Frozen shoulder - the double burden

Frozen shoulder is something that I come across often in my practice. In my initial training as a massage therapist we were taught it was an unexplainable condition that came on suddenly, mostly in women of middle years and would last 1 - 2 years and disappear as suddenly. This intrigued me. How could a condition just disappear?

It is characterised by an inability to move the arm out from the body more than a few inches before intense pain is felt. usually when it first comes on it is noticed in the act of difficulty moving behind the body (as in doing up the bra in women). As it progresses movement will become increasingly limited and painful. What lies behind this symptomology? Is it a trapped nerve, or fascia - and if so how does it spontaneously resolve? What can a physical therapist do to help alleviate? These are some of the questions that have been troubling me.

In my subsequent study and practice of mindbody medicine, there appears to be a more logical explanation. If any of you have come across the work of Peter Levine, author of 'Waking the Tiger' (1) you will know that the mind and body work to keep the organism safe in times of danger or trauma. But, unlike the rest of the animal kingdom, we often do not discharge this energy after a brush with danger. The instinct to shake is often suppressed as we are told to 'pull ourselves together' or have a stiff drink. But in fact this normal body movement is necessary to remove the energy of the stress response from out of the muscles and if we don't do it, or can't do it we can get 'stuck' in an unresolved mobilisation to stress.

Now it is a fact that muscles move in concert with one another. Any movement needs the controlled response of two sets of muscles- the agonist and the antagonist. It is also true that emotions play a part in mobilising this response. Say for instance you are involved in a car crash and you go to move your hands up to protect yourself but they are held by the seatbelt. your instinct is thwarted. your life or the threat of injury has undoubtedly been saved but there may be a lingering response in your brain which is not discharged. It appears that this may be what lies behind such conditions as frozen shoulder. As Peter Levine himself states "the motor expression of two intense instinctual responses creates a conflict and results in frozen states... the energy bound in inhibited (thwarted) responses  is so powerful that it can cause an extreme bracing that often has profound effects" (2, P196).

But it's not only extreme trauma like accidents or shell-shock under war conditions that create stress in the body. I have already written extensively about 'everyday trauma' of common events like poor parenting, bullying, surgery, etc in my recent book (3). These stimulate our stress responses too. And it may be that when this is not cleared from the mind body of the person that conditions like frozen shoulder, or sciatica represent those undischarged muscular and nervous responses to threat.

What can we do then as therapists - or sufferers ourselves to help discharge and heal? Well, there are many ways but all of them involved becoming more aware of the body and helping to tune in (interoception) to the movements our body is trying to make. With frozen shoulder it is suggested to make the small movement you can make without pain extremely slowly while concentrating on what your body is telling you. with gentle encouragement you are often able to increase the range of movement when you discover what messages are being sent to the muscles which are stimulating both the agonist and the antagonist at the same time to lock the range of motion. Go even slower and do it again. The answers will often come spontaneously as a wave of shaking, crying or sweating relief - the is I sympathetic activation and shows you that your body is releasing. obviously for some people this happens spontaneously within 1 - 2 years. but to be able to do this yourself means you don't have to suffer so long.

Peter describes these techniques in much more detail in his books - but for now I leave you with one thought. As an example of how this ant/agonistic muscle stimulation happens - people who jump from burning building often break their legs before they hit the ground (or the net) due to the simultaneous in tense contraction of the leg muscles putting intolerable strain on the leg ,bones!  (2, p198). Food for thought how smaller but perhaps more chronic stresses, especially in a helpless situation may change the brain to lock the body in a protective response cycle. This, I believe explains frozen shoulder than any other explanation I know of. And it may explain too, why women suffer far more from this than men. helplessness is a state characterised by childhood but also by some women (and men of course) in their adult lives. A bullying boss, husband or just the intense suffering caused by living in a world that does not support or encourage you can be enough. Food for thought indeed.

