Treat your own frozen shoulder homeexercise programme

Simeon Niel-Asher & Jonas Broome 2005

1st Edition

Treatyourown frozenshoulderhomeexerciseprogramme

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 formor by any means, electronic, mechanical, printing, photocopying, recording, or otherwise, without written permission from thepublisher or author.

FrozenShoulder.Com Ltd.@ The London Frozen Shoulder Clinic108 Swains Lane Corner 12 South Grove

Highgate, London N6 6BSPhone +44 (0) 208 347 6160 Fax +44 (0) 208 348 1777

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

The Niel-Asher technique is a registeredtrademark

All rights reserved. No part of this publicationmay 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 writtenpermission 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 websitewww.frozenshoulder.com which is regularly updated. Because this technique is new there may not be a practitioner nearyou. Please bear with us; we are endeavouring to teach The Niel-Asher technique worldwide. A training course is alsoavailable 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 qualificationwho belong to a recognised Register. Only practitioners who have completed an accredited course are recognised, soplease check the website.

Text Simeon Niel-Asher/Jonas BroomePhotography Jonas Broome/Matthew ClementsModels Josslyn ThompsonEditor Suzie Goodman

disclaimerThis exercise book is not intended as a substitute for medical advice.The reader should regularly consult a physician or health careprofessional in matters relating to health and particularly in respect ofany symptoms which may require diagnosis or medical attention. Inthe majority of cases of frozen shoulder syndrome there is nounderlying illness or cause. However a proper diagnosis from aregistered practitioner is advised. If you perform exercises from thisbook they are at your own risk.

TableofContents

Chapter 1 Introduction

Chapter 2 Advice for everyone

Chapter 3 Exercises for phase I

Chapter 4 Daily programme phase II

Chapter 5 Exercises for phase III

Chapter 6 Daily programme phase I

Chapter 7 Daily programme phase II

Chapter 8 Daily programme phase III

And Finally

A D V A N C E D E X E R C I S E P R O G R A M M E - 1 -

1

Chapter

2Introduction

Get moving

We have created this exercise manual to support, assist and accelerate you through your frozenshoulder. For most of you this may well be one of the most challenging and difficult periods of yourlife. Please remember, my colleagues and I are here to help you in any way we can. For optimalresults 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, partneror 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 frozenshoulder. We hope to present little gems for you to think about on a daily basis; helping you tomanage your frozen shoulder whether with every day activities or more vigorous exercise. As alwaysit is the little things that make the world of difference.

We recommend you perform daily activities wherever possible and add both general and specificexercises as appropriate. All of the exercises in this book are aimed at maximizing the strengthpower, endurance and flexibility of your shoulder muscles.

We have presented a general exercise section at the beginning of the book followed by a sectionwith specific exercises for each phase of your frozen shoulder (phases I-III). At the end there is aphase specific exercise program.

I CON KEYSValuable information New ExerciseExercise Programme

These programs are just suggestive and in no way definitive, feel free to change the exercisesaround. What suits one person does not suit the next so if something is painful leave italone and try another.

3BenefitsofexerciseIt is an anathema that during your frozen shoulder it is very important to keepthe 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 putice onto it. But it is beneficial to get started as soon as possible with regular, gentle exercises. Thesewill help to:

x Aid the recovery and shorten the duration of your frozen shoulder. Prolonged immobility willonly make the stiffness worse and allow inflammation to build up in and around the shouldertissues, thus creating more pain.

x Significantly speed up your recovery. There is plenty of research evidence that shows thatthe cells which make fibrous bands in muscles (fibroblasts) respond well to mechanicalactivity. Exercise and stretching loosens the scar tissue that builds up in damaged muscles,and promotes increased healing.

x Have a positive effect on general well being. We often hear from patients about the generalfeeling 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 thesituation. Also exercise releases endorphins which have a well documented positive effect onmood.

x Improve muscle function and co-ordination. Right from day 1 of your frozen shoulder there isa loss of mutual muscle co-ordination and co-operation of the rotator cuff muscles. Thisoccurs at the level of the brain. Exercising daily helps to reverse these effects.

x Stretch the sore and damaged muscle fibres in a controlled, co-ordinated and constructiveway; lengthening the contracted and damaged areas within the muscles.

x Strengthen the weakened and (often) wasted muscles.

