The Frozen Shoulder Workbook
This book shouldíve been written by a doctor. By rights, a frozen shoulder ought to be in the medical domain. Youíd hope that a doctor would know all there is to know about shoulders and could proceed to solve your problem in a knowledgeable and confident manner. But this isnít necessarily true, as you may have already discovered. In general, the medical profession isnít doing too well with shoulders, especially frozen shoulders and common shoulder pain.
If you read the medical literature, youíll repeatedly run into the same disconcerting disclaimer, ďWe really donít know what causes a frozen shoulder.Ē What remains unsaid, though itís implied, is ďWe really donít know how to fix a frozen shoulder either.Ē Thatís a pitiful thing for a doctor to have to admit when the cause of a frozen shoulder and the solution have been available to the medical profession since the 1940s. Myofascial (MY-oh-FAH-shul) trigger points, or small contraction knots in muscles, are actually the primary cause of a frozen shoulder. In fact, trigger points are the main thing involved in most chronic pain, but you wonít find this out from your doctor. If your doctor were able to diagnose and treat myofascial trigger points, you wouldnít have the problem youíre having with your shoulder and you wouldnít need this book.
Individual doctors are not really to blame for this. The problem is that doctors have been denied all knowledge about myofascial pain by a system of medical education thatís skewed almost exclusively toward surgery and prescription drugs. As a consequence, a legitimate branch of medicine has been disregarded and even maligned in medical education because it doesnít fit into the traditional practice of medicine.
As the author of this book on shoulder trouble, I should have academic credentials validating that Iím an authority on shoulders. But I have no medical education and Iím not a member of the medical establishment. My authority, such as it is, began with a frozen shoulder of my own. Of course, a good many people have had frozen shoulders without gaining any special knowledge whatsoever, except what itís like to suffer unremitting pain with little hope of relief. My frozen shoulder turned out differently than most, however, because I had the good fortune to discover how to overcome it myself with self-applied trigger point massage.
Youíve probably heard that a frozen shoulder usually takes a year or more to heal, no matter what kind of therapy you undergo, or whether you just live through it without treatment. Curing my own shoulder didnít take a year. It took only about four weeks. I think I was lucky that I didnít learn about shoulders in medical school.
My first efforts at self-treatment fell flat. I tried all the things Iíd heard about: I practiced raising my arm with a cane, trying to get my shoulder muscles to stretch. I used a towel to pull my arm up behind my back. I walked my fingers up a wall. I did the Codman exercises, where you try to free up your shoulder by bending over and moving your arm in circles with a can of soup in your hand. But none of those little tricks did a bit of good. They just caused me more pain, and it wasnít long before I could hardly raise my arm at all.
I couldnít reach across to fasten my seat belt. I couldnít pick up my little one-year-old grandson. If I foolishly grabbed at a closing door, I was rewarded with a murderous shot of pain that left me immobile for most of a minute before I could get my breath and go on. The arm was useless for getting anything down from a shelf. If I needed two arms for anything, my good arm had to lift the bad one. I dreaded putting on my coat because of the torture in getting my arm into the sleeve.
The ache in my shoulder got worse when I went to bed. It awakened me repeatedly in the night, and sometimes I couldnít sleep at all. Iíd get up and spend an hour rubbing the shoulder with ice. That dulled the pain long enough for me to get back to sleep, but it wasnít a cure. Before morning the pain was back, just as bad as ever. I tried soaking my shoulder in a hot shower to soothe it and try to loosen it up. It felt great, but the effect didnít last. I realized I needed to find someone who knew a little more than I did about what was going on.
Several years earlier, Iíd had a good experience with therapeutic massage. A friend had suggested I try it for a back spasm that Iíd had for several weeks. Massage seemed a trivial thing and I really didnít hope for much, but the woman fixed my back in just three sessions. It was one of those watershed events, although I didnít recognize it at the time. Up to that time, Iíd had no notion that massage actually worked for something serious like pain. The therapist showed me the books she used, a couple of medical books about ďtrigger points.Ē The books looked interesting, but I was content at the time to just put myself into her hands.
I thought of that therapist again when I ran into a dead end with my shoulder. I was pretty sure she might have the answer. Unfortunately, she had moved away, so I had to find someone else who had similar abilities. I tried a number of massage therapists and inquired about the skills of many others, but their massage was too much of the ďfeel-goodĒ kind. Nobody really seemed to know how to fix shoulders. I spent a lot of time rubbing my shoulder myself, but I really had no idea what I was doing.