Copyright Patrica Worby 2016. www.patriciaworby.co.uk and www.alchemytherapies.co.uk

1. Levine, Peter (1997). Waking the Tiger. North Atlantic Books.

1. Levine, Peter (2010). In an Unspoken Voice; How the Body releases Trauma and Restores Goodness. North Atlantic Books

1. Worby, Patricia (2015). The Scar that Won't Heal; Stress, Trauma and Emotion in Chronic Disease. CreateSpace.

Fibromyalgia - a mindbody phenomenon

I read a really good update on Fibro today by an experienced bodyworker (fascial work is his thing). Find it here. The criteria for diagnosis may have changed (which is a good thing as it used to pretty much ignore the gut and other symptoms to focus exclusively on the trigger point pain pattern. This would exclude some people for whom the condition hasn't fully expressed itself yet.

My understanding of Fibro is elucidated in my book The Scar that Won't heal - I think it's a mindbody phenomenon brought on my stress, nutrient depletion and hormonal dys-regulation that ultimately affects the mitochondria so they can't produce enough energy. In that is shares much in common with chronic fatigue. But in fibro the body expresses this as poor muscle and connective tissue function so that pain and tightness dominate other symptoms. Lactic acid formed from anaerobic respiration in the tissues causes pain and then the nervous system becomes sensitised to pain so that even non-painful stimulus becomes painful. This brain pain is called central amplification and is a theory proposed by Prof Daniel Clauw which I support. There have been other interesting theories like problem with the small blood vessels of the hand which fail to divert blood to the periphery (hands and feet) properly and another about problems with the heart (POTS). All of these I think are secondary to the stress response (from trauma).

Why is fascia involved? Well fascia is the bodystocking that transmits force throughout the body and it reads subconscious processes in the limbic system, which , if they are activated in a stress response, causes everything to go tight and restricted. It's a fascinating mind-body link which few people outside the body work profession are looking at. In my holistic practice, I use both bodywork and emotional release to help resolve these subconscious tensions. We are not saying everyone can recover completely only that there is much relief to be had and some people DO recover. It is my believe it is possible for everyone but you have to approach the hidden emotional part of your brain and not everyone is willing and not all practitioners are able. We need a new model of the mind and body as interlinked in order to tackle these new phenomena.

Medical contributions to psycho-genic pain

Further to my first blog on reading The Hidden Psychology of Pain by Dr James Alexander, I thought I'd add some more thoughts. I thoroughly agree with his contention that the medical establishment contributes in no small part to the perpetuation of the notion that pain can only have a physical cause. The idea that emotions can cause pain is dismissed in the main, especially since both physician and patient make the mistake of thinking that this means the pain is 'all in the mind' and therefore not real!. Psychogenic pain is completely real - it has a physical manifestation - which can be due to lack of oxygen supply to the tissues or over-contraction (spasm) but the over-riding cause is an emotional memory which has not been released and continues to replay the motor action that was in place at the time that the encoding traumatic event first occurred. So, in simple language the body holds the trauma in memory and, as this is never discharged, chronic pain ensues.. This may take the form of back pain, shoulder pain or in very severe cases, fibromyalgia and other chronic fatigue-related syndromes. There is usually complex childhood trauma at the heart of these syndromes.

The brain is able to create physical symptoms via the combination of limbic system (deep brain) which triggers the Hypothalamus, Pituitary, Adrenal (HPA) axis mediated by the autonomic nervous system; the body is flooded with stress chemicals (mostly cortisol from the adrenal glands) and the stress cycle begins. Cortisol will cause most of the symptoms seen, especially if it is released continuously.

Unfortunately, when a person is misdiagnosed with a physical cause of this (via increasingly sophisticated technological scans which reveal 'pathology' of the various tissues), the belief that there is indeed something physically 'wrong' is corroborated. What you are not told is that many people who are not in pain have the same 'pathology', but since they do not consult their doctors, this is rarely appreciated. However, there are many reliable studies that have confirmed this, it just does not fit the current model. If the pain was caused by the structural abnormalities then why doesn't everyone who has these abnormalities have pain? It just doesn't make sense.

