Frozen Shoulder: THIS Is Why Your Shoulder Won’t Move

[0:00] Have you ever had a frozen shoulder? Jason: I’m a frozen shoulder. When I was in college, I got frozen shoulder all the time. Kathy: No, I’m not talking about your dating history. That’s cold shoulder. Jason: All right, frozen shoulder. I get — I get patients who come in all the time with frozen shoulder. What I find is that a lot of them don’t understand what it really is. Kathy: Yeah, that’s why we want to talk about it today. We’re going to talk all about frozen shoulder, why people get it, and what to do about it. Jason: That’s right. So, if you’ve ever had a shoulder injury, you aren’t going to want to miss this episode. This is the PTCH.

[0:32] What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? Kathy: But chiropractors and physical therapists don’t like each other. Jason: Oh, think again. Kathy: I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger. Jason: I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Kathy: Welcome to the PTCH Podcast. Remember, there’s no I in PTCH. All right, welcome back to the PTCH. This week’s episode is actually brought to you by one of our sponsors, Encore Physical Therapy. Have you heard

[1:02] of that place before, Kathy? Yeah. Jason: Well, I get the privilege of sitting across from Kathy every week, which means that I get a front row seat to how she thinks about movement, pain, and getting people back to the life that they want. That’s the exact same mindset that they have when you walk into Encore Physical Therapy on Ninth Street in Corvallis. So, if you’re recovering from an injury, dealing with nagging pain, or trying to get your body to cooperate with your ambitions, their team knows how to guide you from “this hurts” to “I can do this again.” So, they

[1:34] don’t just hand out generic rehab plans. They build programs around how you move, how you heal, and where you want to go. So, Encore is the kind of clinic where people feel seen, encouraged, and actually excited about the progress that they’re making. So, they blend evidence-based rehab with genuine human support, which is a rare combination in healthcare. So, whether you’re an athlete, a weekend warrior, or someone who wants to pick up their grandkids without having to call 911, the professionals at Encore Physical Therapy

[2:04] can definitely help you. It’s Encore Physical Therapy. PT so good, you’re going to want more. Excellent. Yes. Love our sponsors. Thank you so much. Jason: Dr. Kathy Lynch. Here we are for another episode. Kathy: This one about the fro show. Jason: The fro. Not fro yo. Kathy: No, not fro yo. We’re going to talk about this shoulder problem — fro show. Jason: Fro. Kathy: Yeah. You see a lot of people with frozen shoulder. Jason: Yeah. Otherwise known as adhesive

[2:34] capsulitis. Kathy: Adhesive capsulitis for the nerds out there, right? Nerds and the — Jason: Yes. Kathy: Yeah. And you know, I think that frozen shoulder is one of those conditions where the diagnosis got out there into the open. And so then you get a lot of people who self-diagnose, “oh, I’ve got frozen shoulder.” And it’s — it’s not just as simple as “I can’t move my shoulder very well,” right? Kathy: And it’s important to understand the

[3:04] difference, right? Jason: Okay. Kathy: It sure is. Jason: So, tell us — tell us about frozen shoulder. What is it? Kathy: What is the adhesive capsul— what’s your — what’s your signature question? Frozen shoulder, why are you the way — no. Why did you choose to be frozen shoulder? Jason: What’s so adhesive about it? Kathy: Yeah. Yeah. Why are you all adhesive all of a sudden? Settle down. Okay. So, adhesive capsulitis. Why do they call it that? Well, every joint has

[3:35] a joint capsule. And so the “-itis” of the capsule is inflammation. Jason: Yes. Kathy: And therefore we call it adhesive capsulitis. Jason: Yeah. So it’s inflammation — Kathy: of that capsule. But what about the adhesive part? Like, I use adhesives to connect things — to hang things — Christmas ornaments, cards against the wall, Christmas cards as holiday seasons

[4:05] are coming up. So, I like to sometimes describe it to patients as — so, like, I was explaining the joint capsule kind of holds the two bones together, and then the tendons and ligaments in the shoulder — some of the ligaments are all kind of part of the capsule — but the capsule kind of shrinks down. And I’m not sure if we actually know the exact

[4:35] mechanism as to why it shrinks down, but it kind of shrinks down into scar tissue. And so I kind of explained it to people as like saran wrap. Jason: Yeah. Yeah. Kathy: Shrink wrap around your shoulder and all of a sudden it’s super tight. Jason: Yeah. And I think that that’s one of the reasons that adhesive capsulitis is weird is because we don’t know exactly why it happens. Like, I can tell you how a strain is going to happen — you just overstretch something. I can tell you how a sprain is going to happen — well, same injury, different tissue — but with adhesive

[5:05] capsulitis, it kind of cascades into this problem. Kathy: Mm-hmm. Jason: And yes, sometimes it’s people who have had a surgery or have had an injury, right? That’s like, okay, yeah, this is why you have frozen shoulder. Kathy: Yeah. Well, and the capsule around the shoulder, I think, is kind of unique just because the shoulder has such a big range of motion. It’s the most mobile joint Jason: in your body. Part of the reason for that is you have a very small joint surface and a large — kind of — bone.

[5:36] It’s not “kind of” a bone. It’s actually a bone. Kathy: It’s a real bone. Jason: So, it pivots in there. And so that capsule kind of helps to give some stability to it, but the capsule also has quite a bit of give to it. And it’s got these little folds in it so that you can get all the way around — you can really wind up and pitch that softball, you can push, or you could throw that punch, right? Whatever it is that you want to do. Kathy: And then the adhesions come in those folds — they all stick together. And

[6:07] so then all of a sudden your shoulder’s not moving. Kathy: So Jason: yeah. And that’s kind of usually how it starts. Kathy: Yeah. Jason: So there’s phases of frozen shoulder. Kathy: Yes. Jason: And they are the freezing. Kathy: Okay. That sounds cold. Jason: The frozen part. Kathy: Oh, colder. And then just like ice cream, it thaws out. Jason: Okay. And so what do these phases look like then? Kathy: So the freezing phase is

[6:38] the worst of it all. Jason: Okay. Kathy: That’s when you start to lose your range of motion, but you can have significant pain. Jason: Yeah. Kathy: Like pain that — the way I’ve never had frozen shoulder, but the way people describe it and the way people move with it, it is significant. Seven, eight, nine out of 10 pain. Jason: Yeah. It’s a sharp, stabby pain. Yes. Right. It’s not like the old joints are kind of like stiff. Kathy: Yeah. It feels bad. It feels legitimately bad. Jason: It’s very bad.

