Treat your own frozen shoulder home exercise programme

Simeon Niel-Asher & Jonas Broome 2005

1 Edition

st

Treat your own frozen shoulderhome exercise programme

All rights reserved This Book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, printing, photocopying, recording, or otherwise, without written permission from the publisher or author.

FrozenShoulder.Com Ltd. @ The London Frozen Shoulder Clinic 108 Swains Lane Corner 12 South Grove Highgate, London N6 6BS Phone +44 (0) 208 347 6160 Fax +44 (0) 208 348 1777

warning
The exercises in this book have proven safe and easy to use. However, the following disclaimer has been placed on this guide:

disclaimer
This exercise book is not intended as a substitute for medical advice. The reader should regularly consult a physician or health care professional in matters relating to health and particularly in respect of any symptoms which may require diagnosis or medical attention. In the majority of cases of frozen shoulder syndrome there is no underlying illness or cause. However a proper diagnosis from a registered practitioner is advised. If you perform exercises from this book they are at your own risk.

The Niel-Asher technique trademark

is a registered

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form by any means, electronic, mechanical, photocopying, copying, scanning and faxing without the prior written permission of the author.

The Niel-Asher technique

Patent pending

A list of practitioners of the Niel-Asher technique and their locations can be found on the website www.frozenshoulder.com which is regularly updated. Because this technique is new there may not be a practitioner near you. Please bear with us; we are endeavouring to teach The Niel-Asher technique worldwide. A training course is also available via the website, so please inform your practitioner. NB: The Niel-Asher technique is taught only to practitioners with an existing medical or physical therapy qualification who belong to a recognised Register. Only practitioners who have completed an accredited course are recognised, so please check the website. Text Photography Models Editor Simeon Niel-Asher/Jonas Broome Jonas Broome/Matthew Clements Josslyn Thompson Suzie Goodman

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Chapter

Introduction
Get moving

We have created this exercise manual to support, assist and accelerate you through your frozen
shoulder. For most of you this may well be one of the most challenging and difficult periods of your life. Please remember, my colleagues and I are here to help you in any way we can. For optimal results this guide should be used in conjunction with treatment using the Niel Asher Technique ; preferably from a qualified practitioner. Alternatively treatment can be carried out by a friend, partner or therapist as described in our book and DVD Treat your own frozen shoulder. This manual is designed to offer you advice and exercises for all three phases of the frozen shoulder. We hope to present little gems for you to think about on a daily basis; helping you to manage your frozen shoulder whether with every day activities or more vigorous exercise. As always it is the little things that make the world of difference. We recommend you perform daily activities wherever possible and add both general and specific exercises as appropriate. All of the exercises in this book are aimed at maximizing the strength power, endurance and flexibility of your shoulder muscles. We have presented a general exercise section at the beginning of the book followed by a section with specific exercises for each phase of your frozen shoulder (phases I-III). At the end there is a phase specific exercise program. These programs are just suggestive and in no way definitive, feel free to change the exercises around. What suits one person does not suit the next so if something is painful leave it alone and try another.

ICON KEYS

Valuable information New Exercise Exercise Programme

Benefits of exercise

It is an anathema that during your frozen shoulder it is very important to keep

the shoulder moving as much as possible. Admittedly there are times when the shoulder is so acutely painful that all you can do is rest and put ice onto it. But it is beneficial to get started as soon as possible with regular, gentle exercises. These will help to: Aid the recovery and shorten the duration of your frozen shoulder. Prolonged immobility will only make the stiffness worse and allow inflammation to build up in and around the shoulder tissues, thus creating more pain. Significantly speed up your recovery. There is plenty of research evidence that shows that the cells which make fibrous bands in muscles (fibroblasts) respond well to mechanical activity. Exercise and stretching loosens the scar tissue that builds up in damaged muscles, and promotes increased healing. Have a positive effect on general well being. We often hear from patients about the general feeling of helplessness that is associated with a frozen shoulder, there is nothing I can do. Exercise helps to combat your lowered mood and allows you to take charge of the situation. Also exercise releases endorphins which have a well documented positive effect on mood. Improve muscle function and co-ordination. Right from day 1 of your frozen shoulder there is a loss of mutual muscle co-ordination and co-operation of the rotator cuff muscles. This occurs at the level of the brain. Exercising daily helps to reverse these effects. Stretch the sore and damaged muscle fibres in a controlled, co-ordinated and constructive way; lengthening the contracted and damaged areas within the muscles. Strengthen the weakened and (often) wasted muscles.

