Fascia Disorders – Frozen Shoulder

Once you have ruled out any pathology such as diffuse synovitis and capsulitis, the cause could be fascial.

Although there is some evidence that suggests frozen shoulder is a result of a metabolic change or assault on the body.

Why would that cause a restriction, particularly in the shoulder and not the rest of the body?

Any physiological change in the body affects the fascia. Lack of water makes the fascia ridged and more painful to work with. At the early age of 6, we go from running around to sitting all day, and it creates changes in the fascia. Also, every cold, flu, and other viruses can settle in tissue and ganglia.

According to the study

“The roles of Tenascin C and Fibronectin 1 in adhesive capsulitis: a pilot gene expression study Carina Cohen, Mariana Ferreira Lea

There is a genetic predisposition to frozen shoulder.

“Adhesive capsulitis, or frozen shoulder, is a debilitating condition in which patients present limited active and passive glenohumeral motion. Adhesive capsulitis occurs in 3%-5% of the general population, and the primary cause of the painful restriction of movement is inflammatory contracture of the joint capsule.

The initial inflammation seems to lead to capsular fibrosis, stiffness and pain, therefore, it has been hypothesized that similarities exist between adhesive capsulitis and the fibrous contractures that occur in Dupuytren disease.

However, the molecular mechanism responsible for the underlying glenohumeral capsule inflammation and fibrosis is poorly understood.

Rodeo et al. suggested that cytokines, such as transforming growth factor beta (TGFβ), might be involved in the inflammatory and fibrotic processes that occur in adhesive capsulitis. These cytokines may cause abnormal regulation of collagen expression and augment fibroblast proliferation. Therefore, TGFβ acts as a persistent stimulus that leads to capsular fibrosis.”


Inflammation, trauma, and direct impact cause thickening in the fascia, a laying down of more fascia fibers. This in turn restricts movement, changes form, restricts vessels, and can put pressure on a single nerve.

How do you release nerves, release the fascia, muscle, and system that is either inflamed or pressing up against that structure?


Frozen Shoulder: 3 Stages


  1. Freezes – is caused by pathophysiological changes that point to localized hypoxia with connective tissue shortening and cross-linking of fascia fibers. It is commonly induced by direct trauma, chronic, or acute pain, decreased blood flow, restricted motion, decreased sensation, and compression of nerves and vascular tissues.


  1. Once the pain is present, a fear develops so the individual does not want to experience the pain, so the person stops moving, creating more tightness, decreased the range of motion, causing a protective posture, an endless cycle of pain.


  1. Deficiency in Tenascin-x showed reduced muscular myofascial force transmission.


Two Types of Frozen Shoulder

  1. Primary – defined by Kazuya Tamai – is a painful contracture of the glenohumeral joint that arises spontaneously without an obvious preceding event. Investigation of the intra-articular and periarticular pathology would contribute to the treatment
  2. Secondary – is a result of trauma, rotator cuff disease, and impingement, cardiovascular disease; hemiparesis; or diabetes (could be classified as primary)

Stage 1 – a decreased range of motion any movement and intense pain

Stage 2 – frozen stage – less pain as movement stops, lateral rotation and limited abduction.

Stage 3 – thawing – restriction is released


Can last several months to years depending on the treatment protocol.

Did you know that is more common in women between 40 and 70 years old?

Frozen should also occurs more commonly with people who have diabetes mellitus, up to 36 percent. Stroke could also be a cause, Parkinson’s, cancer or an individual with hypothyroidism; autoimmune modulating hormonal changes can also contribute.

Treatments to Reduce the Thickening Include

  1. PRP
  2. Fascia stripping
  3. Myofascial stretching
  4. ROM during lymphatic therapy
  5. Cranial sacral therapy during movement
  6. Surgery in extreme cases

Relaxing the spasm and taut bands so the brain and the body can start moving again.

For more information and treatment protocols, please email info@simonefortier.com