[7:08] And usually when this is happening, it’s on the heels of a shoulder injury. So, like if you have a rotator cuff tear or something like that, one of the realities is that it can progress into a frozen shoulder. Kathy: Yeah. Jason: So that’s the freezing stage. It’s highly inflammatory and things are changing, Kathy: extremely painful. Jason: Mm-hmm. Now, once you — I always tell people like when you get to the frozen stage, you’re not going to have as much pain, but you won’t be able to move your arm,

[7:39] right? Like it’s literally like this, right? And that’s kind of one of the things I look for — whenever people are trying, I’m like okay, lift your arm. Right. This movement is called abduction. Kathy: He’s lifting his arm to his — Jason: or people say abduction. Right. It’s kind of like the movement that you make for a jumping jack, over your head. Kathy: Exactly. Jason: And then what happens is when you get frozen shoulder, one of the things I look for is somebody starting to raise their arm and then they get to a point where it’s the rest of their body that’s moving. Right. Not just the arm. So, you

[8:09] know, if I’m just moving my arm, but then when it gets to the frozen stage, I’m going like this and Kathy: they’re leaning. Jason: Exactly. And so it’s just a big lean to the side. For me, that’s one of the signs it’s like, okay, we need to evaluate for — heap adhesive cap — the lighting, right? Or the frozen shoulder. Kathy: That’s right. And usually the hallmark sign of — at least the first sign I see — is the external rotation, like that

[8:39] movement when you’re trying to lift your Jason: your hand up to your ear. Kathy: Like imagine that you’re going to be hitchhiking. Yes. Jason: And you get your thumb out there and you want to — hey, take me, take me down the road, right? Like I’m going that way. That’s the external rotation. Kathy: Yeah. I start to see when that one’s restricted, that’s when I start to think about — this could possibly be adhesive capsulitis. That’s one of my first clues Jason: on it. Yeah. And then the thawing stage, and it sounds exactly

[9:10] what is happening. Kathy: Yeah. Jason: So your range of motion starts to come back. You don’t have as much pain. The scarring — so they call it — or they — evidence. Kathy: Oh, we know who they are. Jason: We are. We call it. It’s Kathy: I used to watch the X-Files. Okay. I know who they are. All right. Jason: So it’s actually fibrosis. It’s a fibrotic tissue of the capsule. So that starts to

[9:40] resolve in the thawing stage, Kathy: right? All that stuff kind of loosens up. And frozen shoulder is kind of weird because if you do nothing, most of the time it just resolves. Jason: Yeah. Kathy: Right. You get all or most of your range of motion back. But once it sets in, it’s probably going to be hanging out for a while. Anywhere from like, you know, 6 months to a few years. Jason: Yes. It can last that long to resolve. Kathy: Yeah. And that’s no fun.

[10:10] Jason: No. Doing nothing is not fun. Kathy: Ain’t nobody got time for that. Right. So, Jason: but it will resolve, but it could take years for sure. Kathy: Now, one of the big mistakes that I see made whenever people are trying to diagnose frozen shoulder Jason: is that — one of the hallmarks of it isn’t just that you lose range of motion, because I can lose range of motion because it’s painful. Yeah. Right. It’s like, oh, I’m trying to lift my arm and it just hurts too much or it feels weak. Mm-hmm.

[10:40] Kathy: Frozen shoulder is not weakness Jason: and it’s not pain. That’s not what’s limiting your motion. It’s actually that the capsule is kind of glued shut Kathy: — well, not shut, glued — Jason: glued down, adhered. Kathy: Yeah. It’s adhered. Yes. Jason: Right. I adhere to what you’re saying. Kathy: And so that would be like — we’d have somebody demonstrate their range of motion. So that’s called active range of motion. When a patient or a person — we’ll just call them people. Jason: People. Yeah, they’re people listening

[11:10] to us, not patients. Oh, and this is probably a great time for the disclaimer. What’s the disclaimer? Kathy: This is not medical advice, Jason: y’all. We’re just messing around. Kathy: Yeah, this is entertainment. Jason: We’re not your doctor. We’re not — we’re not some of your doctors, but yeah, we’re just — this is entertainment. Kathy: Yes. Jason: Yeah, it’s all entertainment. So, yeah. So when we have a person demonstrate that active range of motion, they’re stuck. But then there’s something we do called passive range of motion Kathy: where we go and we try and move it for

[11:41] you. Jason: Yes. And with, like, a strain — a muscle strain or joint sprain — a lot of times if you’re not helping, we can get a fuller range of motion because the thing that’s actually painful is you trying to use the muscle. Kathy: Yeah. And then if I go and I try and move your arm and now your whole body rocks to the side — and like, if I really tried, I still couldn’t move it — that’s adhesive. So passive

[12:13] Kathy: and active range of motion need to be decreased in order for it to qualify as frozen shoulder. Jason: Right. Kathy: Yeah. Jason: Right. Because if I can move it Kathy: and you can’t move it, Jason: then it ain’t Kathy: it’s not frozen. Jason: It is not frozen. Kathy: No, it’s just busted. It’s Jason: busted shoulder. That’s a whole other episode. Kathy: It’s a painful shoulder. Jason: Okay. Question for you. Have you ever had somebody come in and they tell you that their doctor took X-rays and that they have frozen shoulder?