With some chronic pain/fatigue syndromes like CFS/ME the symptoms are so varied that it is hard to see how they relate at all. They can range from cognitive disorders, digestive issues, cold hands and feet, postural hyptension (low blood pressure when standing up), etc, etc. The brain lies at the heart of all of these symptoms via, as we have said, the HPA axis and excess cortisol but for someone suffering it is hard to believe this.

I recently had  a client tell me that she has finally got a diagnosis of Menieres disease, a disorder of the inner ear that affects hearing and balance. It causes sudden attacks of vertigo (a spinning sensation), tinnitus (a loud ringing in the ears), and a temporary loss of hearing. She seemed relieved that at last there is an explanation for the very disabling symptoms she has been experiencing. However, I am not convinced that this 'disease' is not simply another manifestation of the autonomic nervous system imbalance. Sadly, it is hard to contradict the medical view as it is so supported in our culture, and, for someone in pain, they need to have an explanation or they fear that people will think they are making it up or 'swinging the lead' as it used to be called. Being told by a doctor that you have 'x disease' and then, worse, being told it is bad enough to merit investigation, usually by tests (in this case MRI), further traumatises the patient and ensures the symptoms will continue and usually get worse. For traumatisation to occur requires that the person be helpless. There is nothing like being subject to medical investigation with complex interventions by 'experts' to make a person feel helpless. They are totally disempowered from their bodies, their self-determination and become stuck in the anxiety loop.

Unless they are able to work with a trusted holistic/mindbody practitioner who can demonstrate the real meaning of these symptoms and give them tools to alleviate the stress, the likely prognosis is poor. We have seen people die from these chronic fatigue related diseases, and most live a thoroughly reduced quality of life. It takes a lot of courage to break free of the medical model, with its round of tests and specialists who each corroborate the view that this is lifelong and nothing much can be done. And the social care model, that only pays disability payments to those with defined conditions simply adds to the burden that these people feel. If they then get better does that mean they never had it in the first place?? how will they live while they are recovering but are still not well enough to work? This places such a pressure on people that they are unlikely to step outside the system, especially since this means losing the little certainty they had.

It is a very challenging field in which to work. But I have no doubt medical science and psychology will eventually unite and prove that this psycho-genic model is the correct one. We will in the future be able to understand our emotional fallibility without blame - and have a collaborative healthcare team to work with us to re-write the programme and release us from pain.

Clinical Hypnotherapist at last!

2 weeks ago I graduated in Clinical hypnotherapy, clutching my certificate and thinking 'now what?'. I have focussed on this moment for the last year so if feels odd to suddenly be free to practise but not know how to start. I have a website www.alchemytherapies.co.uk which has my hypnotherapy page. I try to update regularly and there are some free downloads on that website including some explaining hypnotherapy and the particular use I make of it for chronic conditions. as a tool for re-arranging the mindbody link (where certain memories/traumas are encoded in the body) I find it unsurpassed.

I am aiming to  use it to help clients overcome any limitation whether that be physical, emotional or mental. There is so much trauma out there - and most of it not obvious. A lot of disease has its roots in childhood trauma; it may be something obvious like abuse but often it is something more indistinct - an unloving parent, lack of stability, etc. We may think we have 'got over it' because we have made lives for ourselves as adults but in fact there are lingering beliefs and values that trip us up. Feelings of unworthiness for instance, dog us at every step (particularly women I find though it's not exclusive to them). Ultimately we believe that we ought not to give up security to live the life we want - we ought to work harder, strive for the love that's missing in our lives, do more, be more, and so on. This is exhausting and the longer we 'try' the more we focus on not being true to ourselves. This is how we slowly but surely succumb to dis-ease and depression.

