What You Can Do About Frozen Shoulder in Perimenopause

TL,DR (too long, didn't read)

Frozen shoulder affects women, especially during perimenopause, by limiting range of motion (ROM). While frozen shoulder often develops without knowing the cause, you can implement prevention strategies focusing on mobility, metobolic health, and musculature to help strengthen and regain ROM.

WHY

As we move into perimenopause, joint and bone constitutions begin to change. We begin to see an increase in bursitis, capsulitis, and tendinopathies. Yay us!

Frozen shoulder (or adhesive capsulitis) is a condition that affects women more than men, especially women in perimenopause. Interestingly, hypothyroidism and metabolic derangements like diabetes are strongly correlated with frozen shoulder. These two are also, peculiarly, issues we see pop up in perimenopause, as well.

WHAT

Frozen shoulder is a clinical diagnosis where we see a gradual but deteriorating change in both active and passive range of motion. Active ROM is where the patient initiates the movement, and passive ROM is typically initiated by the clinician doing the exam.

It has been characterized into three phases in its progression to “frozen”:

• Freezing: This is where we see the onset of shoulder pain, with progressive decline in active and passive ROM.
• Frozen: This is usually the worst it’s going to get, with a plateauing of loss of motion.
• Thawing: This is where we see a gradual improvement in pain and range of motion.

Frozen shoulder is often a gradual process spanning six months to as long as two years. When I was in school, we would classify most cases of frozen shoulders in the patient’s chart as “IDK” or idiopathic origin. Or if you’re a smart ass like me, IDK unofficially stood for “I don’t know.”

There is some discussion in manual therapy circles like chiropractic [*] and physical therapy [*] that the spinal accessory nerve (a cranial nerve that winds its way from the neck through to the shoulder) [*][*] may also have an impact on the ability of the patient to lift their arm to the side (called abduction of the shoulder) because of impaired trapezius and scapular innervation.

Even though many cases of frozen shoulder are idiopathic (of unknown origin), there are some clear corollary and potentially causal conditions where we see a greater frequency of frozen shoulder, including diabetes (and prediabetes) [*], thyroid conditions [*], cardiovascular disease, and even post-vaccination [*] called SIRVA (Shoulder Injuries Related to Vaccine Administration), which include frozen shoulder and other conditions of the shoulder.

The vast majority of these are either a metabolic or a mobility problem.

Poor glucose regulation, insulin resistance, dyslipidemia, and body composition changes are implicated in diabetes, CVD, and hypothyroidism, and they all affect women who are over 40 at a much higher rate than women under 40.

Poor mobility implicating neuromechanical integrity of the scapulohumeral rhythm, trapezius, or shoulder girdle activation is also a 40+ female issue if you are not actively working on putting on muscle mass or at the very least maintaining it.

HOW

So at the risk of going dark roast Betty, here are my thoughts on prevention and rehabilitation for frozen shoulder.

MOBILITY

First and foremost, you need to have a plan of action for muscle growth. This will be architected primarily through lifting weights that are heavy enough for you to provide a sufficient stimulus for muscle growth. Meaning, lift as heavy as you can tolerate with good form, coming within one to two reps of failure of that muscle.

Perhaps most importantly, as your strength improves at whatever baseline you start, it needs to progress beyond that. Week over week, you can and should be able to either do a heavier weight or keep the weight the same and do more reps.

I am team full ROM for most exercises. All the way down, stretch, and then all the way up. Finish with some long-length partials and you are golden.

The other thing to consider with lean muscle is the capsular or joint range of motion.

Muscle range of motion is one thing, but we also want to think about a capsular range of motion, too. As a visual, the capsule is the bubble surrounding where the two bones meet. One way to improve capsular range is by making sure you are stretching the muscle at the lengthened portion of the repetition. I talked about long-length partials in Mini Pause #16 as a vehicle for muscle growth. Another benefit to making sure on every rep you stretch at the elongated position is to also induce a capsular stretch as well.

