What is frozen shoulder? And will I need surgery?
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Frozen shoulder can make simple tasks – such as lifting your arm, sleeping on your side, getting out of bed, putting on a bra, driving or playing with your kids – painful and challenging.
This condition usually starts with pain suddenly developing in the shoulder and stiffness. Over time, the pain and stiffness get worse. It can drag on for months or even years.
So, what causes frozen shoulder? And can it be treated?
What is frozen shoulder?
This shoulder condition, also known as “adhesive capsulitis”, affects around 8% of men and 10% of women aged 25–64. But it’s more common over 40, especially for people in their 60s.
We don’t fully understand what causes frozen shoulder.
The tissues around the joint become tight, swollen and stiff. But we don’t know exactly why these changes occur and lead to pain and limited movement.
There are usually three stages:
- freezing – pain gradually gets worse and the shoulder becomes stiff, limiting the range of movement
- frozen – stiffness and pain usually peak, but may begin to ease
- thawing – pain and stiffness slowly improve, and movement begins to return.
While health professionals commonly accept it, this staged description suggests frozen shoulder will follow a predictable pattern and always get better on its own. But research suggests this is not always the case.
For example, the “freezing” stage is usually expected to last at least ten weeks. But some people will start to notice improved movement sooner.
Recovery stages will vary from person to person and can take months to years. Some people may not fully recover, even with treatment.
One 2020 study followed up with 215 patients with frozen shoulder. While over 70% of participants said they were happy with improvements in their symptoms, around 40% still had some movement restriction two years after their symptoms began.
Another study from 2008 found over a third of people they surveyed (41%) had ongoing symptoms two to seven years later, including pain and difficulty sleeping.
Who is most at risk?
Certain groups are more likely to develop frozen shoulder:
- women, especially during menopause
- people with diabetes
- older adults
- those with high cholesterol or thyroid problems.
There is some evidence genetics also plays a role, as a family history increases your risk.
But we need more high-quality research to understand what’s behind these risk factors.
For example, people with diabetes are around five times more likely to develop frozen shoulder than those without diabetes – and also have worse pain. This may be linked to diabetes-related changes in the body, such as reduced blood flow to tissues and chemical changes from high blood sugar. But the exact mechanisms are unclear, and research is yet to determine whether controlling blood sugar better could help prevent or slow frozen shoulder.
Similarly, women are 40% more likely to develop frozen shoulder than men, with one theory suggesting hormone fluctuations during menopause are responsible. But there is no clear evidence yet to support this.
How is frozen shoulder treated?
There is mixed evidence about which treatments are effective, including whether over-the-counter pain medication such as Voltaren helps.
Oral steroids
A review of the evidence suggests oral steroids, such as prednisolone, can provide some short-term pain relief and improve shoulder movement, compared to doing nothing or a placebo. But these benefits don’t seem to last beyond six weeks, and the evidence comes from a few small studies. These require a prescription.
Injections
High-quality evidence shows corticosteroid injections can provide short-term relief, compared to doing nothing.
There is also some limited evidence that corticosteroid injections and platelet rich plasma injections can provide better short-term pain relief, compared with over-the-counter pain relief and physiotherapy. However, the studies are small or poorly designed and the effects are small, so the evidence needs to be interpreted with caution.
Physiotherapy
Moderate-quality evidence suggests physiotherapy can help improve shoulder movement. Benefits of physio are greater when combined with a steroid injection, and followed up by doing the exercises at home. More research is needed to understand how well these treatments work in the long term.
What about surgery?
There are two main procedures for frozen shoulder, both done while the patient is unconscious under anaesthetic.
1. Manipulation under anaesthetic
This is a less invasive procedure where the surgeon stretches the shoulder, without cutting into the joint, to help loosen tight tissue that may be causing stiffness.
2. Arthroscopic capsular release
In this type of keyhole surgery, the surgeon cuts tight tissues inside the shoulder joint to try to free up shoulder movement.
Improvements from these procedures are typically small, and evidence suggests the results are not better than non-surgical treatments. For example, one study showed that after one year, patients who’d had surgery had similar improvements to those who’d had physiotherapy and a steroid injection, but no surgery.
These procedures also have several downsides. It’s more expensive than other treatments, carries additional risks, and typically requires weeks (and up to three months) of rehabilitation.
The bottom line
Being physically active and doing exercises can help if you’re experiencing pain and limited movement. But you don’t have to work this out alone. It’s a good idea to get advice on managing pain and how to stay active.
