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FROZEN SHOULDER

Aetiology / Risk Factors

Prevention

Ayurvedic Diet Regulations for Frozen Shoulders

Rasayana Therapies for Frozen Shoulders

   
 
Frozen shoulder, medically referred to as adhesive capsulitis, is an inflammatory condition that restricts motion in the shoulder. The capsule of a shoulder joint includes the ligaments that attach the shoulder bones to each other. The connective tissue surrounding the (gleno-humeral) joint of the shoulder, becomes inflamed and stiff, and grows together with abnormal bands of tissue, called adhesions, greatly restricting motion and causing chronic pain. This severely limits your ability to move your shoulder normally. When this happens, your shoulder feels like it is "frozen" in place. You probably will have difficulty raising your arm in front of you or putting your hand behind your head or back.

Adhesive capsulitis is most common in middle-aged women and is often related to a minor injury or some form of stress. It is more common in those with a history of thyroid disease or diabetes. Initially, shoulder pain may be noticed during certain activities. However, pain may also occur at rest. Patients then note difficulty finding a comfortable sleeping position. Pain is usually constant, worse at night, when the weather is colder. This condition can last from five months to three years or more. 

The term “frozen shoulder” was first introduced by Codman in 1934. Long before Codman, in 1872, the same condition had already been labelled “peri-arthritis” by Duplay. In 1945, Naviesar coined the term “adhesive capsulitis.” It is also known as 50 shoulder because its victims are usually people around the age of 50. It affects more women than man. The recovery is very slow.

In Ayurveda, frozen shoulder has been named as “Apabahukam” . Apabahukam is mainly caused due to vitiation of Vata dosha.

Aetiology / Risk Factors
The exact cause of frozen shoulder is unknown. It may have an autoimmune component, meaning the immune system may be attacking a healthy body part or there is a malfunction in the brain's injury recognition system. If there is a history of trauma to joint or a fracture or other arm injury, cervical disk disease or surgery then it may manifest as frozen shoulder. Hyperthyroidism (excessive production of thyroid hormones), diabetes, heart/ circulatory diseases and degenerative arthritis could also lead to frozen shoulder.
Adhesive capsulitis affects between 2-5% of the population and is more common in women (60%) and five times more common in diabetics. It affects mainly 40-60+ year olds and approximately 15% of people get it on both sides.

Symptoms

Adhesive capsulitis typically develops in three stages, with each stage usually lasting three to four months.
Freezing Stage: During this stage, pain can occur with any movement or while at rest. It may be difficult finding a comfortable sleeping position.
Frozen Stage: Pain may begin to diminish during this stage; however, shoulder range of motion also begins to decrease. Patients may notice they are not able to reach into their back pocket or comb the back of their hair.
Thawing Stage: During this stage the condition slowly improves and range of motion is slowly regained.

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Prevention
Use your shoulder complex on a regular basis:
Your main shoulder joint (glenohumeral joint) is surrounded by several ligaments and tendons that are meant to provide the joint with enough stability that it doesn't easily dislocate and with enough flexibility that you can use your arms for a wide variety of activities. If you don't use your shoulder complex on a regular basis through everyday activities and exercise, these ligaments and tendons won't receive as much blood as they need for optimal nourishment and removal of waste products. Over time, lack of optimal blood circulation to these ligaments and tendons can cause them to tighten up.
Optimise biomechanics of the shoulder complex:
Your shoulder complex includes your main shoulder joint, your clavicle, breast bone (sternum), shoulder blade (scapula), and upper back (thoracic and cervical spinal regions). All of these areas need to work well for fluid arm movement. For example, hunching over in front of the computer for several hours a day can create an alteration in the alignment of your shoulder blade and upper arm bone, which can put significant stress on the ligaments and tendons that surround your shoulder complex. Over time, this stress can cause a mild to severe degree of inflammation in the region, which can lead to scar tissue formation and shoulder stiffening.