4Arethereanyrisks inexercising?Really the risks of not exercising are much worse! As long as you avoid thatsharp, catching type of pain that is associated with the early phases of yourfrozen shoulder there should be no risk of making the shoulder worse. Do follow

these simple rules:

x Always exercise to potential. It is important especially initially to - start gently. Start withsomething that you know you can handle and step it up. Going into a major exercise routinetoo quickly will only make you sore!!

x If it hurts stop!! Doing exercise that is painful is not beneficial there are some people whohave the attitude no pain, no gain this may be true in some cases but not in relation torehabilitation exercises. Some slight aching in the shoulder during and after exercise can beexpected but if it makes the pain worse you are doing too much.

x Make sure you are doing the exercises correctly. This manual should hopefully help tocombat that problem but if it doesnt feel right then it probably isnt, so try something elseor look for further advice.

Ifanacutespasmstrikes!In the early days of your frozen shoulder any sudden movement; reaching for afalling cup, holding a door open or even being bumped into on the street cancause 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 tendonsits in a grove at the top of the humerus bone bicipital groove. The inflamed tendon slips in and outof the bicipital grove that slip is what causes the acute catching pain and spasm in the shoulderand arm.

Fig 1 - The Biceps Tendon & its sheath

Biceps tendon

Tendon Sheath

5Understanding the spasm helps to control it!These acute attacks of "blinding" pain add to your already considerable burdenby contributing anxiety. Most people find that they can stop these attacks bydoing 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 asdescribed 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 afine line between gently going with the muscles and creating a further 'challenge', so remember thatthe exercise described below is subtle and should be performed slowly and gently.

6Spasm 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 afraction of the force.

7DailyLiving

What you do with your shoulder on a daily basis is important both for managing pain and increasingthe rate of recovery. There are simple things you can think about as you go about your daily life tomake 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 beappropriate for other problems, such as a fracture or ligament sprain, it is not so for a Frozenshoulder

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 armclose to the body even supporting it with the other arm. This position is very important to avoid asit only compounds the problem. In this position the biceps muscle is contracted, stressing the tendonand causing further shortening. It is far better to try to keep the arm straight allowing the arm to hangalong the side of your body. This position stretches the biceps tendon; the weight of the arm alsoslightly 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.

Use the armwherepossible anddont be too

afraid, just try to avoid tweaking the tendon, you will not make it worse.

WalkingWalking through a busy supermarket or going on the Tube at rush hour may not sound much to mostpeople, but for somebody with a frozen shoulder it can be a very stressful experience. The fear of afellow shopper or passenger accidentally bumping into the shoulder is constantly present. In thattype 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:x Relax the shoulder downx Straighten the armx 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.x Breathe and relax

Swinging the arm during a very acute phase may be painful, so achieving the first two points isenough.

Try swinging the arms when walking; dont just hold the arms rigidTry putting the arm up on the sofa when you are sitting watching TVIf you are standing, try leaning against a wall and gently moving your hand higher

8This will help to separate the shoulder joint allowing fluid back into the shoulder capsule. Also gentlymoving the arm will improve blood flow into the shoulder area and thereby ultimately improve healingand reduce pain.

SleepingNight pain and sleeplessness are some of the worst aspects of the frozen shoulder, especially in theearly days. At first, you will probably not be able to tolerate pressure on your affected side. As yoursymptoms ease, however, you will find you can gradually ease into some type of position. Thedegree of night pain is directly proportionate to the amount of inflammation within the joint.