If you suspect you have frozen shoulder, it’s important to see a doctor or physiotherapist so they can rule out other conditions, such as fracture and arthritis.
A health professional can also discuss management – the potential benefits, harms, costs, and how easy it is to access each treatment option.
Fernando Sousa, Research Fellow in Physiotherapy, Monash University; Joshua Zadro, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, University of Sydney, and Peter Malliaras, Professor in Physiotherapy, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Do Try This At Home: The 12-Week Brain Fitness Program
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12 Weeks To Measurably Boost Your Brain
This is Dr. Majid Fotuhi. From humble beginnings (being smuggled out of Iran in 1980 to avoid death in the war), he went on (after teaching himself English, French, and German, hedging his bets as he didn’t know for sure where life would lead him) to get his MD from Harvard Medical School and his PhD in neuroscience from Johns Hopkins University. Since then, he’s had a decades-long illustrious career in neurology and neurophysiology.
What does he want us to know?
The Brain Fitness Program
This is not, by the way, something he’s selling. Rather, it was a landmark 12-week study in which 127 people aged 60–80, of which 63% female, all with a diagnosis of mild cognitive impairment, underwent an interventional trial—in other words, a 12-week brain fitness course.
After it, 84% of the participants showed statistically significant improvements in cognitive function.
Not only that, but of those who underwent MRI testing before and after (not possible for everyone due to practical limitations), 71% showed either no further deterioration of the hippocampus, or actual growth above the baseline volume of the hippocampus (that’s good, and it means functionally the memory center of the brain has been rejuvenated).
You can read a little more about the study here:
As for what the program consisted of, and what Dr. Fotuhi thus recommends for everyone…
Cognitive stimulation
This is critical, so we’re going to spend most time on this one—the others we can give just a quick note and a pointer.
In the study this came in several forms and had the benefit of neurofeedback technology, but he says we can replicate most of the effects by simply doing something cognitively stimulating. Whatever challenges your brain is good, but for maximum effect, it should involve the language faculties of the brain, since these are what tend to get hit most by age-related cognitive decline, and are also what tends to have the biggest impact on life when lost.
If you lose your keys, that’s an inconvenience, but if you can’t communicate what is distressing you, or understand what someone is explaining to you, that’s many times worse—and that kind of thing is a common reality for many people with dementia.
To keep the lights brightly lit in that part of the brain: language-learning is good, at whatever level suits you personally. In other words: there’s a difference between entry-level Duolingo Spanish, and critically analysing Rumi’s poetry in the original Persian, so go with whatever is challenging and/but accessible for you—just like you wouldn’t go to the gym for the first time and try to deadlift 500lbs, but you also probably wouldn’t do curls with the same 1lb weights every day for 10 years.
In other words: progressive overloading is key, for the brain as well as for muscles. Start easy, but if you’re breezing through everything, it’s time to step it up.
If for some reason you’re really set against the idea of learning another language, though, check out:
Reading As A Cognitive Exercise ← there are specific tips here for ensuring your reading is (and remains) cognitively beneficial
Mediterranean diet
Shocking nobody, this is once again recommended. You might like to check out the brain-healthy “MIND” tweak to it, here:
Four Ways To Upgrade The Mediterranean Diet ← it’s the fourth one
Omega-3 supplementation
Nothing complicated here. The brain needs a healthy balance of these fatty acids to function properly, and most people have an incorrect balance (too little omega-3 for the omega-6 present):
What Omega-3 Fatty Acids Really Do For Us ← scroll to “against cognitive decline”
Increasing fitness
There’s a good rule of thumb: what’s healthy for your heart, is healthy for your brain. This is because, like every other organ in your body, the brain does not function well without good circulation bringing plenty of oxygen and nutrients, which means good cardiovascular health is necessary. The brain is extra sensitive to this because it’s a demanding organ in terms of how much stuff it needs delivering via blood, and also because of the (necessary; we’d die quickly and horribly without it) impediment of the blood-brain barrier, and the possibility of beta-amyloid plaques and similar woes (they will build up if circulation isn’t good).
How To Reduce Your Alzheimer’s Risk ← number two on the list here
Practising mindfulness medication
This is also straightforward, but not to be underestimated or skipped over:
No-Frills, Evidence-Based Mindfulness
Want to step it up? Check out:
Meditation Games That You’ll Actually Enjoy
Lastly…
Dr. Fotuhi wants us to consider looking after our brain the same way we look after our teeth. No, he doesn’t want us to brush our brain, but he does want us to take small measurable actions multiple times per day, every day.