As a last resort, I gave physical therapy a chance, but it didnít go well. The therapist seemed a little patronizing when I told her the stretching exercises were making my pain worse. She insisted that this was the correct therapy and that I just had to keep at it. I found out later that she was hiding the fact that she was suffering from a frozen shoulder at the very time she was treating me! She couldnít fix herself and she couldnít fix me, but it didnít keep her from billing me just the same. In desperation, I renewed my determination to find a way to fix my shoulder myself.
I thought I might possibly find an answer in the books about trigger points Iíd been shown by the massage therapist Iíd liked so much. Sheíd been the only person who really seemed to know what she was doing in regard to pain. Absolutely nothing was giving me relief and I was badly in need of some new ideas. I was shocked at the price of medical books, but I swallowed hard and ordered them anyway, the two volumes of Myofascial Pain and Dysfunction: The Trigger Point Manual, by Doctors Janet Travell and David Simons (Simons, Travell, and Simons 1992, 1999). As soon as I began to read, the clouds of mystery around my shoulder problem began to clear away.
The books said that a trigger point was simply a tiny bundle of fibers within a muscle that was staying in a hard contraction, something like what Iíd always called a ďknot.Ē The little knot could cause ongoing pain, or it could exist silently, causing no pain at all unless pressed on. Usually, however, a trigger point would sneakily send its pain somewhere else. For this reason, the pain from trigger points was called referred pain.
I gathered that much of my pain, perhaps all of it, was probably this intriguing displaced pain, this referred pain. I had never been able to figure out why all the rubbing Iíd been doing on my shoulder had never done any good, but now I had the reason: The trigger points causing the pain could be several inches away, or even half the bodyís length away. It was clear that all my trouble lay in the trigger points hiding in various muscles in and around my shoulder, trigger points in twenty-four muscles, as it turned out. I hadnít known what I was doing when Iíd tried self-applied massage before, but Travell and Simons offered me the map to the hidden treasure.
Driven by my misery and by my excitement about these new ideas, I studied Travell and Simons literally night and day. I found that my trigger points would soften and go away under the touch of my own hands if I persisted. To my surprise and delight, after only about a month of diligent application of what I was learning, I found Iíd succeeded in fixing my own shoulder. I was astounded. The pain was gone. I could sleep through the night. I could raise my arm without being punished. Trigger point massage really worked!
I saw immediately that the world needed to know how well this worked. Somebody should write an accessible and affordable book on the subject! I visualized developing a whole system for dealing with trigger points and thought I could come up with a method for the whole body that anybody could understand and use. Once you knew how to find the trigger points and just exactly how to treat them, it wasnít really all that hard.
Using my own body as a laboratory, I learned something new every day. I found I had trigger points hiding everywhere. Like many people, I always had some kind of pain that I was just living with or trying to outlive. Now I saw that all this pain was actually a blessing, a great opportunity to test my self-treatment methods and make sure they worked. Over a period of three years, with the aid of my daughter Amber, who had also had a tough time with chronic pain, I figured out ways to self-treat trigger points in all 120 pairs of muscles that Travell and Simons dealt with in their book.
By the time I was done, my obsession with trigger points had led me to retire from my lifelong profession as a piano technician and become a professional massage therapist. Eventually I also wrote the book that I thought the world needed, The Trigger Point Therapy Workbook (Davies 2001), which was a success almost from the moment it was in print. While I wrote the book, my daughter also became a massage therapist, and later we began giving our trigger point therapy workshops for massage therapists. In our first two years, we taught more than eight hundred therapists from thirty-nine states. Many were seriously afflicted with chronic pain of their own, just like we had been. It was clear that quite a lot of people were ready and eager to learn about trigger points.
Through my daily experience as a massage therapist and from the feedback I got on my book, it became apparent that people everywhere were frustrated by the health care system when it came to pain. I also learned that I wasnít the only one whoíd had a bad experience with physical therapy, but physical therapy was where you generally ended up if you went to a doctor with shoulder pain. For pain in joints and muscles, you got a prescription for a painkiller and a referral to physical therapy as a matter of course. Your problem would also be given an official medical label. If you had pain in your shoulder, you had arthritis, tendinitis, or bursitis. If you had a stiff shoulder, you had adhesive capsulitis. Even though these traditional medical explanations for shoulder trouble are contradicted by everything thatís known about trigger points, people consistently told me their doctors hadnít said anything about trigger points.