Some comfort and relief may be obtained by:

x Lying on your back, with a pillow lengthways under the affected arm(s) and shoulders,supporting them

x Lying on the good side with a pillow or towel over your waist and under the armx Try to avoid sleeping with the arm above your head. This inhibits shoulder tissue repair,

which manly occurs manly at nightx Lying on your back with a good neck pillow

9IceIce can be particularly beneficial in the acute freezing (I) and thawing phases (II) when theinflammation is most active. You may feel sceptical about this, but so many people haveenthusiastically described the relief they felt from applying ice to their shoulders that it is worth trying.

x Wrap some crushed ice or frozen peas in a towel and place over the front of the shoulderjoint. Leave it there for 5 to 10 minutes.

x Let the area rest without ice for 5 to 10 minutes and repeat.x 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 wherethere 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 visitwww.frozenshoulder.com

10

HeatIn the early stages of a frozen shoulder applying direct heat is not a good idea, though a warm bathmay 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 5minutes warmth ending with 5 minutes ice can be tried. It is very important to end the cycle with ice.

PostureThe benefits of maintaining a good posture are something that we Osteopaths often try toemphasise to our patients. During the frozen shoulder the posture you adopt is of great importanceas 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 workinefficiently and can lead to a pinching of the tissues; causing further damage. Also rememberyour neck posture; the neck muscles often become rigid in a frozen shoulder where they areheaving around the stiff shoulder.

11

Shoulder At WorkAlthough the pain of a frozen shoulder can be constant, the demands of life do not necessarily letup. At work you may spend a long time in the same position or perform some repetitive tasks. Hereare some tips on how to get through the day with the least amount of discomfort:

x Avoid carrying heavy bags or cases for long distances; this has been demonstrated toprecipitate tears in the supraspinatus a vital shoulder muscle.

x If you are driving all day, or keeping your arm in a fixed position, take regular breaks; this isbecause the muscle becomes fatigued and lactic acid builds up in the muscle, over time thiscan cause damage.

x When working in front of the computer screen, take regular breaks. Get up and walk awayfrom your work station and the P.C. for a couple of minutes every half an hour. This isimportant for the same reasons as above.

x Make sure your chair has good back support and preferably adjustable arm rests.x Adopt the ideal work posture if you are sitting at a desk. See below:

12

Use It!!Maybe that is the last thing you want to be doing whenthe arm is hurting, but it really will help Long term!The only thing to avoid is the catchy type of pain thatI am sure you are familiar with.

Whatever you normally do with the arm, try to keepdoing it as long as it is not too painful. Things likebrushing your teeth, shampooing your hair orusing your knife and fork. Although it may be difficult,these little things together will help to keep the shoulderfree and more mobile.

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

13

ADVICE FOR EVERYONE

In this chapter we will point out some general exercises that should benefit you all, you can do theseduring all three phases of your frozen shoulder. These exercises can all be done in combinationwith 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, justresting and icing the shoulder may be the best course of action for a few days. But dont rest toolong 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 ifthe shoulder is hurting.

Cardiovascular ExerciseThe benefits of cardiovascular exercise in relation to chronic and long standingproblems, like a frozen shoulder, are well documented.

Although perhaps it does not seem like you are helping your shoulder when youare going for a brisk walk or getting onto the treadmill you are!! This helps to:

x Improve blood flow generally, specifically to the shoulder joint.x Pump away some of the inflammation and toxins thereby lessening the pain.x Activate the part of the hormonal system that stimulates tissue repair.

Chapter

C.V. exercise will also help combat thelowering in mood which is a commonoccurrence during a frozen shoulder. Thisgives you a sense of taking charge of thedifficult situation.

When exercising, if something feels wrong then it probably is, so stop, and try somethingelse or get more advice.