Are there any risks in exercising?

Really the risks of not exercising are much worse! As long as you avoid that sharp, catching type of pain that is associated with the early phases of your frozen shoulder there should be no risk of making the shoulder worse. Do follow these simple rules: Always exercise to potential . It is important especially initially to - start gently. Start with something that you know you can handle and step it up. Going into a major exercise routine too quickly will only make you sore!! If it hurts stop!! Doing exercise that is painful is not beneficial there are some people who have the attitude no pain, no gain this may be true in some cases but not in relation to rehabilitation exercises. Some slight aching in the shoulder during and after exercise can be expected but if it makes the pain worse you are doing too much. Make sure you are doing the exercises correctly. This manual should hopefully help to combat that problem but if it doesnt feel right then it probably isnt, so try something else or look for further advice.

If an acute spasm strikes!

In the early days of your frozen shoulder any sudden movement; reaching for a falling cup, holding a door open or even being bumped into on the street can cause a sudden and excruciating protective muscle spasm. The spasm you feel is due to a twanging of the tendon sheath surrounding the (long head of the) biceps tendon. This gets massively inflamed during phases I and II of a frozen shoulder. The tendon sits in a grove at the top of the humerus bone bicipital groove. The inflamed tendon slips in and out of the bicipital grove that slip is what causes the acute catching pain and spasm in the shoulder and arm. Fig 1 - The Biceps Tendon & its sheath

Biceps tendon

Tendon

Sheath

Understanding the spasm helps to control it!

These acute attacks of "blinding" pain add to your already considerable burden by contributing anxiety. Most people find that they can stop these attacks by doing the following exercise; however, this exercise needs to be understood first. When an unexpected movement goes through the joint the inflamed biceps tendon can twang as described above. The muscles all lock into protective spasm, especially the biceps muscle itself. This sudden increase in the tone of all the muscles can be reversed by going with the contraction. The muscles no longer 'see' a need for their activity and are switched off. However, there is quite a fine line between gently going with the muscles and creating a further 'challenge', so remember that the exercise described below is subtle and should be performed slowly and gently.

Spasm Exercise

* Rest the hand on a table or chair back palm up. * Allow the weight of the arm to rest on the hand, causing slight compression at the shoulder joint. * Breathe deeply and slowly. It helps to apply the pressure as you breathe out. * It is as though you were about to lean your body weight on your hand, while only applying a fraction of the force.

Daily Living

What you do with your shoulder on a daily basis is important both for managing pain and increasing the rate of recovery. There are simple things you can think about as you go about your daily life to make the ordeal of your frozen shoulder more bearable. The instinct we have when something is hurting is not to use the painful area. Whereas this may be appropriate for other problems, such as a fracture or ligament sprain, it is not so for a Frozen shoulder Classically the frozen shoulder patient we see comes in holding the arm in a protective posture. They tend to hunch the affected shoulder forward, bend the arm at the elbow, and cradle the arm close to the body even supporting it with the other arm. This position is very important to avoid as it only compounds the problem. In this position the biceps muscle is contracted, stressing the tendon and causing further shortening. It is far better to try to keep the arm straight allowing the arm to hang along the side of your body. This position stretches the biceps tendon; the weight of the arm also slightly separates the shoulder joint which will allow fluid back into the shoulder capsule. You can do most activities but avoid those that you know will cause that sharp catching pain. Try swinging the arms when walking; dont just hold the arms rigid Use the arm Try putting the arm up on the sofa when you are sitting watching TV where If you are standing, try leaning against a wall and gently moving your hand higher possible and dont be too afraid, just try to avoid tweaking the tendon, you will not make it worse.

Walking
Walking through a busy supermarket or going on the Tube at rush hour may not sound much to most people, but for somebody with a frozen shoulder it can be a very stressful experience. The fear of a fellow shopper or passenger accidentally bumping into the shoulder is constantly present. In that type of scenario it may be difficult not to remain tense and protective towards the shoulder. However, whenever possible it is important to allow the shoulder to relax and straighten the arm when walking. The tension caused by fear of pain will only compound the problems. This is what to do when walking: Relax the shoulder down Straighten the arm Let it swing, swinging the arm along the side of your body like you would under normal circumstances. It may feel odd initially but if you persevere, you will soon get used to it. Breathe and relax Swinging the arm during a very acute phase may be painful, so achieving the first two points is enough.