Autoimmune response:
Emotional stress, a poor diet, a weak digestive system, and a genetic predisposition for autoimmune activity can cause your body to produce antibodies that can damage your own tissues, in this case, the tissues that surround your shoulder complex. And damage of any kind to your tissues will invariably lead to scar tissue formation, which can certainly contribute to capsular tightening in your shoulder.
Here are some simple steps that you can incorporate into your daily life that can virtually eliminate your chances of developing frozen shoulder in the years

Hula Hoop:

Stand a couple of feet away from the corner of a table, facing the table with legs slightly more than shoulder width apart. Put the hand of your 'good arm' on the corner of the table and lean forward so it supports your body weight, and so that the hand of your 'bad' arm (the one with the frozen shoulder) is hanging down. Let your bad arm just hang there. Do NOT swing your bad arm. GENTLY rotate your hips and upper body in a circular motion, similar to hula hooping in slow motion. You will notice that your hanging arm also rotates very gently in the same direction. Allow your hanging arm to move naturally. After a few rotations (between 10 and 20) pause for a few seconds, then rotate the hips and body in the opposite direction a similar number of times.
If the above exercise is very painful, or increases your pain, STOP immediately. It isn't working for you. If the exercise doesn't increase your pain, try repeating it after 15 minutes. If you find it relieves the pain, then the next time your shoulder is painful repeat the exercise. After doing the exercise a few times try doubling the number of rotations to see if this increases the period of relief.

Stretch your shoulders:
To stretch the entire shoulder region, take a towel in your right hand and hold it behind your head as though you are holding a long back scratcher. Wrap your left arm around your left lower back so that the bony side of your left hand is against your left lower back, just as a lady would begin to reach around to fasten her bra. In this position, your left hand should be able to easily hold onto the bottom of the towel. Once both hands are firmly holding onto both ends of the towel, use your right hand to slowly pull upwards on the towel until you feel a good stretch in your left shoulder. Hold this stretch for about 30 seconds and make sure that you don't stop breathing. Then, slowly pull downwards on the towel with your left hand until you feel a good stretch in your right shoulder. Hold again for 30 seconds and maintain steady breathing. Repeat the same routine in reverse - with your left hand holding the top of the towel and your right hand holding the bottom.

Strengthen the tendons around your shoulders:
There are many ways to strengthen the tendons that surround your shoulders, but the single best method that is to hang on a bar. This may sound easy, but not many people can hang on a bar for more than 60 seconds. Hanging on a bar for even 5-10 seconds a day can dramatically improve the strength of the tendons that surround your shoulders and your upper body in general.
If you can't support your body weight on a bar, find one that is at a height that allows your feet to be on the ground so that you can use your legs to give you some help. For optimal results, flex your elbows ever so slightly to increase the amount of tension on your shoulder tendons.
The position of your hands can vary from day to day. Having your palms face forward will strengthen mainly the tendons that are at the front of your shoulder complex. Having your palms face backward will strengthen mainly the tendons that are at the back of your shoulder complex. And having your palms face each other (if you can find monkey bars or rings that allow you to do this) will strengthen the entire region equally.

Stretch your spine: 
In order for the main joint of your shoulder complex to move properly, it is essential to have a healthy upper back region, one that isn't curved forward anymore than it should be due to slouching forward all day long.
To combat the natural tendency to hunch forward at a desk, at least once per day, you should perform a stretch that allows your spine to be pushed forwards. The simplest such stretch is to take a pillow and lay it length wise on the ground or on your bed, lay your back on the pillow so that your bum hangs off the bottom of the pillow, your head hangs off the top, and your arms are allowed to fall off the sides of the pillow to rest on the ground. If you don't feel that your mid and upper back is being stretched forward by this position, add another pillow to increase the height of your arch. Rest in this position for as long as is comfortable, up to 15 minutes each evening.

Include vitamin D and beneficial bacteria in your diet: 
Whether you have a genetic predisposition to developing autoimmune activity in your body or not, including reliable sources of vitamin D and friendly bacteria in your diet can significantly strengthen your immune system and decrease your risk of developing conditions that have an autoimmune component, frozen shoulder included.

