I won’t be able to give my wife much science-based advice about frozen shoulder

My wife, Kim, has a fairly advanced case of frozen shoulder. Unfortunately, husbands make poor therapists. I have avoided trying to wear my therapist’s hat with Kim, offering sympathy and encouragement from the sidelines instead, and only as much advice as I think I can get away with.

Her condition has advanced quite a ways, however. She is not getting treatment, and I am concerned about her and finding it harder and harder to be on the bench.

Recently I dove into the subject to satisfy my own curiosity, and to eliminate certain uncertainties in my own mind. I have never had a good understanding of adhesive capsulitis. I’ve worked with only a few cases of it, and read almost nothing — the basics, of course, but nothing compared to the amount of research I’ve put into other topics. I’ve always been aware that the condition is poorly understood and “controversial by definition,” as one author put it.

So, when I waded into the literature this morning, I expected exactly what I found: a mess!

Frozen shoulder suffers from a lack of scientific research, scarcely more than a few dozen papers in the last decade (and only five clinical trials this decade, studying almost as many different treatment methods). But that’s more or less par for the course — most musculoskeletal conditions are woefully understudied.

Frozen shoulder is poorly understood and “controversial by definition.”

Disturbingly, in the case of adhesive capsulitis, there isn’t just a lack of research, but extensive disagreement and inconsistencies concerning treatment methods and even their safety. Although certain physical therapies are often recommended, and perhaps supported by some of the evidence, some authors strongly assert that such methods not only don’t work, but are dangerous and can significantly prolong recovery. (Some believe that forceful mobilizations of the glenohumeral joint are dangerous, not helpful.)

Although it’s common in the manual therapies for there to be arguments about what works better, it’s relatively rare for a common therapeutic approach to actually be condemned as harmful, while being recommended by others without even a mention of the controversy. If you had no other information, and you read three statements by experts recommending a treatment as dangerous, and three other experts recommending it as effective without even acknowledging the controversy, what would you make of it? That’s an almost impossible call to make.

Experts also seem to have substantially mutually exclusive theories about the condition. Interesting ideas are put forth by some experts and totally ignored by others. For instance, Travell and Simons proposed a role for myofascial trigger points in the condition (which I wrote about a few days ago). Although the theory certainly has weak points, it seems to be a pretty important idea to consider and study … and yet, many years after publication, that idea is still 100% absent from all other literature that I have found so far.

It’s rare for a common therapeutic approach to be condemned as harmful by some, but actually recommended by others with no mention of the controversy.

Given all of the above, no therapist should be pretending to “know” how to treat adhesive capsulitis. Obviously no one really knows much of anything about this condition. That is amazingly true of most musculoskeletal problems, but it appears to be especially true of this one.

And so I will be studying it more, and writing about it, trying to get to the bottom of it, for the sake of a wife with a shoulder that’s hurting badly enough she might actually be interested in my advice now. Unfortunately, I fear this topic may be bottomless, and I really won’t know what to tell her!