This will help to separate the shoulder joint allowing fluid back into the shoulder capsule. Also gently moving the arm will improve blood flow into the shoulder area and thereby ultimately improve healing and reduce pain.

Sleeping
Night pain and sleeplessness are some of the worst aspects of the frozen shoulder, especially in the early days. At first, you will probably not be able to tolerate pressure on your affected side. As your symptoms ease, however, you will find you can gradually ease into some type of position. The degree of night pain is directly proportionate to the amount of inflammation within the joint. Some comfort and relief may be obtained by: Lying on your back, with a pillow lengthways under the affected arm(s) and shoulders, supporting them Lying on the good side with a pillow or towel over your waist and under the arm Try to avoid sleeping with the arm above your head. This inhibits shoulder tissue repair, which manly occurs manly at night Lying on your back with a good neck pillow

Ice
Ice can be particularly beneficial in the acute freezing (I) and thawing phases (II) when the inflammation is most active. You may feel sceptical about this, but so many people have enthusiastically described the relief they felt from applying ice to their shoulders that it is worth trying. Wrap some crushed ice or frozen peas in a towel and place over the front of the shoulder joint. Leave it there for 5 to 10 minutes. Let the area rest without ice for 5 to 10 minutes and repeat. The cycle can be repeated 4 to 5 times and can be done several times during the day. You can also apply the ice to the back of the shoulder joint, the top, the side or other areas where there is acute pain. It is a good idea to ice the front of the shoulder even if it is not painful. When ice is not appropriate (at work etc) then cold sprays or gels may be useful. NB: never apply ice directly to the skin as it burns and leaves brown marks. For our full recommended range of sleeping, ice, heat and cooling products visit www.frozenshoulder.com

Heat
In the early stages of a frozen shoulder applying direct heat is not a good idea, though a warm bath may be helpful. Warm packs / hot water bottles that are not too hot can be applied in the second and third phases. If you find that heat does give you temporary relief, then an alternating cycle of 5 minutes ice 5 minutes warmth ending with 5 minutes ice can be tried. It is very important to end the cycle with ice.

Posture
The benefits of maintaining a good posture are something that we Osteopaths often try to emphasise to our patients. During the frozen shoulder the posture you adopt is of great importance as it affects the speed of your healing and repair. The shoulder girdle operates best when the shoulders are held back in their correct alignment. Round shoulders and long term poor posture causes the shoulder muscles and joints to work inefficiently and can lead to a pinching of the tissues; causing further damage. Also remember your neck posture; the neck muscles often become rigid in a frozen shoulder where they are heaving around the stiff shoulder.

09

Shoulder At Work
Although the pain of a frozen shoulder can be constant, the demands of life do not necessarily let up. At work you may spend a long time in the same position or perform some repetitive tasks. Here are some tips on how to get through the day with the least amount of discomfort: Avoid carrying heavy bags or cases for long distances; this has been demonstrated to precipitate tears in the supraspinatus a vital shoulder muscle. If you are driving all day, or keeping your arm in a fixed position, take regular breaks; this is because the muscle becomes fatigued and lactic acid builds up in the muscle, over time this can cause damage. When working in front of the computer screen , take regular breaks. Get up and walk away from your work station and the P.C. for a couple of minutes every half an hour. This is important for the same reasons as above. Make sure your chair has good back support and preferably adjustable arm rests. Adopt the ideal work posture if you are sitting at a desk. See below:

00

Use It!!
Maybe that is the last thing the arm is hurting, but it The only thing to avoid is I am sure you are familiar Whatever you normally do doing it as long as it is not brushing your teeth, using your knife and fork. these little things together free and more mobile. you want to be doing when really will help Long term! the catchy type of pain that with. with the arm, try to keep too painful. Things like shampooing your hair or Although it may be difficult, will help to keep the shoulder

To make life easier we have sourced a range of products to help you. These are available on our website www.frozenshoulder.com

01

Chapter

ADVICE FOR EVERYONE

In this chapter we will point out some general exercises that should benefit you all, you can do these
during all three phases of your frozen shoulder. These exercises can all be done in combination with the more phase-specific exercises that will be presented later in the book. It has to be said that if you are going through a particularly painful period with you shoulder, just resting and icing the shoulder may be the best course of action for a few days. But dont rest too long as getting the shoulder moving as soon as possible will aid the recovery and lessen the pain. When doing these exercises, make sure you dont over do it. Always stop before getting tired or if the shoulder is hurting. When exercising, if something feels wrong then it probably is, so stop, and try something else or get more advice.