[12:43] Kathy: No, actually. Jason: What about MRI? Kathy: Probably MRI. Jason: I’ve had that happen before. Somebody’s like, “Yeah, my doctor took an MRI of my shoulder and I’ve got frozen shoulder.” Oh, they saw that on the MRI. Kathy: Which would be a miracle because you cannot see it on an MRI. Jason: And I just want to say I doubt that that’s what the doctors are saying. Kathy: Yes. Jason: But maybe it just wasn’t communicated well enough to the patient, or maybe it

[13:13] was Kathy: like conveyed to them at the same time that they were reviewing MRI results that yes, we think you have frozen, but you can’t see it on an MRI. Jason: No. They probably saw nothing on the MRI. Yeah. Kathy: Which was why they’re like, “Okay, there’s nothing. There’s no rotator cuff tear. There’s no labral tear. So we’re going to call this frozen shoulder.” Jason: Right. Right. Exactly. Diagnosis of exclusion. Kathy: Yeah. Jason: No, but I just bring that up because stop asking us for MRIs when we tell you that you have frozen shoulder. It’s not helpful from a diagnostic

[13:44] standpoint. Kathy: Yeah. Jason: And Kathy: Yeah. So, but they can occur together. You can have a tear or a sprain and frozen shoulder. You can have a labrum injury and frozen shoulder, but it’s kind of its own separate thing. All right, I’m going to climb off my soap box. Jason: Okay. Kathy: All right. So, Jason: I’ll give you a couple minutes. Kathy: Yeah. What about some conditions that might predispose somebody to frozen shoulder? Like, who gets this? Jason: Well,

[14:15] I’m going to get on my soap box. Kathy: Get on your soap box, Kathy. Get up there. It’s more common in women. Jason: Preach. I mean, wait. Sorry. I was just getting excited. Okay. More common in women. Kathy: And the Lord said, Jason: “Hallelujah. Adhesive capsulitis.” Kathy: Oh, women will have more adhesive capsulitis. Jason: Sorry, Adam. This is Eve. Yeah. Kathy: Yeah, it is more common in women. And the demographic I see a lot of —

[14:46] the demographic is women over 40. Yeah. So, fifth, sixth decade, that kind of thing. Jason: Doesn’t mean other people can’t get it, especially people that have had shoulder injuries, shoulder surgery, a fall, something like that. Yeah. Kathy: You know, a man can get it. Jason: Yeah. And men are more frustrated by it. That’s just my experience. That’s my observation. Men who get adhesive capsulitis, it’s almost hilarious, right? Because what is going on with me? What’s wrong with me? Kathy: You can tell them a hundred times. Jason: Exactly. So,

[15:16] Kathy: sure. Jason: Because I don’t know, some men just aren’t built tough, right? Not as tough as women. Women are tough as nails. So, yeah. And then, what about conditions that might predispose people besides — you know, being a woman is not a condition — but like what about conditions that might predispose somebody to Kathy: diabetes, people with thyroid issues. Jason: So if you got the sugar. Kathy: Yeah, Jason: I got the sugar. I got the sugar. Kathy: Yeah.

[15:46] Jason: Mhm. Kathy: Yeah. Because when you have diabetes, you’re just going to have more trouble with inflammatory conditions, period. Don’t get diabetes. Jason: Yep. All right. Kathy: First of all, Jason: yes. Kathy: Yeah. Jason: Yes. Kathy: Yeah. Jason: Frozen will be the least of your problems. Kathy: Yeah. Right. Exactly. You got bigger fish to fry. Right? And diabetes is what, like the number six leading cause of death in America. So, yeah. Jason: Very underrated. Kathy: Yeah. Frozen shoulder. What’s the death toll on frozen shoulder?

[16:16] Jason: I think it’s zero. Kathy: I think it’s pretty close to zero if not below. Right. Jason: And then I think the other thing is like sometimes you see this in people who have had a shoulder surgery. Kathy: Yes. Jason: Right. So it’s just Kathy: sometimes a side effect of recovering from like a labrum repair Jason: or like a rotator cuff repair or something like that. Kathy: Yeah. Because those people who have had a rotator cuff repair know that you’re in a sling for six weeks. Yeah. And

[16:48] for a good part of those six weeks, depending on your surgeon, you’re not moving your arm. Jason: Right. Kathy: They say do not move it. Jason: Right. Kathy: And so unfortunately, one of the side effects of that is then your shoulder’s frozen. Jason: Yeah. Kathy: Not everybody. So you say depending upon your surgeon, Jason: so, in your experience, what’s a good protocol for that? Like when somebody has a rotator cuff repair, how soon do you think they should get back to moving, or is it best to really immobilize it? What do

[17:19] you think? Kathy: Well, I think it’s best to immobilize it early Jason: because it is a really fragile repair. Kathy: I mean, those rotator cuff tendons and muscles are not big. Jason: Mhm. Kathy: And keeping it immobilized in the short term saves it. First of all, you’re going to protect the repair. The other part of having the sling on too, it reminds you not to use your arm. Jason: Yeah. Kathy: For example, if something’s falling off

[17:50] a table, the reflex is to go and grab it. If you’ve got a sling on, you’re not going to move your arm, Jason: right? So, but a lot of surgeons I see — or a lot of surgeons that send patients to us with a rotator cuff repair — they want them in PT within two weeks, Kathy: and then we can passively move it for them to help reduce Jason: frozen shoulder. There are surgeons also that don’t let their patients start PT for eight weeks because they don’t want you to move it at all. Kathy: Wow. Jason: Yeah.

[18:20] Kathy: What do you think about that?

Jason: Well, that’s a long time. I’ve had a conversation with the surgeon.

Kathy: Yeah. Yeah. Yeah.

Jason: Of course, I think they should start PT earlier.

Kathy: Their point of view is, “I’d rather reverse engineer the shoulder than to tear the repair that I made.” So, they — you know — and it’s, we get those shoulders, they’re so stiff.