If you are dealing with a shoulder injury, the first thing you want to look at is restoration of the glenohumeral joint range of motion. So, working within your pain-free range of motion is where you start (however limited that may be), AND ALSO we want to think about opportunities to increase supporting and local structures of the glenohumeral joint.

We have a massive opportunity with frozen shoulder to improve the strength and resilience of the scapula, the rib cage, the neck, and even the trunk and pelvis. It’s all related. This probably requires rehab with a chiropractor or bodyworker with a strong understanding of shoulder mechanics.

METABOLIC HEALTH

Related to increasing lean muscle mass, having more muscle is going to directly improve your blood glucose levels, insulin sensitivity, markers of inflammation, and lipid profile.

We can improve our metabolic health in a vast number of ways, but perhaps the simplest way to start is by walking after a meal and forgoing food two hours before bedtime. These two simple, free habits are available to everyone and you will see marked changes in your blood glucose metabolism just by doing these.

NOW

Think about your current exercise program: Have you dedicated enough reps and sets to your shoulders and back?

A lot of the rear deltoid and some of the medial deltoid muscle is engaged and working with most back exercises.

If you are working your chest, you’ll also engage with the deltoid's front head.

When you are training your shoulders specifically, most of your focus should be on the lateral deltoid because it is precisely that movement (raising your arm out to the side) that is impacted with frozen shoulder.

• Are you progressing week over week in terms of both reps and/or volume? Begin to keep a journal of your progress or use an app.
• When performing each shoulder repetition, think about not only elongating the arm all the way down, but also think about stretching the joint capsule as well
• Pick one of the following: walking after a meal or cutting food off two hours before bedtime and do it every day this week! Note your digestion, mood, and sleep patterns changing, if at all.

Question of the Week

Q: Can you talk about self-sabotage? Why it happens and how to shift mindsets around it?

Thank you to consciouswithkirth on IG who sent in this question. There are many ways to answer it, and truthfully, I feel it needs its own podcast episode!

I will say that self-sabotage stems from a past where we were told that somehow we were not allowed to make a mistake, that we had to be perfect, or that we were conditionally loved. That somehow we were not good enough or worthy enough unless we lived up to others' expectations and standards.

While as adults we certainly know that the behaviors around self-sabotage do not serve us, in a way, it’s a familiar feeling to us as we somehow experienced letting someone down when we were younger. And even though the familiarity and the behaviors associated with it are toxic, we just cannot help ourselves.

• The first reframe in our quest for success – be it health, career, finances, or our personal relationships – we must allow ourselves to feel our feelings. If we feel sad, guilty, or down, acknowledge what we are feeling and be able to name it.

So often self-sabotage comes at us almost out of nowhere, largely because we are trying to run away from a feeling or cannot recognize we are feeling a certain way. Old coping mechanisms resurface, and we fall off our path.

• The second piece to it is recognizing that failure is an essential part of your success. The individuals who have achieved what you are seeking have failed more times than they have succeeded. They became comfortable with failure, learned the lesson that failure was meant to teach them, and did not give up.

So let's use weight loss as an example. You are absolutely going to mess up. A LOT. But it is in the mess-ups where the lessons for expansion and growth are. Welcome the failure, welcome the self-sabotage as much as it feels uncomfortable or like you’re “letting yourself off the hook.”

Speak to yourself as if you were a wide-eyed 6-year-old looking to adult you for advice and comfort. What would you say to that 6-year-old version of you who was scared, frightened, and maybe tired and overwhelmed?

Those are the words you can begin to direct to yourself when you fall off the wagon. And you can begin to look for the lessons embedded in each situation.

YOUR TURN!

I’ll be answering your questions every week right here in the Mini Pause! Let me know what’s on your mind. I’ll be checking for both questions and feedback at support@drstephanieestima.com

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As if we didn’t have enough to deal with managing low energy, mood swings, and brain fog, within the first five years after menopause, we can expect to lose 30% of our skin’s collagen — and collagen production continues to drop another 2% every year for the next two decades! In this feature article, learn “How Peptides Combat Collagen Loss.”