14

Repositioning the ShoulderThis is originally an Alexander technique exercise which is excellent for resettingthe shoulder position. This is good to do everyday:

x Place a duvet or thick towel on the floor and lie on it, face up. Placepillows under both elbows and forearms. Rest the hands on yourstomach, palm downwards (if that is not possible just rest the arms on

the pillow).x 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 dropbackwards, towards the floor.

x When your shoulder has started todefrost in the second and third phase,you might be able to place the arms at 45degree angle from the body.

x Turn the palms upwards if possible.

You may not be able to get the hands flat for awhile, but eventually you will. If necessary youcan place a cushion on your abdomen and rest

the hands there.

x Gradually try to lower this cushion to a few towels and eventually nothing.

x Try putting on some relaxing music

AdviceforEveryone

15

Shoulder RetractionThis is another exercise for resetting your shoulder position and posture. Thegood thing about this exercise is that it can be done anywhere, and does notrequire any equipment:

x Turn your hands palm outwards slowlyx Try to squeeze your shoulder blades together, automatically bringing your shoulders

backwardsx Keep your shoulders where they are but let the hands roll back into your sidesx Hold that position for 30 secondsx Rest and repeat

Advice

forEveryone

16

SwimmingAs soon as the night pain is gone it is a good idea to get into the water. At firstit may not look or feel like you are swimming. But do not despair; you are stilldoing your shoulder the world of good. The resistance of the water will helpmobility and improve the strength of the shoulder.

x Try to go when it is quiet in the poolx If you cant swim then simply walk up and down using your arms to help youx Dont try to swim fifty laps; you are swimming to help your shoulder, not to win the Olympicsx Rest after every lapx Vary the type of stroke you use after each lapx Concentrate on trying to move the shoulder as much as possible rather than swimming fast

or farx Dont over do it!! Easily done, stop well before you are tired or when the shoulder is hurting

Advice

forEveryone

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

17

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 likelyhave one there. Getting on a cross trainer for five to ten minutes on low pressure will do yourshoulder the power of good.

In the earlier phases you may not be able to put much pressure through the arm, but just hanging onto the poles and letting the legs do most of the work will help to free the shoulder capsule and loosenthe shoulder muscles.

Once you are able to put some pressure through the arm, this will also help to rebuild musclesaround the shoulder that have wasted away.

18

Exercises for Phase I

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

Chapter

19

Neck Stretching

After performing any exercises it helps to do some neck stretching. With afrozen 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 asthe nerves supplying the shoulder are in the neck. Here is an easy stretch to

get on with:

x Stand upright in a good posturex Lean your head away from the affected shoulder gentlyx You should feel a light stretch in the neckx Maintain this stretch for about 10 secondsx Repeat on the opposite sidex Do this 3 times on each side of the neck

Phase

I

If you want to increase the tension, put the hand on the same side as you are stretching onto thehead (if you can) and lightly pull to increase the stretch.

20

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 buteasy 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

21

Shoulder shrugging

This can be performed up to five times daily for 2 5 minutes. You can moveboth shoulders at the same time and then independently. Raise the shoulder upto the neck and push them downwards towards the floor. Be careful if you havea 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.

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

Phase

I

22

Shoulder rotation

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

Phase

I

23

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:

x Stand upright near a wall or a door framex Keep your arm hanging straight downx Push the arm against the door with about 20% of your strengthx Push for ten seconds then relax and repeat 3-4 timesx This can be done both forward, backward and to the side

The Elephant

This exercise stretches the back of the shoulder and is therefore particularlyhelpful in relation to a posterior type of frozen shoulder:

x Stand uprightx Bring the affected shoulder forward and inwards

x Use the other arm to bring the affected arm further over, like this you are creating a stretch inthe back of the shoulder

x Maintain a nice even stretch, this shouldstretch not hurt

x Hold that position for up to 30 secondsx Relax and repeat

PhaseI

PhaseI

24

Exercises for Phase II

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

Keep going with the phase I exercises

You can also add the following exercises:

Chapter

25

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.