You can’t just spend the day doing nothing but brushing your teeth for the entirety of January the 1st and then expect them to be healthy for the rest of the year; it doesn’t work like that—and it doesn’t work like that for the brain, either.
So, make the habits, and keep them going
Take care!
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How To Prevent And Reverse Type 2 Diabetes
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Turn back the clock on insulin resistance
This is Dr. Jason Fung. He’s a world-leading expert on intermittent fasting and low carbohydrate approaches to diet. He also co-founded the Intensive Dietary Management Program, later rebranded to the snappier title: The Fasting Method, a program to help people lose weight and reverse type 2 diabetes. Dr. Fung is certified with the Institute for Functional Medicine, for providing functional medicine certification along with educational programs directly accredited by the Accreditation Council for Continuing Medical Education (ACCME).
Why Intermittent Fasting?
Intermittent fasting is a well-established, well-evidenced, healthful practice for most people. In the case of diabetes, it becomes complicated, because if one’s blood sugars are too low during a fasting period, it will need correcting, thus breaking the fast.
Note: this is about preventing and reversing type 2 diabetes. Type 1 is very different, and sadly cannot be prevented or reversed in this fashion.
However, these ideas may still be useful if you have T1D, as you have an even greater need to avoid developing insulin resistance; you obviously don’t want your exogenous insulin to stop working.
Nevertheless, please do confer with your endocrinologist before changing your dietary habits, as they will know your personal physiology and circumstances in ways that we (and Dr. Fung) don’t.
In the case of having type 2 diabetes, again, please still check with your doctor, but the stakes are a lot lower for you, and you will probably be able to fast without incident, depending on your diet itself (more on this later).
Intermittent Fasting can be extra helpful for the body in the case of type 2 diabetes, as it helps give the body a rest from high insulin levels, thus allowing the body to become gradually re-sensitised to insulin.
Why low carbohydrate?
Carbohydrates, especially sugars, especially fructose*, cause excess sugar to be quickly processed by the liver and stored there. When the body’s ability to store glycogen is exceeded, the liver stores energy as fat instead. The resultant fatty liver is a major contributor to insulin resistance, when the liver can’t keep up with the demand; the blood becomes spiked full of unprocessed sugars, and the pancreas must work overtime to produce more and more insulin to deal with that—until the body starts becoming desensitized to insulin. In other words, type 2 diabetes.
There are other factors that affect whether we get type 2 diabetes, for example a genetic predisposition. But, our carb intake is something we can control, so it’s something that Dr. Fung focuses on.
*A word on fructose: actual fruits are usually diabetes-neutral or a net positive due to their fiber and polyphenols.
Fructose as an added ingredient, however, not so much. That stuff zips straight into your veins with nothing to slow it down and nothing to mitigate it.
The advice from Dr. Fung is simple here: cut the carbs. If you are already diabetic and do this with no preparation, you will probably simply suffer hypoglycemia, so instead:
- Enjoy a fibrous starter (a salad, some fruit, or perhaps some nuts)
- Load up with protein first, during your main meal—this will start to trigger your feelings of satedness
- Eat carbs last (preferably whole, unprocessed carbohydrates), and stop eating when 80% full.
Adapting Intermittent Fasting to diabetes
Dr. Fung advocates for starting small, and gradually increasing your fasting period, until, ideally, fasting 16 hours per day. You probably won’t be able to do this immediately, and that’s fine.
You also probably won’t be able to do this, if you don’t also make the dietary adjustments that help to give your liver a break, and thus by knock-on-effect, give your pancreas a break too.
With the dietary adjustments too, however, your insulin production-and-response will start to return to its pre-diabetic state, and finally its healthy state, after which, it’s just a matter of maintenance.
Want to hear more from Dr. Fung?
You may enjoy his blog, and for those who like videos, here is his YouTube channel:
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Unlock Your Menopause Type – by Dr. Heather Hirsch
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We featured Dr. Hirsch before, here, and mentioned this book which, at the time, we had not yet reviewed. So, here it is:
What sets this apart from a lot of menopause books is that there’s a lot less “eat these foods and your body will magically stop exhibiting symptoms of menopause” and a lot more clinical observations and then evidence-based recommendations.