Eat mainly whole, minimally processed foods and adopt healthy eating habits:
In the event that you do have a genetic predisposition to developing autoimmune activity in your body, it is critical for you to adopt a healthy, whole food diet and eating habits that promote a healthy digestive system. Genetic predispositions do not have to be expressed and can actually lay dormant for your entire life as long as you consistently eat healthy foods in a healthy way.
The real key to adopting any new lifestyle habits is to have enough motivation to do so. Believe me, having pain and stiffness in your shoulders to a point where you can't perform activities of daily living is not something that you want to add to your list of life experiences.
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Ayurvedic Diet Regulations for Frozen Shoulders
Diet regulation will be suggested for patients suffering from frozen shoulder. Proper diet is a brilliant means of controlling and curing this disease. Ayurveda diet provides adequate nutrition as well as rest for the needed organs.
Frozen shoulder patients are advised to consume navara rice, wheat, sorghum (jowar), black gram, sesame, mustard oil, ghee, milk, citrus fruits, tender coconut, kokam (Garcinia Indica) , garlic, onion, Cumin seeds (jeera, Cuminum cyminum), asafoetida, cardamom, turmeric, mutton, fish, chicken etc to be had
Avoid: Bengal gram, betel nut, bitter gourd, cold water, leafy vegetables, black plum (jamun, Syzygium Cumini). Also avoid contradictory foods.

Yoga
Yoga is beneficial in curing every type of disease. Yoga exercises done every day replenish and rebalance the physical and emotional systems that are depleted by the everyday stresses that lie so heavy on our lives. Yoga makes it possible to rest on a strong base of confidence and strength within oneself.

Parvatasana

  1. Sit in Padmasana
  2. Interlock the fingers, and stretch the hands vertically up over the head. Keep the head bent forward with the chin on the breast bone.
  3. Stretch the arms up while you pull up the shoulder-blades. The palms should face upwards.
  4. Hold the pose for a minute or two with deep and rhythmic breathing. Next time change the crossing of the legs and the interlock of the fingers and repeat the pose, keeping the back erect.

Effect
This asana prevents and relieves stiffness in the shoulders and rheumatic pain. It helps free movement and to develop the chest muscles. The abdominal organs are drawn in and the chest expands fully increasing the lung capacity.

Treatment
The Ayurveda treatment includes administration of Kashayams, Arishtams, oils for both internal and external use and Virechana (purgation) for complete removal of toxins from the body). Panchakarma treatment includes oil massage (Abhyangam), steam bath (Swedanam), Nasyam, Narangakizhi (a special type of Panchakarama therapy of Kerala.) a minimum 10 days Panchakarma therapy is advised, followed by 7 days rest.

The treatment would include a set of appropriate Panchakarma treatments and Rasayana therapies. The Panchakarma Treatments are meant to flush out the toxins, They are classified as pre-purification, main purification and post purification phases and include various types of therapies like oil massages, fermented liquid massages, medicinal enemas, herbal purification methods.

The Rasayana Therapies are meant to nourish the body, to bring the doshas back to balance and to regenerate the body. These comprise diet regulations, daily regimens, intake of oral medicines and Ayurveda tonics, yoga and a stress free life. After the treatment the Ayurveda doctors will advise you how to lead a healthy life. The benefits and results of the treatment are seen only after the Rasayana treatment is over and doctors’ advice is strictly followed. The results will manifest normally after 3 to 4 weeks as the body takes time to regenerate itself.