Cardiovascular Exercise
The benefits of cardiovascular exercise in relation to chronic and long standing problems, like a frozen shoulder, are well documented. Although perhaps it does not seem like you are helping your shoulder when you are going for a brisk walk or getting onto the treadmill you are!! This helps to: Improve blood flow generally, specifically to the shoulder joint. Pump away some of the inflammation and toxins thereby lessening the pain. Activate the part of the hormonal system that stimulates tissue repair.

C.V. exercise will also help combat the lowering in mood which is a common occurrence during a frozen shoulder. This gives you a sense of taking charge of the difficult situation.

02

Repositioning the Shoulder

This is originally an Alexander technique exercise which is excellent for resetting the shoulder position. This is good to do everyday: Place a duvet or thick towel on the floor and lie on it, face up. Place pillows under both elbows and forearms. Rest the hands on your stomach, palm downwards (if that is not possible just rest the arms on the pillow). Stay in this position for twenty minutes. (Listen to the radio). Very slowly the muscles at the front of their chest should relax, allowing the shoulders to drop backwards, towards the floor.

Advice for Everyone

When your shoulder has started to defrost in the second and third phase, you might be able to place the arms at 45 degree angle from the body. Turn the palms upwards if possible.

You may not be able to get the hands flat for a while, but eventually you will. If necessary you can place a cushion on your abdomen and rest the hands there. Gradually try to lower this cushion to a few towels and eventually nothing. Try putting on some relaxing music

03

Shoulder Retraction
This is another exercise for resetting your shoulder position and posture. The good thing about this exercise is that it can be done anywhere, and does not require any equipment: Turn your hands palm outwards slowly Try to squeeze your shoulder blades together, automatically bringing your shoulders backwards Keep your shoulders where they are but let the hands roll back into your sides Hold that position for 30 seconds Rest and repeat

Advice for Everyone

04

Swimming
As soon as the night pain is gone it is a good idea to get into the water. At first it may not look or feel like you are swimming. But do not despair; you are still doing your shoulder the world of good. The resistance of the water will help mobility and improve the strength of the shoulder. Try to go when it is quiet in the pool If you cant swim then simply walk up and down using your arms to help you Dont try to swim fifty laps; you are swimming to help your shoulder, not to win the Olympics Rest after every lap Vary the type of stroke you use after each lap Concentrate on trying to move the shoulder as much as possible rather than swimming fast or far Dont over do it!! Easily done, stop well before you are tired or when the shoulder is hurting

Advice for Everyone

Water aerobics classes may also be useful so check if there is a class in your area.

05

Cross Trainer, Nordic Ski Machine

Not everyone has this machine in their homes, but if you are a member of a gym they will most likely have one there. Getting on a cross trainer for five to ten minutes on low pressure will do your shoulder the power of good. In the earlier phases you may not be able to put much pressure through the arm, but just hanging on to the poles and letting the legs do most of the work will help to free the shoulder capsule and loosen the shoulder muscles. Once you are able to put some pressure through the arm, this will also help to rebuild muscles around the shoulder that have wasted away.

06

Chapter

Exercises for Phase I

This is a crucial time for starting a gentle stretching regime. Gentle is the operative word. Your
shoulder is likely to be very inflamed at the beginning of this phase but gently stretching the capsule three times per day for five minutes stops the adhesions getting too tight. If you are in too much pain, do as much as you can or stop completely for a few days. Remember to use ice or gels for pain relief.

07

Neck Stretching After performing any exercises it helps to do some neck stretching. With a frozen shoulder, people tend to hold the shoulder in a tense protective posture. This posture also pulls into the neck muscles causing stiffness and neck pain. Stretching out the neck will also help the neurological output to the shoulder as the nerves supplying the shoulder are in the neck. Here is an easy stretch to

get on with:

Stand upright in a good posture Lean your head away from the affected shoulder gently You should feel a light stretch in the neck Maintain this stretch for about 10 seconds Repeat on the opposite side Do this 3 times on each side of the neck If you want to increase the tension, put the hand on the same side as you are stretching onto the head (if you can) and lightly pull to increase the stretch.

