pain, cortisone injections can cause tissue damage over time. Nowadays they are mostly administered with X-ray guidance to ensure precision.
Remember, the key is to find the treatment that works best for you, as what works for one person may not work for another.
Which supplements are beneficial for frozen shoulder?
Once again, we look at the data, and there is good evidence for certain supplements. Magnesium is beneficial for its anti-inflammatory properties, support for adrenal function, and muscle relaxation. Similarly, research shows that ashwagandha’s anti-inflammatory, antioxidant, and stress-reducing abilities make it helpful for reducing inflammation around a frozen shoulder. Supplements tailored for your frozen shoulder journey can provide that extra targeted support your body might need.
Do you have any additional advice to support the body through the recovery process?
I would like to round off with a couple of final important research findings.
The top 8 global experts on frozen shoulder pooled their knowledge to develop a Gold Standard therapeutic approach. Their conclusion, eagerly awaited, was this: "Optimize your health, keep moving, and you will have a quicker and better resolution of your frozen shoulder."
What does this mean? Optimizing your health involves paying attention to what you put into your body and how you process experiences.
The other key point was about exercise intervention. For many frozen shoulder sufferers, exercise can aggravate symptoms. Despite extensive research and grants dedicated to finding the best exercise program, the data shows that these specialized programs fare no better than simply "keep moving/incidental exercise."
Your take-home message is: "Get your body healthy to reduce systemic inflammation, think positively, and keep moving even if it hurts a bit."
If you're looking for additional support, magnesium glycinate in our natural Sleep aid is known for its ability to relax muscles and help you drift into a deep sleep. Ashwagandha, a key ingredient in our Energy Complex, is enriched with all eight B vitamins, vitamin C, and zinc—essential nutrients for a healthy immune system and cellular protection.
Alison Linn, BSc (Hons) Ost. Med Cert TCM & Acup (musculoskeletal) - runs her own clinic, Rozelle Osteopaths, in Sydney. In addition to osteopathy, she provides shockwave therapy, needling, traditional Chinese medicine (TCM), cupping, exercise prescription, craniosacral osteopathy, and visceral osteopathy.
Discover our range of evidence-based supplements, developed with mind and body nutrients to support your body and your needs before, during, and after this transitionary life stage.
This article has been reviewed by our expert advisory team.