[18:51] And you know, probably the outcomes — it takes those people a little bit longer to recover from the rotator cuff because we’re really having to stretch tissue.

Jason: Yeah.

Kathy: We should get an orthopedic surgeon on sometime so we can ask them these tough questions.

Jason: That would be great.

Kathy: Sir or ma’am, why — why eight weeks?

Jason: Tell us now.

Kathy: You’re in the hot seat.

Jason: Yeah. Well, that’s really interesting. And it kind of brings up — I think sometimes people, when they’re thinking

[19:21] about physical therapy, because you talked about getting into physical therapy early — I think sometimes whenever we’re thinking about a referral, we are thinking not about the person or the professional that we’re referring to. We’re only thinking about the technique.

Kathy: Yeah.

Jason: Right. And so I always favor an early referral. The reason is because you have training in how to protect this and you know how to rehab it and everything like that. And so a doctor who’s referring

[19:54] to a physical therapist may think that day one everybody’s showing up and getting exercises,

Kathy: which isn’t necessarily the case, right? No way.

Jason: And so getting the right professionals involved early in the case — you know, that person might show up post-op and the treatment, the therapy is really, “Let’s talk about this. Let’s make some strategies. How are you going to function in your home? What kind of job do you do? What do you have to do now?”

Kathy: Like, I know people are like,

[20:25] “Oh yeah, I shouldn’t go to a chiropractor for that because dot dot dot.” And they’re thinking, “I shouldn’t get adjusted, right?” It doesn’t mean you shouldn’t go to a chiropractor. You know, people come in, they see you, and part of your job is, “Let’s deploy the tools that we have at the right time.”

Jason: Right. So if your doctor says, “Let’s wait eight weeks before a PT referral,” just go to the physical therapist.

Kathy: You can call us. You don’t need a referral.

Jason: Yeah. I mean, if I was going to get my shoulder repaired,

[20:55] I would go see Kathy like the day after, and she might not be like, “No, moving you around.”

Kathy: Yeah.

Jason: But I want her opinion. I want to know, like, what should I — and should I, shouldn’t I be doing? And that’s also part of the skill set, not just giving people three sets of 10.

Kathy: Right.

Jason: Yeah. And that was kind of the other point, too — you know, they’re drugged up when they leave surgery

[21:26] and they have surgeons.

Kathy: Yes.

Jason: Yeah. I’ve noticed the nurses

Kathy: and the patient. Yeah. The patient.

Jason: Oh, and the patients get some drugs.

Kathy: So — — the surgeons are giving them all these instructions, you know, they may have someone there with them listening.

Jason: Yes. Oh.

Kathy: And so the instructions after surgery get garbled.

Jason: Yeah.

Kathy: Right. Dealing with sober patients and giving them instructions — it’s like,

Jason: yeah, imagine some of the things that people come back and they’re like, “Well, you said last time.”

Kathy: Yeah.

Jason: Oh, like I had somebody who came in this morning and we had talked about

[21:57] their condition, and he’s like, “If I remember correctly, whenever I came in and you saw this, you said, ‘We can fix that right up.’” I said, “I did not say that. We had no such conversation, sir.” Yeah.

Kathy: You said you could regrow me a leg.

Jason: Nope. That is not what I said. That was that guy down the street.

Kathy: That is the other chiropractor, right?

Jason: Yeah. So, sometimes people are high

Kathy: when they’re getting their instructions,

Jason: and surgeons also give out exercises on a piece of paper.

[22:28] Kathy: Yeah. And what I see come in — after people look at that piece of paper, they’re like, “Okay, I’ll do it this way.” And then I see them do it and I say, “That is the exact opposite of what you should be doing.”

Jason: Right. So, having — coming into PT, we could just have a conversation your first visit, and I don’t have to move you, and we can talk about, like you said, what you should and shouldn’t do, and we go over the exercises that the surgeon gave you to make sure that you are doing

[22:58] them correctly.

Jason: Yeah. And not everybody’s starting from the same place.

Kathy: Right.

Jason: Right. Some people — a lot of that has to do with your prehab, right? Because I know that you do this also, where if I have frozen shoulder, or let’s say I have a rotator cuff tear and I know that I’m going to need surgery for it,

Kathy: I should start PT now.

Jason: Yes.

Kathy: Not wait till after the surgery. Like, what’s better for me if I start now rather than

going after the surgery?

[23:28] Kathy: No, not yes or no. Like, what’s better?

Jason: I thought that was a rhetorical question. Yes. Yes. What’s for dinner tonight?

Kathy: Was that a question?

Jason: But why does that help for people to see a physical therapist before they get a surgery, like a joint replacement or a rotator cuff or anything like that?

Kathy: I agree.

Jason: Oh gosh.

Kathy: The strong — I think what you’re looking for is: the stronger you go into surgery, the stronger you’re going to be out.

[23:59] Jason: Yeah.

Kathy: That’s usually what I preach to people.

Jason: Yeah. Hallelujah.

Kathy: Yeah. And amen.

Jason: Amen.

Kathy: Amen to that.

Jason: Yes. This is our most religious episode.

Kathy: Really?

Jason: Yeah.

Kathy: We kind of went off on a tangent there.

Jason: Yeah. So, if there are any churches that want to sponsor the PTCH Podcast, hit us up.

Kathy: Yeah. Well, let’s talk a little bit about natural history.

Jason: I love that term, “natural history.” Like, people are like, “Oh,

[24:30] “Yeah, I go to a naturopath.” So I think we talked about this a little bit where the average case of adhesive capsulitis is going to last anywhere from a few months to a few years. So what happens if you do nothing? Well, it will resolve. Yeah, great point. Yeah. I kind of walked straight right into that.