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 circlesx Repeat anticlockwisexPerform 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 maynot be able to reach up behind your back until your shoulder has improved, but never the less, thisexercise is highly recommended when you are able.

x Using a large bath towel roll it into a long sausage shape

x Throw the towel over your affected shoulder using the good arm

x Hold one end of the towel with the frozen shoulder hand

x With the other hand pull the towel down until you feel a stretch in the shoulder

Phase

II

26

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

(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

PhaseII

27

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

PhaseII

28

Back of the shoulder

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

Chest stretch in door frame

The tendency when having a frozen shoulder is to carry the arm in a slingposition, thus creating a shortening of the muscles in the front of the shoulder.This stretch helps to combat that shortening:

x Stand in a door framex Turn your hand out and put it against the door framex Arm at 45 degrees or as high as possible (if you can get it up to 90 degrees even better!)x Turn away from the arm with your body also turn your head away, thus creating a stretch

in the front of the shoulderx Maintain a nice even stretch, this should stretch not hurtx Hold that position for up to 30 secondsx Relax and repeat

PhaseII

29

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

PhaseII

30

Using a fit ballArms over head

x Lying on your back on to the ball, the ball between the shoulder blades, head supported bythe ball, squeeze the buttock muscles to keep the spine in a neutral position

x Bringing straight arms over the head until you feel a stretch in the shoulderx The other arm can be used as a weight by putting it onto the armx Maintain that stretch, trying to relax into the stretch. A good way to achieve this is to use the

breathing to stretch the arm furtherx Maintain the stretch for up to a minute. Rest and repeat 2-3 timesx This should stretch not hurt! Start gently and increase the stretch slowly

Phase

II

31

Front of shoulder stretch

This is a brilliant stretch using the fit ball. This exercise stretches out the front ofthe shoulder. The stretch is also so comfortable that it may be held for a longtime, it allows you to really work into the stiff areas of your shoulder. This is howit is done:

x Sit your knees on a matt or a pillowx Hands onto the ballx Then roll the ball forward until you feel a stretch in the front of your shoulderx Keep your head down.x Maintain that posture for up to a minutex Rest and repeat 3-4 times

PhaseII

32

Exercises for Phase III

After a few weeks of performing the Niel-Asher Technique and adding the above stretches you shouldfeel ready to strengthen your weak shoulder muscles.

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 ispreferable. 40% of cases, however, really seem to need a bit of extra help. Now it is time to add thefollowing exercises to those already mentioned.

Strengthening

The following exercises involve either a using a small 1kg weight or using anelasticated resistance band.

These should only be performed when the night pain has diminished more than90%.

Stretching using a 1kg weight

Chapter

PhaseIII

33

Elastic resistance rep-band or thera-band

These are high quality latex-free products. They are a more advanced product than many cheaperalternatives. 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. Theelastic resistance band is a good exercise tool because of its versatility and it gives the ability toadjust the resistance to suit you individually.

Using an elastic resistance Thera-band or rep-band

PhaseIII

34

Starting at waist level, slowly pull both sides of the resistance band- If in pain, stop.

External Rotation

x Stand upright, elbows tucked in to your sidesx Have arms at ninety degrees, straight in front of youx Turn your hands with palms upwardsx Hold the exercise band between your handsx In this position, keeping your elbows next to your body, separate your hands. This will tense

up the exercise band, thus strengthen the shoulder musclesx Adjust the exercise band to get the right resistancex Do this 10-15 times rest and repeat 3-4 times daily