Doctors Travell and Simons believe that the single most important issue regarding shoulder pain is misdiagnosis, and that trigger points are the cause of virtually all shoulder problems. This includes pain, stiffness, and reduced range of motion. But even rotator cuff tears and impingement syndrome are thought to result from the partial disarticulation of the ball-and-socket joint by muscles stiffened by trigger points. Because too few practitioners realize the involvement of myofascial trigger points in these problems, the medical community almost uniformly blames the shoulder joint for shoulder trouble. This is why standard medical treatments so often fail to solve the problem. One of the biggest shortcomings of modern medicine is that the majority of physicians still havenít studied or tried Travell and Simonsís trigger point therapy for pain.
After I became a massage therapist, I retained my particular interest in the shoulder. As a consequence, people with shoulder trouble began to seek me out. They told me some very disturbing stories about their experience with the health care system. The more I learned about how doctors were treating shoulders, the angrier I got. A frozen shoulder was obviously one of the worst things you could take into a doctorís office. At best, you got drugs to deaden your pain and a referral for physical therapy. At worst, you got your shoulder wrenched loose under general anesthesia. The bottom line in the medical world was that a frozen shoulder took a year or two to return to normal, whether you got treatment or not. Physicians and physical therapists didnít appear to be making much of a difference in the timeline.
I wrote about frozen shoulder in The Trigger Point Therapy Workbook (Davies 2001), and a great number of people have benefited. But since the book had to cover the entire body, I could devote only a couple of dozen pages to the shoulder. Subsequently, my publisher suggested that I write a separate book about the specific problem of frozen shoulder, as there were no books that focused on just that issue and there seemed to be a market for one. I liked the idea because it would allow me to go deeper into what was really my favorite subject. The reality of how people with frozen shoulder were being misdiagnosed and mistreated told me that there was indeed a pressing need for a book that dealt with just this problem in a truly comprehensive way. Maybe I could be of help not only to the public but to health care professionals as well. The success Iíd had with my own shoulder and the shoulders of many other people led me to believe I had a great deal more to say.
And now Iíve said it. Everything Iíve learned about the shoulder is now in your hands. Thereís a good chance you can get rid of your own shoulder pain and stiffness just by following the simple instructions youíll find in this book. If for some reason youíre physically unable to treat your own trigger points, youíll find alternate techniques that a friend, spouse, partner, or family member can use to help you. In addition, with considerable help again from my daughter, Iíve also provided a complete set of clinical techniques for physical therapists, occupational therapists, and massage therapists. These hands-on techniques would also be well suited for any physician whoís open to trying an efficient method for diagnosing and treating myofascial pain in the shoulder.
You may have already been searching the Internet for solutions to your shoulder difficulty, in which case you know that good information is widely scattered and hard to separate out from the thousands of sales pitches and other nonsense. Even the most authoritative Web sites contain only a rehash of the same antiquated beliefs about what causes frozen shoulder. Itís likely that the only therapies youíve found are the same parroted dogma about stretching. This book assembles wide-ranging information about shoulder problems in one place and presents an effective, if relatively unknown, concept of therapy to help you make better decisions regarding what steps to take in healing your shoulder. Just as important, you may get a better idea of what things to avoid.
With persistence in applying what you find here, you may never have to make another appointment with anyone for your shoulder, desperately hoping they might actually know how to solve your problem. You can try trigger point massage right now and know within two or three days whether the method will work for you. Most people find that, if done correctly, trigger point massage can begin to relieve pain almost immediately.
If youíre not intimidated by the technical side of things, you may want to start with chapter 1 and read straight through the book. If you prefer to get right to the meat of the matter, go to chapter 4 to find out the best way to do trigger point massage. Then go to chapter 5 to begin finding and treating the amazing little knots in your muscles that have been making your life so miserable. The key to an organized approach to self-treatment is the Trigger Point Guide at the beginning of chapter 5 or at the end of the book. You might like to take a look at it now and then decide where to begin.