[25:00] Cool. Yeah, it’s all good. Yeah. So, you can just wait it out. Uh-huh. Is that smart? I would not suggest a family member of mine to wait it out. Is that because you’re selling physical therapy? Yes. Okay. Otherwise, no. Slightly biased. Uh-huh. But frankly, I do tell some patients when they are in the freezing stage, if they’re that painful, I just tell them, you know, to

[25:32] wait, and I’ll see them during the frozen stage, right? Because it can be too painful for me to even move their arm. So, but I can give them some isometric exercises. I can get them some pendulum exercises that they can do in the meantime, to keep the shoulder moving, but coming to PT sometimes can be just too painful when we really just need to get to the freezing stage or the frozen stage. Yeah. Yeah. Where we have a few different treatment options

[26:03] and so doing some things like pain and inflammation management. So like NSAIDs —

Jason: NSAIDs for people who don’t know are non-steroidal anti-inflammatory drugs. So like your ibuprofen, Aleve, Advil. Again, we’re not giving medical advice or prescriptions. That’s what we’ve read.

Kathy: But yes, we might have read that from smarter people. Yeah. So, and, is there a risk if you do nothing of having long-term damage?

[26:34] Good question. Damage. Dropped the D-word there. You could probably long-term have a loss of range of motion. You’re probably gonna get most of your range of motion back, but doing nothing you may lose that end range. Yeah, I agree. Motion and strength. For sure. Yeah, you get some muscle atrophy, right? Especially those deltoid muscles and rotator cuff for sure. Yeah. So, there’s some long-term consequences if you’re looking at a

[27:05] three-year frozen shoulder as opposed to one that’s a few months or a year, right? And so, I mean, do you want to risk that all by yourself? No. Right. It kind of goes back to what I was saying before where it’s like it’s not just, “Hey, give me some exercises.” It’s like part of the job is helping guide people through these things. So, even if we’re not trying to do the thing where I put my foot on your waist and then I’m wedging up on your — nobody does that,

[27:35] right?

Kathy: Well, what’s the chiropractic solution?

Jason: Yeah. So typically, 99% of the time if you just adjust somebody, that frozen shoulder is going to go away instantly.

Kathy: Wow.

Jason: Yeah. That’s awesome. Just send everybody to —

Kathy: That’s a flat-out lie. And you know, this is interesting because over the years I’ve encountered chiropractors who have

[28:07] some approaches to this that end up getting some big results. Like I saw one guy who had a whole protocol where he would go through adjusting the upper cervical spine and there’s quite a few of these shoulder type things that responded. What I would put out there is that it probably wasn’t frozen shoulder, just because I think that what they were probably missing was the passive range of motion portion of it. Because once you get to the part

[28:39] where you’re not able to have passive range of motion, it doesn’t make sense to me that an adjustment would undo the kind of physical barriers that are associated with it. But sometimes improving the function of the cervical spine or the neck or the upper back can maybe help you avoid getting into that cascade of problems that eventually

[29:09] becomes frozen shoulder. When you have a shoulder injury, one of the — because your shoulder is so mobile, your brain is very incredible in terms of finding new ways and pathways to get a job done. So I need to put this dish in the cabinet — your body’s going to figure out some other way to do it. And the idea that I’m getting at here is if I can make sure that as many joints are moving

[29:39] like they should, it’s going to give you much more in terms of options to get your daily tasks done and maybe take some of the burden off your shoulder and help it at that point to avoid maybe a frozen shoulder. Yeah.

Kathy: Other than that, you know, our approach to it is kind of really similar to what a PT would do, because it’s a good way to do it. So, yeah, I looked up what are the gold

[30:10] standard treatments for frozen shoulder. And it’s kind of interesting because what I found were things that, when we had talked about this before, we’re like, “Oh, yeah, that doesn’t always work. Oh, that doesn’t always work. That doesn’t always work either.” But let me tell you what I found. So kind of the gold standard treatments would be intraarticular corticosteroids. So if you caught our

[30:41] episode a couple weeks ago, Dr. Liam Vu talked about injection therapy. One of the things he talked about was injecting corticosteroids or cortisone. Intraarticular means inside the joint. So they inject some cortisone into that joint, and the reason that works is because of the inflammatory portion of this. And so that cortisone injection, I think if done at the right time —

Jason: Right —

Kathy: timing is important, because once — and I

[31:12] think that’s really during the freezing stage.

Jason: Yeah.

Kathy: Right. If you’re doing that during the freezing stage before you get to the frozen stage, you have a chance of kind of stopping that inflammatory process.

Jason: Not profit —

Kathy: no —

Jason: process. We’re getting religious again.

Kathy: You’re able to kind of stop that inflammatory process that then leads to those layers of the capsule adhering to each other. And so timing is everything though. And

[31:44] then along with that, structured physical therapy. So, I don’t know what structured physical therapy is versus unstructured physical therapy. Kathy: We practice unstructured at — Jason: you do. Okay. All right. So, is that like basically stuff that you get off of TikTok? Kathy: Yeah. What TikTok are we doing today? Jason: Yeah. It’s the — let me print you out this paper, right? This is — this is — yeah. So, but the thing that’s interesting is in kind of researching this, there

[32:15] aren’t a lot of therapies that on their own are — have — have good evidence for dealing with frozen shoulder, right? Kathy: That was kind of a bit of a surprise. Jason: Yeah. Yeah. We have not come up with a good solution to frozen shoulder other than suck it up. Kathy: Yeah. Suck it up, buttercup. Um, and then so that’s kind of the early tier is — let’s get a cortisone shot. Let’s do some structured physical therapy. That’s right. Right.

[32:45] Kathy: And then if that doesn’t work, then it could escalate to hydrodilation, which — do you have any information on hydrodilation, what that is? Jason: Yes. So that is also an injection. Kathy: Mm-hmm. Jason: But they take a mix of cortisone, saline, and local anesthetic. And the idea, the theory — Kathy: I thought there was some ginger ale in there, too. Jason: Well, I thought it was Dr. Pepper. Kathy: Dr. Pepper. That’s it. That’s right. Okay.