Phase I

08

Capsule Stretching This important exercise is best done gently in between each treatment session. Start with this passive exercise before you add any weights. It is very simple but easy to get wrong so please follow the instructions carefully.

Bend forward at the waist Let the affected arm drop towards the floor under its own weight Feel the sense of tugging and traction in the shoulder joint You can support your other hand on a chair Move your body to make the hanging arm swing gently Use this method to swing or rock the arm in small to medium-sized clockwise circle Perform 3 times daily for 5-8 minutes You may want to use ice after this

Phase I

19

Shoulder shrugging This can be performed up to five times daily for 2 5 minutes. You can move both shoulders at the same time and then independently. Raise the shoulder up to the neck and push them downwards towards the floor. Be careful if you have a neck problem. You can then gently rotate the shoulders in circles together then independently, again, take it nice and slow if you have any neck problems.

Phase I

Stand upright Shrug your shoulders upwards as high as you can for 8 seconds Let the shoulders drop Squeeze the shoulders downwards Repeat 3 times

10

Shoulder rotation

Phase I

Stand upright Keep the hands by the sides Rotate the shoulder in a circle Change direction Repeat on other arm Repeat slowly for 2 minutes

11

Pushing the arm This is a good exercise to do when trying to relax the muscles of the shoulder. The way to do it is very simple and can be done almost anywhere: Stand upright near a wall or a door frame Keep your arm hanging straight down Push the arm against the door with about 20% of your strength Push for ten seconds then relax and repeat 3-4 times This can be done both forward, backward and to the side

Phase I

The Elephant This exercise stretches the back of the shoulder and is therefore particularly helpful in relation to a posterior type of frozen shoulder: Stand upright Bring the affected shoulder forward and inwards Use the other arm to bring the affected arm further over, like this you are creating a stretch in the back of the shoulder Maintain a nice even stretch, this should stretch not hurt Hold that position for up to 30 seconds Relax and repeat

Phase I

12

Chapter

Exercises for Phase II

You will know you are approaching the end of phase I when your night pain reduces significantly
and there is less internal burning. This indicates that there is less inflammation. Now is the time to start stepping-up your exercise programme by adding slightly deeper stretches to the capsule and using weights where indicated.

Keep going with the phase I exercises

You can also add the following exercises:

13

Capsule Stretching with weight This important exercise is best done gently in between each treatment session. You are now ready to add a weight to this exercise.

Phase II

Bend forward at the waist Let the affected arm drop towards the floor and add a small weight Feel the sense of tugging and traction in the shoulder joint You can support your other hand on a chair Move your body to make the hanging arm swing gently Use this method to swing or rock the arm in small to medium-sized clockwise circles Repeat anticlockwise Perform 3 times per day for 5-8 minutes Towel Pulling This exercise is great for improving the range of motion. It is best performed in phases II and III. You may not be able to reach up behind your back until your shoulder has improved, but never the less, this exercise is highly recommended when you are able. Using a large bath towel roll it into a long sausage shape Throw the towel over your affected shoulder using the good arm Hold one end of the towel with the frozen shoulder hand With the other hand pull the towel down until you feel a stretch in the shoulder

14

Crawl the - wall (part 1) Turn sideways to the wall Using the affected arm, gently crawl the fingers up the wall Remember where you get to Crawl back down the wall slowly Repeat several times

Phase II

(Part 2) Turn to face the wall and repeat the exercise slowly

Simple shoulder stretches These are simple exercises that can be performed sitting at a dining table.

/Front of shoulder

15

Phase II

Sit square to a table and lean forwards on a bent elbow

16

Back of the shoulder Sitting at table crawl the hand forward and lean on it slightly until you feel a stretch at the back of the shoulder joint.

Phase II

Chest stretch in door frame The tendency when having a frozen shoulder is to carry the arm in a sling position, thus creating a shortening of the muscles in the front of the shoulder. This stretch helps to combat that shortening: Stand in a door frame Turn your hand out and put it against the door frame Arm at 45 degrees or as high as possible (if you can get it up to 90 degrees even better!) Turn away from the arm with your body also turn your head away, thus creating a stretch in the front of the shoulder Maintain a nice even stretch, this should stretch not hurt Hold that position for up to 30 seconds Relax and repeat

17

Traction and stretch

Sit on a table or plinth near to the edge Hold the table edge with the hand Gently lean away from the table edge You should feel a stretching in the shoulder and neck

