PERIMENOPASUE & FROZEN SHOULDER.

What is the relationship of frozen shoulder and perimenopause? To date there have been no actual significant or specific studies looking into the relationship of frozen shoulder and perimenopause.

Quite often frozen shoulder is miss-diagnosed which impedes treatment. It has a huge impact on performing regular daily tasks; from reaching up for something out of the cupboard to doing up your bra. Treatment involves multiple facets to manage each stage of frozen shoulder and it can persist on and off for a few years.

Things that we know about frozen shoulder:

• There is an intricate reciprocity between inflammation and fibrotic changes within the joint capsule. 

• The absolute pathophysiological reason for frozen shoulder still remains uncertain.

• It is a painful and debilitating condition with 3 distinct stages with a progressive reduction in range of motion of the shoulder to external rotation, flexion and abduction.

• There is a higher prevalence of occurrence in women, typically in middle-age around 55, which may be related to hormonal factors.

• Risk factors include diabetes, thyroid disorders, prolonged immobilisation, and previous shoulder injuries.

What is Interesting to note, is the term inflammation coming up quite often and although without actually saying the words 'perimenopause' and 'menopause', these may be contributing factors. There is a lot of reference to ‘hormonal changes’ being the explanation as to why frozen shoulder is more prevalent in women to men.

Things that we know about perimenopause:

Women in perimenopause are generally in systemic inflammation due to hormonal fluctuations of estradiol (E2) and progesterone. Systemic inflammation is a state where the whole body is affected; including fatigue, hot flushes, migraine, brain fog, joint pain, mood changes and insulin resistance and weight gain.

Insulin resistance requires the body to produce more insulin to achieve the same effect as insulin sensitivity, where cells effectively use blood glucose. Insulin resistance can lead to higher blood sugar levels and T2 diabetes. There’s that inflammatory terminology again. Remember, perimenopausal systems are under stress and in a sympathetic inflammatory state.

How can we better reduce systemic inflammation during perimenopause.

Stay with me. We will circle is back to frozen shoulder in a couple of paragraphs. Regular physical activity that is appropriate for our new normal in perimenopause is one way we can reduce systemic inflammation. Movement that is more anaerobic based like: Sprint interval training, weightlifting, high-intensity interval training and plyometrics. (*there are all separate blogs on the way, but I am sure you can research this).

Why can age appropriate exercise help with systemic inflammation? Simply put, we have a better metabolic response with appropriate exercise. With increases in lean skeletal muscle mass which pulls glucose from the bloodstream for energy and thus helping to manage blood sugar levels and lower the risk for insulin resistance. It keeps supporting muscles around our joints strong helping to manage joint pain.  It is also beneficial for better immunity as it releases myokines during muscle contraction and it influences the parasympathetic nervous system.

We want to reduce the instance of elevated stress-hormone levels, especially in perimenopause when cortisol can already be elevated. Higher cortisol can also ‘steal’ the benefits of our anti-inflammatory sex hormone, progesterone. Side note. Cortisol is not evil. It plays an important role in regulating and supporting various bodily functions and systems, including cardiovascular, metabolic, homeostasis, cellular health, and the central nervous system. Once released into the bloodstream, cortisol helps the body respond to stress by increasing fuel (blood glucose), alertness and cognition. We just don’t want to be in that chronic systemic inflammatory state.

Perhaps we can now begin to see the possibility of a relationship existing between perimenopause and menopause changes and the instance of frozen shoulder.

how to support your client with managing frozen shoulder.

Supporting clients who are presenting with frozen shoulder is important. Work with the guidance of your client’s physiotherapist and where possible, add the client’s physio driven exercises to their programs in the studio. This will also give them practice and confidence to be doing their exercises out of the studio and physio space.

Avoid being the ‘fixer’. Hand autonomy and control for recovery to the client. Affirm the importance of continuing regular daily exercises to maintain shoulder mobility and to build strength. The effected shoulder would have been immobile for sometime and with this comes a deconditioning of the muscles.

Work on exercises that encourage range of motion to external rotation, abduction and flexion of the shoulder, within their comfort zone. Poles are great for this, using the unaffected arm to gently 'push' the affected arm into the require range of motion your working on.

Appropriate loading using appropriate equipment for the task at hand and again in the ranges of motion that are comfortable. Through correct implementation of spring load in the studio, we can begin to bring a level of resistance to the joint.

Having a mirror for clients to be able to see how the shoulder is behaving when they are performing their movement is very beneficial. Most humans are visual learners and their nervous system would have learned to move the shoulder in a compensatory manner to move 'around the pain'. Being able to see the movement will feed back to their interoception and proprioception, therefore retraining those neural pathways back to better, hopefully, pain free function.

The human body is a complex system and it's all connected. I do believe that the inflammatory state is just piece of something highly complex. We could dive deeper into how posture is effected through aging, we know it is, and this could also have a logical effect on how the shoulder girdle is placed and therefore how it performs. We also have simple age related wear and tear usage. It's a human thing.