Internal rotation

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

PhaseIII

35

Bent arm abduction

x Make a handle by tying a knot on theexercise band

x Tie the exercise band to a door handlex Hold the handle with the affected armx Stand with your good shoulder

towards the door handlex Arm at 90 degreesx Bringing arm straight out to the side,

maintaining the 90 degree angle of theelbow

x Adjust the exercise band to get theright resistance

x Do this 10-15 times rest and repeat 3-4 times daily

Bent arm extension

x Make a handle by tying a knot on theexercise band

x Tie the exercise band to a door handlex Stand facing the point where you fixed the

exercise band, holding the handlex Arm slightly bentx Keeping the bent arm at the same angle,

pull straight backx Adjust the exercise band to get the right

resistancex Do this 10-15 times, at a slow even pace,

rest and repeat 3-4 times daily

PhaseIII

36

The pull across

This exercise is great for strengthening up the back of the shoulders and improving the range ofmotion, strengthening major shoulder movements:

x Make a handle by tying a knot on the exercise bandx Put the affected arm in the handlex Hold the other end of the band with a straight arm, holding with opposite armx Stand in a straight posturex Pull the affected arm diagonally across and up with a straight arm as far as you are ablex Adjust the exercise band to get the right resistancex Do this 10-15 times, at a slow even pace, rest and repeat 3-4 times daily

Straight arm extensions

This is another great exercise for strengthening the back of the shoulder. This is a progression fromthe bent arm extensions in phase II. Make sure that you are able to perform that bent arm exercisefirst before attempting this exercise. This is how to do it:

x Make a handle by tying a knot on the exercise bandx Tie the exercise band to a door handlex Stand facing the point where you fixed the exercise band,

holding the handlex Arm straightx Keeping the arm straight pull straight backwardsx Adjust the exercise band to get the right resistancex Do this 10-15 times, at a slow even pace, rest and repeat 3-4

times daily

PhaseIII

37

Straight arm abduction

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

Stretch band behind back

This exercise works on complex movements; it is similar to the towel in phase I. But because youare using a stretch band you are not only improving the mobility you are working the muscles of theshoulder too. This is how to do the exercise:

x Make a handle by tying a knot on the exercise bandx Hold the handle with the affected armx Put the arm bent over your shoulderx Hold the opposite end of the stretch band with the other hand, behind your back by your

buttockx Straighten the affected arm, thus creating stretch in the bandx Adjust the exercise band to get the right resistancex Do this 10-15 times rest and repeat 3-4 times

PhaseIII

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.

38

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 exercisestretches the front of the shoulder and is therefore well suited for an anteriortype of frozen shoulder, but it may also benefit the posterior and lateral

presentations too. This is how you do it:

x Stand upright in a good posture, legs shoulder widths apartx Bring the affected arm up behind your back (or onto your hip) as far as possiblex Make sure you dont start leaning forward to get the arm further up the back as the exercise

then will be less effectivex Then bring your other arm up from the opposite side, holding onto the hand of the affected

arm.x Using the good arm, bring the hand further up your back, thus creating a stretch in the front

of the shoulderx Hold this position for 30 seconds then rest and repeat 2 3 timesx Start gently; the exercise should stretch the shoulder it should not hurt

The Prince-Charles

Phase

III

39

Fit ball exercises

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

The airplane

x Lye onto your front on the ball, toes touching the floorx Keep the spine in neutral, this means you have to tense your lower back. If this is

uncomfortable or painful in the low back, then try this exercise standingx Keep arms 45 degrees from your bodyx Turn your hands so they are facing the floorx Squeeze your shoulder blades togetherx Maintain posture for 15-20 secondsx Rest and repeat 3-4 times

Phase

III

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Strengthen back of shoulder

Now it is time to start looking after the weak muscles around your shouldergirdle; weakened by the lack of use due to the immobility of your frozenshoulder. This exercise strengthens the back of the shoulder and improvesmobility:

x Lye with your back on to the ball, the ball between the shoulder blades, head supported bythe ball, squeeze the buttock muscles to keep the spine in a neutral position

x Hold a light weight (initially 1-2 kilos) with straight arms over your face; holding the weightwith both hands.

x Bring the arms down above your head until you feel a stretch in the front of your shoulder,keeping the arms straight

x Then bring the arms up againx Perform at a nice steady pace 10-12 timesx Rest and repeat 3-4 times