[33:15] Kathy: The idea — Jason: really everything but the Dr. Pepper and ginger ale. Okay. Kathy: The idea is that — it’s a kind of a big injection of fluid that it’s going to help stretch the joint capsule Jason: like from the inside. Kathy: Yes. Jason: Okay. So, let’s blow it up like a water balloon. Kathy: Yes. Jason: See what happens. Kathy: It’s blown up. Jason: I want to know who came up with that. Kathy: That’s a great idea. Jason: Hey, how about this idea? Kathy: Uh-huh. It was probably a chiropractor. Jason: I mean, the cortisone is going to help

[33:45] with the inflammation. The local anesthetic, I think, is just there for the injection part of it, right? And then the saline is just going to kind of blow up the joint to kind of stretch the capsule. Kathy: Yeah. Saline is kind of like — it’s like you don’t just want to put water in there. So, but saline is just kind of the basic fluid that they use to do injections. Yeah. Yeah. Jason: Yeah. So, yeah. And you know, the other thing about the early cortisone is like

[34:15] we talked about — the freezing stage is so painful people can’t sleep. Kathy: Yes. Jason: I mean, they might get an hour or two at a time. Kathy: Dude, a shoulder injury is not good for sleep. Jason: No. Kathy: Yeah. And you can’t find a good comfortable position to sleep in and then you roll over and it’s just like — Jason: Yeah. And then it takes a while to get back to sleep. So — Kathy: Well, and the thing that’s terrible is sleep is required for healing. Jason: Yes. And so if you can’t sleep well, you’re going to have a very difficult time getting your shoulder to

[34:45] mend. Kathy: Yeah. So, exactly. And then the other thing that they do in extreme cases — like I can think of two other therapies. There is surgery where they go in and they try and kind of basically cut some of the adhesions, right, and open that up. But one of the challenges there is then you’re introducing kind of a new injury,

[35:16] new inflammation and it could just adhere again. Jason: Yeah. So even with that you need to get that mobilized afterwards. And so, the other thing is something called MUA — manipulation under anesthesia — which sounds horrible. Kathy: Do not Google it. Jason: Yeah. It’s — yeah, it’s brutal. It’s like — they put you to sleep. Kathy: Yeah. Jason: And then they’re going to move that thing. They crank that up. Kathy: Right. Yeah. While you’re asleep and you can’t say how — but you know, and that’s

[35:46] like — allow me to get sidetracked here. Kathy: Yeah, please. Jason: I saw recently — and this probably isn’t new, but I’ve just discovered it because it hit my social media algorithm — have you heard of getting tattoos under anesthesia? Kathy: No. Jason: Holy smokes. It’s crazy. I watched this video of a guy and he went in and they have him knocked out and they did a full sleeve on each arm and a full

[36:16] chest tattoo, and they spend like a few hours doing it, but you can get all that ink and it would have taken like months or a year to get all those. Yeah. But yeah, they just knock him out. Kathy: They’re just putting him out — like, is there an anesthesiologist? That was my question. And there has to be some sort of regulation around this because it’s like, you know, as much as people want to bag on chiropractors and like, you’re not a real doctor — Jason: yeah — Kathy: you can’t tell me

[36:46] that a tattoo artist is qualified to be knocking people out. Jason: No. Yeah. I don’t know anything about it but I just saw that and I thought it was crazy. But MUA — manipulation under anesthesia — like, it’s done in a hospital and so they put you under, they, you know, crank that thing around and get it moving. And so that sounds like it would not be fun at all. Kathy: No, it sounds terrible. Jason: It’s like taking you right back to freezing from frozen.

[37:16] Kathy: Yes. Jason: But I think when you escalate the process, that’s one of the things that’s on the table, right? Uh, so anecdotally, one thing that I have seen that’s been successful is shockwave therapy. And so, who knows why? Like, I’m just going to throw out my theories of why it’s helpful. I don’t know if this is really the case, but what I’ve done — and I’ve probably had like, in the last couple months, I’ve had

[37:47] about five or six patients that I’ve treated for frozen shoulder, they were in the frozen stage, they got some range of motion back. But the idea is when you’re introducing that pressure wave, it kind of helps to soften up or break up some of those adhesions. And so if you’re doing that with some mobilization, they get some range of motion back. Like, one or two of the cases it was like the whole shebang, which my

[38:18] Jason: First thought is, was it really frozen shoulder? Right? If you’re getting all that range of motion back.

Kathy: Sure.

Jason: And my guess would be it probably wasn’t truly adhesive capsulitis. Just because there isn’t a lot of evidence out there that says that shockwave therapy would do that. So basically what we’re doing is treating a misdiagnosis, which — cool, great. All I care about is that they got the range of motion back.

Kathy: Yeah.

Jason: And then the other people got some range of motion back. Not the whole thing, but it’s noninvasive.

[38:50] It doesn’t feel amazing, but you know, if your goal is to get some of that range of motion back, that’s something that could be helpful, too.

Kathy: So, yeah. And then, of course, essential oils and homeopathics.

Jason: Yes.

Kathy: Wrong.

Jason: That was Lysol into the veins.

Kathy: Lysol. Yeah.

Jason: Can we go back and talk about why women —

Kathy: Yeah. Yeah.

Jason: — are getting this? Totally. I lost — I went down a different train of thought.

Kathy: Yes. Let’s get back on track with that.

[39:22] Jason: So, yeah. Why women, Kathy?

Kathy: Why women? What happens to women around their 40s, Jason?

Jason: That is an interesting question. Could it be something with the hormones?

Kathy: It might be.

Jason: Let me take a menopause and see if I can —

Kathy: Yeah. So, what is the relationship between menopause and frozen shoulder? Well, as we know, estrogen — or if you don’t know, you’re going to learn it now.

Jason: I’m going to learn it.

Kathy: Yes.

[39:52] Jason: I’m going to learn.

Kathy: Estrogen is an anti-inflammatory hormone.

Jason: Mhm.