Which is not to say don’t eat broccoli and almonds; by all means, they’re great foods and contain valuable nutrients that will help. But it is to say that if your doctor’s prescription is just broccoli and almonds, maybe have those as a snack while you’re looking for a second opinion.
Dr. Hirsch goes through various “menopause types”, but it’s not so much “astrology for gynecologists” and more “here are clusters of menopause symptoms set against timeline of presentation, and they can be categorized into six main ways that between them, cover pretty much all my patients, which have been many”.
So if you, dear reader, are menopausal (including peri- or post-), then the chances are very good that you will see yourself in one of those six sets.
She then goes about how to prioritize relief and safety, and personalize a treatment plan, and maintain the best menopausal care for you, going forward.
The style is easy-reading pop-science, punctuated by clinical science and 35 pages of references. She’s also, unlike a lot of authors in the genre, manifestly not invested in being a celebrity or making a personality cult out of her recommendations; she’s happy to stick to the science and put out good advice.
Bottom line: if you or someone you love is menopausal (including peri- or post-), this is a top-tier book.
Click here to check out Unlock Your Menopause Type, and get the best care for you!
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Occupational therapists tackle obstacles in the home, from support to cook a meal, to navigating public transport
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Occupational therapists (OTs) have been in the spotlight this month after the National Disability Insurance Agency (NDIA) froze NDIS payments for these services at $193.99 per hour for the sixth year.
The NDIA also cut travel payments for OTs who visit people in their home and community by 50%.
Health Minister Mark Bulter says it’s important people on the NDIS aren’t paying more for therapy and support than they would pay in the health or aged care system.
But OTs are concerned this could affect therapists’ viability, including their ability to support people with disability in their homes and communities.
But what can OTs actually do? And why is it often better to do this in a person’s home and community?
Who might see an OT?
Imagine trying to get back to your daily life after a major health setback, such as a car accident or stroke, or an episode of a long-term condition or disability, such as depression or arthritis. The things you used to do with ease can become difficult and exhausting.
After such a setback, your home or community can also feel like an obstacle course. Maybe you can’t carry the laundry basket out to the line anymore, or you’re struggling to keep up with your children.
This is where occupational therapy can make a real difference. OTs are health professionals that enable people to do the things they need, want and love to do in daily life, from getting dressed to cooking dinner, gardening to driving.
Occupational therapists work with people of all ages. They overcome barriers by changing the environments and objects we use, teaching new skills, rehabilitating old ones and tweaking the way we tackle tasks.
What can OTs do in the home and community?
Seeing people in their own homes and communities allows the therapist to get a more accurate picture of a person’s strengths and abilities, which can be difficult to understand in a clinic.
OTs use their skills and creativity to provide personalised care, tailored to individual needs and circumstances.
An older person with dementia might, for example, cause alarm by putting a plastic kettle on the stove of a hospital kitchen. But they could make their cup of tea perfectly safely at home with their stove top kettle.
OTs can support home and community mobility, such as checking a wheelchair passes smoothly through doorways and can manoeuvre in tight spaces such as bathrooms.
But they can also advise on kitchen aids and seating to save energy for people with conditions such as multiple sclerosis, to support them continuing to cook family meals.
In their work with neurodivergent people of different ages, an OT might help an autistic teen develop sensory strategies to deal with their busy and noisy school day.
For other people, OT support might help them navigate their local public transport system. Learning and practising skills where they’re used makes it easier to carry them over into everyday life.
What does the research say?
Research shows home and community OT can lead to better activity and participation than clinic-based therapy. It’s also cost-effective.
For stroke survivors, OT makes everyday tasks like showering or getting dressed easier.
OT at home eases burden and stress for the parents of children with cerebral palsy and carers of people with dementia.
OT at home helps older people with ongoing health issues to be more actively involved in their communities.
Community OT is also effective in supporting recovery for people with mental health problems, enabling them to enjoy community and leisure activities, seek and maintain employment and enhance physical activity.
OT focuses on helping you do the things that keep you well and independent, which means fewer trips back to the hospital. OTs can spot and solve trip hazards within homes, for example, before a frail person has a fall.
People who get OT at home soon after leaving hospital are less likely to be readmitted. Emerging research also suggests OT can work jointly with paramedics when someone falls at home by visiting and offering immediate treatment that prevent avoidable hospital stays.
There are some downsides, such as limited access in disadvantaged communities. While telehealth can address some barriers, it is not suitable in every case.
How do Australians access OTs?