Phase II

18

Using a fit ball

Arms over head

Lying on your back on to the ball, the ball between the shoulder blades, head supported by the ball, squeeze the buttock muscles to keep the spine in a neutral position Bringing straight arms over the head until you feel a stretch in the shoulder The other arm can be used as a weight by putting it onto the arm Maintain that stretch, trying to relax into the stretch. A good way to achieve this is to use the breathing to stretch the arm further Maintain the stretch for up to a minute. Rest and repeat 2-3 times This should stretch not hurt! Start gently and increase the stretch slowly

Phase II

29

Front of shoulder stretch This is a brilliant stretch using the fit ball. This exercise stretc hes out the front of the shoulder. The stretch is also so comfortable that it may be held for a long time, it allows you to really work into the stiff areas of your shoulder. This is how it is done: Sit your knees on a matt or a pillow Hands onto the ball Then roll the ball forward until you feel a stretch in the front of your shoulder Keep your head down. Maintain that posture for up to a minute Rest and repeat 3-4 times

Phase II

20

Exercises for Phase III

Chapter

Phase III

After a few weeks of performing the Niel-Asher Technique

feel ready to strengthen your weak shoulder muscles.

and adding the above stretches you should

Remember they havent been used properly for months, so take it slowly and gently. In my experience, 60% of people re-develop their muscle power just by going back to the normal every day activities; this is preferable. 40% of cases, however, really seem to need a bit of extra help. Now it is time to add the following exercises to those already mentioned.

Strengthening The following exercises involve either a using a small 1kg weight or using an elasticated resistance band. These should only be performed when the night pain has diminished more than 90%. Stretching using a 1kg weight

21

Phase III

Elastic resistance rep-band

or thera-band

These are high quality latex-free products. They are a more advanced product than many cheaper alternatives. The way you hold the band is up to you but try varying your handhold every 3 days. You should aim to do a total of 35-50 repetitions of these per day. This can be in 3 sets. The elastic resistance band is a good exercise tool because of its versatility and it gives the ability to adjust the resistance to suit you individually. Using an elastic resistance Thera-band or rep-band

22

Starting at waist level, slowly pull both sides of the resistance band- If in pain, stop. External Rotation Stand upright, elbows tucked in to your sides Have arms at ninety degrees, straight in front of you Turn your hands with palms upwards Hold the exercise band between your hands In this position, keeping your elbows next to your body, separate your hands. This will tense up the exercise band, thus strengthen the shoulder muscles Adjust the exercise band to get the right resistance Do this 10-15 times rest and repeat 3-4 times daily

Phase III

Internal rotation Make a handle by tying a knot on the exercise band Tie the exercise band to a door handle Stand with your shoulder towards the door handle Arm at 90 degrees angle, keeping the elbow by the body Turning the arm in towards the tummy, maintaining the point above. Adjust the exercise band to get the right resistance Do this 10-15 times, at a slow even pace, rest and repeat 3-4 times daily

23

Bent arm abduction Make a handle by tying a knot on the exercise band Tie the exercise band to a door handle Hold the handle with the affected arm Stand with your good shoulder towards the door handle Arm at 90 degrees Bringing arm straight out to the side, maintaining the 90 degree angle of the elbow Adjust the exercise band to get the right resistance Do this 10-15 times rest and repeat 34 times daily

Phase III

Bent arm extension Make a handle by tying a knot on the exercise band Tie the exercise band to a door handle Stand facing the point where you fixed the exercise band, holding the handle Arm slightly bent Keeping the bent arm at the same angle, pull straight back Adjust the exercise band to get the right resistance Do this 10-15 times, at a slow even pace, rest and repeat 3-4 times daily

24

The pull across This exercise is great for strengthening up the back of the shoulders and improving the range of motion, strengthening major shoulder movements: Make a handle by tying a knot on the exercise band Put the affected arm in the handle Hold the other end of the band with a straight arm, holding with opposite arm Stand in a straight posture Pull the affected arm diagonally across and up with a straight arm as far as you are able Adjust the exercise band to get the right resistance Do this 10-15 times, at a slow even pace, rest and repeat 3-4 times daily

Phase III

Straight arm extensions This is another great exercise for strengthening the back of the shoulder. This is a progression from the bent arm extensions in phase II. Make sure that you are able to perform that bent arm exercise first before attempting this exercise. This is how to do it: Make a handle by tying a knot on the exercise band Tie the exercise band to a door handle Stand facing the point where you fixed the exercise band, holding the handle Arm straight Keeping the arm straight pull straight backwards Adjust the exercise band to get the right resistance Do this 10-15 times, at a slow even pace, rest and repeat 3-4 times daily

