Rolfing/Structural Integration for Frozen Shoulder

Frozen shoulder, or adhesive capsulitis, is a condition affecting approximately 3% of the population, usually found in people between the ages of 40 and 70. It is characterized by stiffness and pain in the shoulder joint. As the condition worsens, the shoulder's range of motion (ROM) becomes significantly reduced. Although frozen shoulder usually occurs only on one side, approximately one in five people experience it in both shoulders.

Rolfing, also known as Structural Integration, is a system of deep tissue massage developed over fifty years ago by Ida Rolf. It realigns and balances the body so that ones head, shoulders, chest, pelvis, and legs are in a better vertical alignment. It has the ability to dramatically alter ones posture and structure. Through the assistance of Rolfing and self-care efforts, most people with frozen shoulder eventually regain nearly full shoulder ROM and strength as signs and symptoms improve.

How Can Rolfing Help Frozen Shoulder?

Rolfing consists of 10 one-hour sessions, called a Ten Series. Treatments are preferably given weekly, starting from the head and working down to the feet. Each session builds upon the last until the body is totally aligned, front to back, side to side, top to bottom, and inside to outside.

The underlying principle of Rolfing is that injuries, poor movement habits, and chronic muscle tension from stress cause the fascia to stiffen. Fascia is the tough, densely woven connective tissue which spreads continuously throughout the body in a three dimensional web from head to foot. This stiffening in turn prevents one from moving freely and easily. Rolfing is designed to loosen the fascia, resulting in a freedom in muscle movement and unlearning of bad patterns of muscle strain and misuse. This release should then enable the body to properly align itself.

Rolfers incorporate Joint Mobilization Techniques - a range of soft tissue massage techniques that release the motion restrictions that impede whole body organization. Mobilization of the shoulder joint is helpful in treating frozen shoulder. Fascia of the surrounding muscles is targeted for loosening, including muscles that attach at the clavicle, or collar bone: the Pectoralis major, Trapezius, Sternoclaedomastoid, Sternohyoid, and Subclavius. Also addressed would be muscles surrounding the scapula, or shoulder blade: Serratus anterior, Pectoralis minor, Levator scapulai, and the Rhomboideus major and minor. A successful result is the lengthening of the muscles and increased range of motion of the shoulder joint.

Rolfers may also incorporate Rolf Movement Integration, in which the Rolfer helps clients become aware of their inhibiting movement patterns, and then teaches clients how to change these patterns, helping to accelerate the treatment of frozen shoulder. This approach adds a functional aspect to the structural approach of Rolfing.

What Are the Symptoms of Frozen Shoulder?

Typically, frozen shoulder develops in three stages across time, with each stage potentially lasting a number of months.

In the “painful” stage, pain occurs with any movement of the shoulder, resulting in limited range of motion (ROM). Typically the pain worsens at night, especially when lying on the affected shoulder, resulting in the disruption of normal sleep patterns. Additionally, mobility can decrease so much in some cases that performing everyday activities — such as combing ones hair, preparing food, or reaching for a wallet in the back pocket — becomes difficult or even impossible.

Pain may begin to lessen during the second stage, called the “frozen or stiffening” stage, although the shoulder becomes stiffer and the ROM decreases. It is important to avoid extreme movements that cause pain during this stage, although normal use of your shoulder can continue.

The final, or “thawing” stage produces improvement in the range of motion of the shoulder and alleviation of pain. Some have found, however, that pain can temporarily re-appear as stiffness eases.

What Causes Frozen Shoulder?

The exact cause of frozen shoulder is unknown. It can occur due to poor posture, particularly rounded shoulders, or after an injury or prolonged immobilization of ones shoulder, such as after surgery or an arm fracture. Frozen shoulder is believed to have an autoimmune component because people with diabetes (particularly insulin-dependent) have a greater risk of developing the condition. The theory is that the immune system of those with frozen shoulder syndrome can begin to attack the shoulder capsule and its connective tissue, with glucose molecules attaching to the collagen fibers in the joint capsule, causing stiffness.

Frozen shoulder impacts the Glenohumeral Joint, one of the three main joints in the shoulder capsule. This ball-and-socket joint forms where the round end of the upper arm bone (humerus) fits into a shallow groove on the shoulder blade (scapula), much like a golf ball rests on a tee. Tough connective tissue, called the shoulder capsule, surrounds the joint.

When frozen shoulder occurs, the shoulder capsule becomes inflamed and begins to “stick” due to the formation of scar tissue. The inflammation may cause bands of tissue, called adhesions, to develop between the joint's surfaces. Synovial fluid, which helps to keep our joints lubricated and moving smoothly, may decrease. As a result, pain and subsequent loss of shoulder movement occurs.

Is Rolfing Safe?

Rolfing is generally believed to be safe for most individuals. However, Rolfing should not be used as the only therapeutic approach to disease, and should not delay speaking with a health care practitioner about a potentially severe condition.

Because structural integration involves deep manipulation of tissues, some people should avoid this technique, including pregnant women and people with broken bones, individuals with severe osteoporosis, disease of the spine or vertebral disks, skin damage or wounds, bleeding disorders, varicose veins, or blood clots in areas being manipulated. Additionally, those taking blood thinner medications such as warfarin (Coumadin) should also avoid Rolfing, as well as other deep tissue massage techniques.

Patients with certain diseases (such as Hodgkin's disease, leukemia, or any form of cancer) or diabetes should seek medical advice before undergoing Rolfing® structural integration. The same is true for those with joint diseases such as rheumatoid arthritis, ankylosing spondylitis or aortic aneurisms.

People who have had procedures or diseases affecting the abdomen, kidneys, liver, or intestines should speak with their health care provider before starting. Women who are menstruating and people with connective tissue disorders such as osteomyelitis, lupus, or scleroderma should use Rolfing cautiously.

Finally, some certified Rolfing practitioners discourage structural integration services in people with psychosis or bipolar disorder and suggest that therapy may cause the release of suppressed memories of severe emotional anguish. However, there is no known scientific basis for these precautions.

Additional Resources

InteliHealth article on Rolfing.
MayoClinic article on Frozen Shoulder.