There are many pathways to access OT services, but the complexity of the health-care system means the process is challenging to navigate.
OT services can also be costly, due to severely limited funding, equipment and transport costs.
OT is available as part of Home Care Packages and the Commonwealth Home Support Programme for older people.
OT has also played a key role in supporting NDIS participants since the scheme’s inception. However, waiting lists often stretch for many months and not everyone knows about what OT can offer.
You can also access community OT through Medicare Chronic Disease Management plans, local community health centres and councils and through private health insurance rebates.
Thanks to Lana O’Neil (Occupational Therapist at Western Health in Victoria) and Sarah McCann (Senior Occupational Therapist at Western Health) for sharing their clinical expertise for this article.
Danielle Hitch, Senior Lecturer in Occupational Therapy, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Nanotechnology vs Alcohol Damage!
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One Thing That Does Pair Well With Alcohol…
Alcohol is not a healthy thing to consume. That shouldn’t be a controversial statement, but there is a popular belief that it can be good for the heart:
Red Wine & The Heart: Can We Drink To Good Health?
The above is an interesting and well-balanced article that examines the arguments for health benefits (including indirectly, e.g. social aspects).
Ultimately, though, as the World Health Organization puts it:
WHO: No level of alcohol consumption is safe for our health
There is some good news:
We can somewhat reduce the harm done by alcohol by altering our habits slightly:
How To Make Drinking Less Harmful
…and we can also, of course, reduce our alcohol consumption (ideally to zero, but any reduction is an improvement already):
And, saving the best news (in this section, anyway) for last, it is almost always possible to undo the harm done specifically to one’s liver:
Nanotechnology to the rescue?
Remember when we had a main feature about how colloidal gold basically does nothing by itself (and that that’s precisely why gold is used in medicine, when it is used)?
Now it has an extra bit of nothing to do, for our benefit (if we drink alcohol, anyway), as part of a gel that detoxifies alcohol before it can get to our liver:
Gold is one of the “ingredients” in a gel containing a nanotechnology lattice of protein fibrils coated with iron (and the gold is there as an inert catalyst, which is chemistry’s way of saying it doesn’t react in any way but it does cheer the actual reagents on). There’s more chemistry going on than we have room to discuss in our little newsletter, so if you like the full details, you can read about that here:
Single-site iron-anchored amyloid hydrogels as catalytic platforms for alcohol detoxification
The short and oversimplified explanation is that instead of alcohol being absorbed from the gut and transported via the bloodstream to the liver, where it is metabolized (poisoning the liver as it goes, and poisoning the rest of the body too, including the brain), the alcohol is degraded while it is still in the gastrointestinal tract, converted by the gel’s lattice into acetic acid (which is at worst harmless, and actually in moderation a good thing to have).
Even shorter and even more oversimplified: the gel turns the alcohol into vinegar in the stomach and gut, before it can get absorbed into the blood.
But…
Of course there’s a “but”…
There are some limitations:
It doesn’t get it all (tests so far found it only gets about half of the alcohol), and so far it’s only been tested on mice, so it’s not on the market yet—while the researchers are sufficiently confident about it that a patent application has now been made, though, so it’ll probably show up on the market in the near future.
You can read a pop-science article about it (with diagrams!) here:
New gel breaks down alcohol in the body
Want to read more…
…about how to protect your organs (including your brain) from alcohol completely?
We’ve reviewed quite a number of books about quitting alcohol, so it’s hard to narrow it down to a single favorite, but after some deliberation, we’ll finish today with recommending:
Quit Drinking – by Rebecca Dolton ← you can read our review here
Take care!
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The Book of Lymph – by Lisa Levitt Gainsely
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The book starts with an overview of what lymph is and why it matters, before getting into the main meat of the book, which is lymphatic massage techniques to improve lymphatic flow/drainage throughout different parts of the body, and in the context of an assortment of common maladies that may merit particular attention.
There’s an element of aesthetic medicine here, and improving beauty, but there’s also a whole section devoted to such things as breast care and the like (bearing in mind, the lymphatic system is one of our main defenses against cancer). There’s also a lot about managing lymph in the context of chronic health conditions.
The style is light pop-science; the science is explained clearly throughout, but without academic citations every few lines as some books might have. The author is, after all, a practitioner (CLT) and/but not an academic.
Bottom line: if you’d like to improve your lymphatic health, whether for beauty or health maintenance or recovery, this book will walk you through it.
Click here to check out The Book of Lymph, and give yours some love!
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