Kathy: And so, when we’re in perimenopause and menopause, our estrogen levels drop — eventually to zero.

Jason: Yes.

Kathy: And so —

Jason: Not good.

Kathy: It’s not good. There are estrogen receptors on muscles, tendons, ligaments. And so, without that — when our estrogen levels reduce,

[40:23] it also reduces collagen synthesis.

Jason: Okay.

Kathy: And collagen is a key part of what makes our tendons and ligaments flexible —

Jason: Yeah. It’s a —

Kathy: — more pliable.

Jason: It’s an important protein.

Kathy: Um —

Jason: It’s like WD-40.

Kathy: It is. Well, it’s — actually when I describe it to people, it’s kind of more like cotton, right? Because I talk about collagen a lot with people in the context of hypermobility. So, you have elastin and then you have collagen. And if you thought about pants, right,

[40:54] collagen is more like the cotton because it’s a little more structural and firm, and the elastin is more stretchy. It’s like your elastic waistband — which, you know, my pants have a lot of elastic. But yeah, you end up with some hormone changes that lead to structural changes in your body. And so, if you lose an anti-inflammatory like estrogen,

then you have a higher risk of something like adhesive capsulitis, because you enter that inflammatory cascade which

[41:25] glues those folds of the capsule together.

Jason: Boo. Yeah. Right.

Kathy: There is good news about that, though. What’s the good news? There is a study — this was reported by Duke Health — that postmenopausal women on hormone replacement therapy had a lower risk of developing a painful shoulder condition known as adhesive capsulitis.

Jason: I’ve heard of that.

Kathy: Yes.

Jason: Yes.

Kathy: That’s cool.

Jason: So, one more reason to ask your doctor for hormone replacement therapy.

[41:56] Kathy: There we go. Don’t ask us. Ask your doctor.

Jason: Ask your doctor. That’s awesome.

Kathy: We don’t prescribe.

Jason: And I think that maybe something that people don’t realize is that a pretty common phenomenon is women around that age just getting random rotator cuff tears.

Kathy: Yeah.

Jason: Right. I call them unearned rotator cuff tears.

Kathy: Yeah. Like, I don’t know what she did.

Jason: Yeah. It’s just — yeah. All of a sudden, oh man, I can’t really move this. Did you — were you playing pickleball? Like, why not? Why weren’t you playing pickleball,

[42:27] you know? Or like, were you lifting something? No, it’s just all of a sudden my shoulder hurts, and like you go do an MRI and — yep, sure enough, they got a torn rotator cuff.

Kathy: Yeah.

Jason: So, it’s something to be on the lookout for.

Kathy: Yeah.

Jason: Whenever I have patients come in and it’s a shoulder problem and it’s a woman in her 40s or 50s, that is the first thing that comes to mind — we have to evaluate for rotator cuff and frozen shoulder.

Kathy: Yeah. Yeah. Exactly. Yeah.

[42:57] Whew.

Jason: Okay. That was my soapbox.

Kathy: That was your soapbox.

Jason: Came back down.

Kathy: That’s great.

Jason: Yeah.

Kathy: Well, you know what soapbox I like to get on every single episode —

Jason: — is a game.

Kathy: Yay! We’re going to play a game.

Jason: Okay.

Kathy: Okay. I call this game Cold Stuff Trivia. So — yeah. Cold Stuff Trivia, because maybe I’ve run out of names for games. But this is a trivia game, as the name would imply, and all of the answers involve something

[43:28] cold.

Jason: Okay.

Kathy: Get it? Frozen shoulder.

Jason: Okay.

Kathy: So, Cold Stuff Trivia.

Jason: The word “cold” isn’t in the answer, it’s just that —

Kathy: No, it doesn’t have to be cold. It’s just something cold. You’ll get it.

Jason: Okay. Okay. Okay. Okay.

Kathy: First one I think is pretty easy. All right. So, if you’re listening at home, play along. And I just want to give a shout out to Mandy, who helped with some of these. Some of these are directly from her.

Jason: Good job, Mandy.

Kathy: Yes. So, Cold Stuff Trivia question number

[43:59] one. In which Disney movie did the main character give the mental health advice, “Let it go, let it go”?

Jason: Let it go. Frozen.

Kathy: That is correct.

Jason: All right.

Kathy: Number two. Who was the first rap artist to have a single reach number one on the Billboard charts?

Jason: Is it Ice-T? Ice Cube?

Kathy: Incorrect. Incorrect. See, those are the

[44:30] ones that Mandy guessed, too. It’s Vanilla Ice.

Jason: It is not.

Kathy: 1990, “Ice Ice Baby.”

Jason: I mean, that was my glory days.

Kathy: Holy smokes.

Jason: But I didn’t think he was the first. He was the first?

Kathy: He was the first. Yeah, the irony there. I went and saw him at Spirit Mountain. Went with my brother and sister —

Jason: Recently?

Kathy: Yeah. It was C+C Music Factory, All-4-One, and Vanilla Ice. Yes. It was incredible.

Jason: Incredible.

[45:00] Jason: Yeah. And so it was so good, dude. He got up there and it was such a good show. He’s like, “Hey, everybody.” He’s like, “Who wants to get up here on stage with me?” He’s like, “Let’s have a party. Let’s have fun.” So people are like, “I do.” He brought everybody up who wanted to be up. So there’s people up there dancing and having a good time. Everybody’s singing the lyrics along. At one point he brought out a freaking Ninja Turtle. Kathy: What? Jason: Yes. I was like, Kathy: “Oh my gosh, take me back.” Jason: 14-year-old Jason was like, “This is heaven.” It was such a good show.