Strengthen the back of the shoulder

Phase

III

Start off using light weights, you can increasethe weight when you get more confident withthe exercise

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Stretching the Front of Shoulder

x Lye with your back on to the ball, the ball between the shoulder blades, head supported bythe ball, squeeze the buttock muscles to keep the spine in a neutral position

x Bring the arm of the affected shoulder diagonally out from the body until you feel a stretch inthe front of the shoulder

x Maintain that stretch; try to relax into the stretch. A good way to achieve this is to use thebreathing rhythm to stretch the arm further

x Maintain the stretch for up to a minutex Rest and repeat 2-3 timesx This should stretch not hurt! Start gently and increase the stretch slowly

Strengthening front of shoulder

x Lye with your back on the ball, the ball. Ball between the shoulderblades, head supported by the ball, squeeze the buttock muscles to keepthe spine in a neutral position

x Hold a light weight in the affected arm (initially 1-2 kilos)x Hold the weight with a straight arm above your face, the other arm resting on the chestx Bring the arm diagonally out from the body until you feel a stretch in the front of the shoulder

and chest, keeping the arm straightx Then bring the arms up againx Perform in a nice steady pace 10-12 timesx Rest and repeat 3-4 times

PhaseIII

NB/ It may be difficult to balance on the ball when doing this exercise so be careful and do notattempt it if you feel insecure. Balance exercises are good because they help strengthen yourcore abdominal muscles and thereby improve your posture. If you are unable to performthe exercise use a weight in the other hand. This makes balancing on the ball much easier.

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Daily Exercise ProgrammePhase I

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

Chapter

43

Capsule Stretching 5min

Shoulder Shrugging 4 min

Neck Stretching 4min

Shoulder rotation 5 min

The Elephant 2 to 3 min

Pushing the arm 3 to 4 min

Follow with some rest and ice (if required)

Phase I stretch 3 times daily!

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Daily Exercise ProgrammePhase II

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

Try to stretch twice a day for 20 30 minutes.

Chapter

45

Capsule stretching with weight up to 5 min

The towel 5 min

Stretch the back of the shoulder 3 min

The elephant 3 min

The Prince-Charles 4 minEnd of Phase II into phase III

Crawl the wall (parts 1 & 2) 4 min each

Fit ball 5 min

Arms over head 5min

Stretching Phase II

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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 regainingthe mobility as quickly as possible and getting those muscles working that havent been moving fora long time. This is where the stretch band and fit ball come into their own! They are very easy touse and you can do all these exercises in your own home. Here, we are aiming to get the movementback and thus increase the joint lubrication by stimulating the production of more synovial fluid.

Chapter

47

Front of Shoulder 5 min

The airplane 4 min

Fit ball 5 min

Arms over head 5 min

Stretching Phase III

48

Bent arm extension

The Prince Charles

The pullacross

Bent armabduction

Straight armabduction

Strengthening Phase III

49

And finally

Best of luck

Simeon & Jonas

Thank you all so much for purchasing thisprogramme. With your self help book (or VCD),exercise programme and DVD to reinforce it, youcan start the process of getting better. I am veryexcited to be sharing my success with you all. Asthis technique is still new, you may find it difficult tofind a properly trained practitioner. For moreinformation on a practitioner near you visitwww.frozenshoulder.com. If this programme worksfor you, please tell your friends or therapists about it.We have developed training modules and seminarsin the Niel-Asher Technique.

For maximum benefit you may wish to see aqualified Niel-Asher Technique practitioner.Information on practitioners is regularly updated onour website. Please check that your therapist islicensed and has a valid Niel-Asher Techniquecertificate.

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About the Authors

Simeon Niel-Asher

BPhil BSc (Ost)

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

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 lecturesin Sweden, New Zealand and England. Jonas works at the London frozen shoulder clinicand is a qualified Niel-Asher Technique practitioner.

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