25

Straight arm abduction Make a handle by tying a knot on the exercise band Tie the exercise band to a door handle Hold the handle with the affected arm Stand with your better shoulder towards the door handle Holding the arm straight Bringing arm straight out to the side, keeping the arm straight Adjust the exercise band to get the right resistance Do this 10-15 times rest and repeat 3-4 times daily

Phase III

Stretch band behind back This exercise works on complex movements; it is similar to the towel in phase I. But because you are using a stretch band you are not only improving the mobility you are working the muscles of the shoulder too. This is how to do the exercise: Make a handle by tying a knot on the exercise band Hold the handle with the affected arm Put the arm bent over your shoulder Hold the opposite end of the stretch band with the other hand, behind your back by your buttock Straighten the affected arm, thus creating stretch in the band Adjust the exercise band to get the right resistance Do this 10-15 times rest and repeat 3-4 times You can turn this exercise around to bring the arm up towards your bottom and back. Keeping the other arm above your shoulder and pulling down with the affected arm.

26

The Prince Charles This is a lovely exercise that is easy to do. It is called the Prince Charles; looking at the picture I am sure it is easy to understand why. This exercise stretches the front of the shoulder and is therefore well suited for an anterior type of frozen shoulder, but it may also benefit the posterior and lateral presentations too. This is how you do it: Stand upright in a good posture, legs shoulder widths apart Bring the affected arm up behind your back (or onto your hip) as far as possible Make sure you dont start leaning forward to get the arm further up the back as the exercise then will be less effective Then bring your other arm up from the opposite side, holding onto the hand of the affected arm. Using the good arm, bring the hand further up your back, thus creating a stretch in the front of the shoulder Hold this position for 30 seconds then rest and repeat 2 3 times Start gently; the exercise should stretch the shoulder it should not hurt

The Prince-Charles

Phase III

27

Fit ball exercises This reasonably new exercise tool can greatly aid shoulder rehabilitation. It may be used in many ways; its use is really endless. Here we are going to show some of the ways in which the fit ball can help you rehabilitate your shoulder.

The airplane Lye onto your front on the ball, toes touching the floor Keep the spine in neutral, this means you have to tense your lower back. uncomfortable or painful in the low back, then try this exercise standing Keep arms 45 degrees from your body Turn your hands so they are facing the floor Squeeze your shoulder blades together Maintain posture for 15-20 seconds Rest and repeat 3-4 times

If this is

Phase III

28

Strengthen back of shoulder Now it is time to start looking after the weak muscles around your shoulder girdle; weakened by the lack of use due to the immobility of your frozen shoulder. This exercise strengthens the back of the shoulder and improves mobility: Lye with your back on to the ball, the ball between the shoulder blades, head supported by the ball, squeeze the buttock muscles to keep the spine in a neutral position Hold a light weight (initially 1-2 kilos) with straight arms over your face; holding the weight with both hands. Bring the arms down above your head until you feel a stretch in the front of your shoulder, keeping the arms straight Then bring the arms up again Perform at a nice steady pace 10-12 times Rest and repeat 3-4 times

Start off using light weights, you can increase the weight when you get more confident with the exercise

Phase III

Strengthen the back of the shoulder

39

Stretching the Front of Shoulder Lye with your back on to the ball, the ball between the shoulder blades, head supported by the ball, squeeze the buttock muscles to keep the spine in a neutral position Bring the arm of the affected shoulder diagonally out from the body until you feel a stretch in the front of the shoulder Maintain that stretch; try to relax into the stretch. A good way to achieve this is to use the breathing rhythm to stretch the arm further Maintain the stretch for up to a minute Rest and repeat 2-3 times This should stretch not hurt! Start gently and increase the stretch slowly

Phase III

Strengthening front of shoulder Lye with your back on the ball, the ball. Ball between the shoulder blades, head supported by the ball, squeeze the buttock muscles to keep the spine in a neutral position Hold a light weight in the affected arm (initially 1-2 kilos) Hold the weight with a straight arm above your face, the other arm resting on the chest Bring the arm diagonally out from the body until you feel a stretch in the front of the shoulder and chest, keeping the arm straight Then bring the arms up again Perform in a nice steady pace 10-12 times Rest and repeat 3-4 times

NB/ It may be difficult to balance on the ball when doing this exercise so be careful and do not attempt it if you feel insecure. Balance exercises are good because they help strengthen your core abdominal muscles and thereby improve your posture. If you are unable to perform the exercise use a weight in the other hand. This makes balancing on the ball much easier.

