Treating Severe Shoulder Pain Using the Coaching the Body Approach

Frozen shoulder and chronic shoulder pain is a stressful experience for anyone. The term "frozen shoulder" itself is only descriptive, and not a diagnosis as most people assume. The “frozen” aspect refers to an extreme limitation of pain-free movement, but this is in general not due to capsular adhesions, rather to trigger points in muscles. Mainstream medicine fails to provide any reasonable explanation of why this condition develops. Severe pain combined with disempowerment, and a lack of understanding is a formula for stress.

The common worldview assumes that shoulder pain, and pain in general, originates in a tear or some other kind of injury that needs to be repaired. My own work has show me that this generally is untrue - I can help shoulder clients get out of pain very quickly, and they can learn to take control of their own health.

I see worsening shoulder pain and frozen shoulder as way stations along a route of progressive adaptation to painful movement, which generally begins with the development of some active trigger points. Trigger points develop very easily with chronic or acute overload, can produce severe pain symptoms, and have nothing necessarily to do with soft tissue damage or injury. Sometimes trigger points may set in during the acute phase of an injury because of stress on the muscles. Long after the injury has healed, the trigger points remain. 

A good example of this is fraying of the supraspinatus tendon, also known as a rotator cuff tear. Repairing the tear, which may have little or no contribution to the pain experienced, fails to address either the pain or the original cause of the tear (assuming there wasn’t a specific event such as an accident).

Trigger points and taut fibers in the supraspinatus muscle belly cause pain in the lateral shoulder, and also cause it to bunch up and shorten and pull the head of the humerus up into the glenoid fossa. This reduces joint space underneath the acromion, which then mechanically rubs on the vulnerable supraspinatus tendon. The pain and trigger points remain long after the healing of the tendon.

Whatever the initial cause of shoulder pain, I see frozen shoulder as a process of adaptation, a seemingly sensible response of the nervous system to protect the shoulder from further “injury”. This is borne out in repeatedly in practice when we unravel the system of adaptations and the pain goes away.