Pre-purification therapies are the first ones applied to loosen the toxins, open up the circulation channels and get the body ready for discarding these wastes. These methods are highly relaxing for the body and mind.  The following pre-purification methods are usually adopted in the treatment of frozen shoulder:

Njavarakizhi:

This is a tissue-nourishing treatment, making use of highly nutritious rice called 'Njavara'.It is beneficial in treating diseases like paralysis, Parkinson's disease, cervical spondylosis, frozen shoulder etc. Njavarakizhi is also an excellent rejuvenating therapy to keep the body young and healthy. It nourishes the muscles, improves their tone, and imparts longevity. As a result of extended treatments of 2 to 3 weeks the body recoups its lost vitality.
Lepam is spreading of thick herbal paste on any affected part of the body. The paste is a blend of many powerful herbs, spices, juice of leaves and buttermilk. This localized form of treatment relieves various inflammatory diseases of the body such as rheumatoid arthritis, back aches, headaches and frozen shoulder.

Choorna Pinda Swedam:
It is an herbal powder poultice fomentation. Dry powders are roasted in castor oil. A poultice is prepared. It is then poured again in warm oil, which is kept in a vessel over the heating system. Choorna Pinda swedam has been found to be highly effective in the treatment of frozen shoulder.

Main Purification Therapies for Frozen Shoulders:
This is the phase of elimination of toxins that were loosened at the pre purification treatment stage. These therapies are highly potential methods and are usually overseen by doctors. The main purification therapy adopted for frozen shoulder is Nasyam.

Nasyam, with Mahamasdi Thailam, is the pouring of herbal oil in drops in to the nostrils and inhaling the contents. This opens up the head channels and enables the herb extracts to act directly on the central nervous system. Nasyam treatment lasts for twenty to thirty minutes.

Another treatment is Elakizhi (a special herbal pack massage) with Pizhichil (squeezing of medicated oil with the help of a cotton cloth all over the body with full concentration on the shoulder along with a different stroke of massage) with Mahanarayana thailam gives strength to the muscle and improves the mobility of the shoulder joint. 
Duration for all the therapies is in courses of 7, 14 or 21 days depending upon the severity of the symptoms along with oral medicines for 3-4months.

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Rasayana Therapies for Frozen Shoulders
These are body nourishing therapies to rejuvenate the body and mind after the Panchakarma treatments. They keep the enzymes in the tissue cells in their normal functioning condition, restore and balance the body functions and maintain the overall health and well being of an individual for much longer periods after the Panchakarma course. Rasayana treatments for frozen shoulder consist of oral medicines and diet regulation.

Oral medicines for Frozen Shoulders

Herbal medicines form an important part of any Ayurvedic treatment. Oral medicines for frozen shoulder will be extracts of pure medicinal herbs, leaves, spices etc. These are prepared specifically to restore the lost balance and to provide the needed inputs to cure frozen shoulder.
Kashayam and Arishtam herbal decoctions and fermentations Lehyam– semi solid formulation are commonly prescribed Ashwagandha and Shatawari, are the two main medicinal herbs used in the preparation of Kashayam, Lehyams and aristams meant for frozen shoulder patients.

The Ayurvedic treatment of frozen shoulder is aimed at treating stiffness and pain and preserving the mobility of the shoulder joint. Medicines like Yograja Guggulu, Triphala Guggulu, Kaishora Guggulu, Sinhanaad Guggulu, Maharasnadi Guggulu and Punarnavadi Guggulu are used to reduce the inflammation in the shoulder joint. Medicines like Mahavatavidhwansa Rasa, Vatagajankusha Rasa, Vishtinduka Vati, Dashmoolarishtam, Sarpagandha (Rauwolfia serpentina), Nirgundi (Vitex negundo), Tagar (Valeriana wallichii) and Khurasani ova (Hyoscyamus niger) are used to reduce pain in the joints. Stiffness in the shoulder capsule can be reduced using medicines like Trayodashanga Guggulu, Tapyadi-Loh, Ekangveera Rasa, Lakshadi Guggulu, Shallaki (Boswellia serrata) and Ashwagandha (Withania somnifera).
The type and quantity of the medicines to be taken are decided by the doctor after a detailed consultation and examination. The patient’s body type, age etc are also important factors to be considered.

Frozen shoulder almost always resolves by itself. However, it may take many months or even up to three years for the pain and stiffness to go away completely.
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