It's not easy to become aware of these subconscious beliefs - it's not simply a case of 'deciding' to let go. This is a process and it needs

1. awareness - becoming mindful of what you tell yourself - the negative self-talk e.g  'I'm useless'
2. challenge - here's where we ask the all important question - is that true? 'what at everything?'
3. substitution - CBT therapists like myself use the term 'restructuring'. 'I'm good at other things'

Hypnosis makes this process infinitely more powerful as it talks to a deeper part of you that is holding on to these beliefs by switching off the analytical mind. You can't make these changes by willpower alone. You have to have access to that deeper part of you - and there are many techniques for doing this of which hypnosis, meditation, breath-work and bodywork (massage, Reiki) are some.

My reading and practice makes it clear that no one size fits all in this respect. Some people respond more to touch, others to a mindful exploration. That is why, in the end I have chosen to call myself a 'holistic therapist' and not one or the other. I treat the person not the disease/condition. This means I have to choose from a range of approaches and, working with the client, design a treatment plan. Nutrition is always a part because you can't work on a body that is struggling with toxins and expect it to work optimally. But ultimately, I use intuition and consultation with the client to work together to heal whatever they have come in with. This is true (w)holism. Interestingly the words whole, and heal come from the same root which signifies to me that for true healing we must become whole again. I'll leave with that profound thought...

My theory of mindbody

Coming to the end of my hypnotherapy training now and what an eye opener it has been! I am beginning to see how powerfully we are limited by our beliefs. Not just in our behaviours but in our physical ailments..
Hypnotherapy is widely understood to be powerful in treating habits and unwanted behaviours like smoking and overeating. It also has proven use in treating depression and anxiety (something I am very interested in having suffered myself) but the degree to which it can reverse chronic pain is a new area and one which I am currently developing.

I have long used EFT (Emotional Freedom technique)  in pain control - the tapping sequence appears to stimulate the amygdala or other deep emotional centres of the brain and allows pain that is pychosomatic in origin (that is it results from the body memory of trauma or some other unresolved emotion like grief or anger) to be reduced/released. This requires a degree of positive intention and focus on the part of the person doing it and is best directed by a skilled practitioner as the feelings that come up can be frightening if done on one's own. I recently had a client who told me she was tapping over her labyrinthitis (technical name for inflammation of the ear canal causing dizziness) and started to shake which scared her so much she stopped. When I explained that animals do this to release trauma and it is, in fact a healthy reaction, she was much relieved. (see Peter Levine's book 'Releasing the Tiger' for more details of this).

But the use of hypnotherapy in this medium is still in it's infancy - it has been used in pain control during dental and operative procedures but in terms of pain reduction/removal in chronic conditions like Fibromyalgia and arthritis its use is not widely known. This is something I would like to change. Indeed, I have just written about the subject in my dissertation for my Higher International Diploma in Naturopathy with the School of Natural Health Sciences (http://www.naturalhealthcourses.com/Reading_Room/index.html).
I have titled it 'Treating chronic pain with hypnotherapy and EFT'.

I have found in the course of my studies and working with clients that much of the pain of these so-called physical diseases has its roots in the emotional responses and can be altered with hypnotherapeutic intervention. When you take someone into hypnosis their critical mind (the monkey mind - the analytical, critical voice inside our heads) is quietened and therefore set aside for a while and we can communicate directly by the larger subconscious mind. This allows us to get to the root of where the negative feelings reside (past memories, physical trauma) and allows us to challenge and rewrite the thoughts and feelings.
By using certain techqniques such as consulting the inner coach and perceptual positions (detailed more completely in my download from the hypnotherapy page of my website www.alchemytherapies.co.uk  one can unravel these complex mindbody associations.

This has lead me to develop my theory that most if not all physical disease may have its origins in the subconscious mind. How else to explain the complete remission of cancer in people like Anita Moorjani (see her book 'Dying to be me')? I understand that the subconscious is a metaphor or working model of a complex neurology (there is no true separation of minds in physical terms - it is a process of thinking that differs) and there is much still to learn in this fascinating field. But I am beginning to find such remarkable results from treating physical disease in this way that I am speculating that there is nothing that cannot be cured if you have the right tools to do so. The mindbody interaction may be the key to this process.