30

Chapter

Daily Exercise Programme Phase I

Now it is time to put all of these exercises together into a daily routine. We have
suggested some programmes for you to follow, but feel free to add and subtract from this.

31

Phase I stretch 3 times daily!

!#$8-;& C%'&%."/*< D > =/*

C"+-;,&' C"'-<</*< D 9 =/*

E&.F C%'&%."/*< D 9 =/*

C"+-;,&' '+%#%/+* D > =/*

G"& 6;&$"#*%H D 0 %+ 5 =/*

I-8"/*< %"& #'= D 5 %+ 9 =/*

B+;;+J J/%" 8+=& '&8% #*, /.& K/3 '&L-/'&,M

32

Chapter

Daily Exercise Programme Phase II

Your night pain should have diminished and you should now be able to sleep on your
affected side for more than 15 minutes. Here is a suggested programme to accelerate regaining your range of movement, try to wait until you are well into phase II before using the exercise bands. Again, if anything hurts please stop it and try again in a few weeks.

Try to stretch twice a day for 20 30 minutes.

33

Stretching Phase II

!#$8-;& 8%'&%."/*< J/%" J&/<"% D -$ %+ > =/*

NG"&

%+J&;H D > =/*

C%'&%." %"& O#.F +3 %"& 8"+-;,&' D 5 =/*

G"&

N&;&$"#*%H D 5 =/*

NG"& I'/*.&P!"#';&8H D 9 =/* 6*, +3 I"#8& )) /*%+ $"#8& )))

N!'#J; %"& J#;;H K$#'%8 ( Q 0M D 9 =/* &#." B/% O#;; D > =/*

1'=8 =/*

+2&' "&#, D >

34

Chapter

Daily Exercise Programme Phase III

Once you are into phase III there is no stopping you.

The stiffness is easing and most of the pain is long gone. The exercises now are all about regaining the mobility as quickly as possible and getting those muscles working that havent been moving for a long time. This is where the stretch band and fit ball come into their own! They are very easy to use and you can do all these exercises in your own home. Here, we are aiming to get the movement back and thus increase the joint lubrication by stimulating the production of more synovial fluid.

35

Stretching Phase III

B'+*% +3 C"+-;,&' D > =/*

NG"& #/'$;#*&H D 9

=/*

B/% O#;; D > =/*

1'=8 +2&' "&#, D > =/*

36

Strengthening Phase III

R&*% #'= &7%&*8/+*

!"# $%&'()# *"+&,#-.

G"& $-;; #.'+88

R&*% #'= #O,-.%/+*

C%'#/<"% #'= #O,-.%/+*

37

And finally

Thank

you all so much for purchasing this programme. With your self help book (or VCD), exercise programme and DVD to reinforce it, you can start the process of getting better. I am very excited to be sharing my success with you all. As this technique is still new, you may find it difficult to find a properly trained practitioner. For more information on a practitioner near you visit www.frozenshoulder.com. If this programme works for you, please tell your friends or therapists about it. We have developed training modules and seminars in the Niel-Asher Technique .

For maximum benefit you may wish to see a qualified Niel-Asher Technique practitioner. Information on practitioners is regularly updated on our website. Please check that your therapist is licensed and has a valid Niel-Asher Technique certificate.

Best of luck

/'0#1( 2 31(+-

38

About the Authors

Simeon Niel-Asher

BPhil BSc (Ost)

Graduated from The British School of Osteopathy in 1992. BPhil in Comp Health Studies at the University of Exeter 1995. Clinic tutor at the COET. Clinical research Addenbrookes hospital 01 to 03. Currently involved in lecturing, writing, research and promoting Osteopathy worldwide.

Jonas Broome

Dip C BSc (Hons.) Ost.

Jonas Broome is a personal trainer, qualified in both sports training, coaching and Osteopathy. Qualified, at the European School of Osteopathy he lectures in Sweden, New Zealand and England. Jonas works at the London frozen shoulder clinic and is a qualified Niel-Asher Technique practitioner.

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