[45:31] Kathy: Take me back. Jason: Yeah. Robert Van Winkle, Vanilla Ice, you’re a real one, legend. Kathy: It was so, so good. Yeah. Jason: Okay. And so I got one more little aside. Kathy: Yeah. Jason: I got a t-shirt, right? And so I want to wear it — it says “Ice Ice” and then it’s got like his logo, which is like a little baby angel with a gun. Kathy: Oh, Jason: right. And so I love that shirt. It’s a fun shirt. We were going out to something and my

[46:01] family was like, “You can’t wear that.” And I was like, “What are you talking about?” I was like, “It’s Vanilla Ice.” They’re like — my kids are like, “Dad, ice? Really?” I’m like, “Oh, don’t politicize my — don’t politicize my Vanilla Ice shirt.” I’m like, “Everybody out there understands what this means.” Everybody who’s over what, 12 or whatever? I don’t know. They’re older than that. Anyway, okay, back to the trivia. Cold stuff trivia. Kathy: All right. “Yellow,” “Fix You,” and “Viva la Vida.” What do they all have in common?

[46:31] Jason: “Yellow.” Kathy: “Yellow.” Jason: Mm-hmm. Kathy: “Fix You” and “Viva la Vida.” What do they all have in common? I’m not — Jason: remember this is cold stuff trivia. Kathy: Cold. Yeah, I know. What? What’s what’s yellow and cold? Jason: And “Viva la Vida.” Kathy: Raul knows. Jason: What is it, Raul? Kathy: What is it, R? Jason: Coldplay. Yes, they’re all Coldplay songs.

[47:01] Kathy: That’s why I didn’t know it. Jason: Yeah. And “It Was All Yellow.” All right, you’ll get this one. Okay. Kathy: Well, I don’t like Coldplay. Jason: Hall of Fame basketball player George Gervin, known for his cool demeanor and smooth style of play, was known by what nickname? Kathy: Iceman. Jason: That is the Iceman. Oh, it’s just the best. Kathy: I think I had the poster of him on the ice throne. You know what I’m talking about? Or was that Sports Illustrated? Jason: No, I think — yeah. So, and his finger roll. Oh, so good. Okay. Anyway, in Game of Thrones, what was the motto of House

[47:31] Stark? Remember, these are cold things. Kathy: I know — winter is coming. Jason: That is correct. Yes, we got it. Kathy: I didn’t know if that was their — that was their Jason: that’s their thing. Winter is coming. Okay. Kathy: Mm-hmm. Jason: What is the freezing temperature for water in degrees Celsius? Kathy: Oh, Celsius. Zero. Jason: Hey, very good. Good. Yeah. Kathy: All right. Number seven. You’ll get this one, too, because you’re a child of the 80s. Okay. Chicago Bears

[48:03] superstar and 1985 Super Bowl champion William Perry was known by which nickname? Jason: The Fridge. Kathy: Yes, the Refrigerator. Good. Jason: These are fun. This is a fun one. Kathy: Are you having a good time? All right, let’s go. All right. Which fundraiser was popularized on social media in the summer of 2014 as a way to raise money for ALS research? Jason: The ice bath. Kathy: Close. The ice — Jason: dump — Kathy: bucket — Jason: bucket challenge. Kathy: Yes, the ice bucket challenge. Very

[48:34] good. Jason: All right, this is a fun one. Ready? Chubby Hubby, Schweddy Balls, and Cherry Garcia. Kathy: What are these all names for? Jason: Ben and Jerry’s ice cream. Kathy: Yes, Ben and Jerry’s ice cream flavors. All right, last one. Who is famous for asking the question, “Honey, where is my super suit?” Jason: I don’t know that one. Kathy: I was just excited to get the quote. “Honey, where’s my super suit?” Jason: I don’t know that one.

[49:04] Kathy: “Where’s your super suit?” “I said, where’s my super suit?” “It’s for the greater good.” “I’m all the greater good you’re going to need.” Jason: You know this one, Raul? Kathy: Who is it? Jason: Frozone. Kathy: It is Frozone from The Incredibles. Jason: Oh, that’s — Kathy: all right. You got homework now. You got to go watch The Incredibles. Jason: Okay, Incredibles. All right, Kathy, it’s time for takeaways. Kathy: What do we take away from this episode where you gave most of the information?

[49:34] Jason: If you have frozen shoulder, best treatment, gold standard from what we could find. Kathy: Mm-hmm. Jason: PT plus some early steroid injection. Kathy: Yeah. Yeah. It’s not monotherapy. Monotherapy is just one approach. It’s going to take multiple approaches, right? Jason: Okay. And then my takeaway — I think I’m going to do this one for the girls. Kathy: Yeah. It’s like — this is a condition that affects women more, and so it

[50:06] really needs more awareness and we should be talking about it to help benefit, you know, mom and aunties and grandma and everybody like that. So, yeah, really focus on women’s health. And that’s a big deal. Definitely don’t rely on Dr. Google, right? And sometimes your best friend’s advice is not the best advice. Jason: or the Facebook page, Kathy: right? Well, and tell your surgeon if you got to get a surgery, get me into a

[50:36] PT early. Yeah. And when they’re like, “Well, we want you to wait on exercises,” say, “Cool.” Kathy: Okay. Most PTs would, you know. Jason: Excellent. Kathy: Let’s, yeah, I think let’s wrap it up there. This is the part of the show where we tell you to subscribe. We’re not going to ask you. We’re going to tell you at this point. Jason: Got to do it. Kathy: Yeah. We have some serious cultural authority at this point. This is our 35th episode. We’re in the top 25% of podcasts in the world. Yeah.

[51:07] Jason: And it’s just because we have stuck with it. And so this is the best podcast Kathy: that I’ve ever done. Jason: Yeah. Exactly. So, yeah. No, we want to thank our loyal listeners and followers. Follow us on Spotify. If you already do, why don’t you hop on over to YouTube and like and follow us there, too? Kathy: Watch it. Jason: Most importantly, though, we want your comments. Like, we want to know — what’s important to you? What’s important? Yeah, like what should Kathy be doing

[51:39] Jason: Right now, right? What do you need from me?

Kathy: Tell me what to do.

Jason: But most importantly, there’s one more thing to cover, and that’s that there is no “I” in PTCH.