Lucy came to Mike in November of 2012 with a “frozen” right shoulder that severely limited her range of motion and was causing significant pain. Lucy had been injured several months earlier when her arm was yanked backwards by her horse. Over time, she had gradually reduced the range of moving her right arm due to chronic discomfort. She had tried acupuncture treatment for about two and half months. There was some temporary relief of the discomfort after each visit, but the effects were short-lived and had no impact on her range of motion. At her initial visit, she could not raise her arm to the side any higher than the shoulder, and was unable to reach behind her to the lower back, or across her chest to her left side.
Three and a half years earlier, her other shoulder had become “frozen” after falling from a horse and experiencing significant soft tissue damage. She consulted an orthopedic surgeon in April of 2009, who gave her a cortisone shot to the shoulder. The cortisone gave no relief. The doctor also sent her for an MRI. She was diagnosed with adhesive capsulitis (joint tissue restrictions) in the shoulder, and was referred to physical therapy. Lucy attended physical therapy sessions twice a week for nearly 3 months, without any improvement in range of motion or pain. She reported that the physical therapy itself had been painful at times. She returned to the orthopedic surgeon who then recommended “manipulation under anesthesia” to break loose adhesions in the shoulder. Lucy underwent this procedure on July 20, and returned to physical therapy from July 21 to August 27 to prevent the shoulder from “freezing” up again. Her range of motion in the injured shoulder was eventually restored, but this treatment approach was lengthy, painful, and expensive.
When Lucy consulted The Caruso Method for the new injury, she said she did not want to go through what she had with her other shoulder. In addition to hearing her concerns, we performed a functional movement assessment and determined that her external rotation was severely limited (a seminal finding of adhesive capsulitis). Based on her values and concerns, we chose a different approach to her care. Rather than “treatment” for her shoulder, she agreed to a “guided self-care approach.” Absent the usual modalities (heat, electrical stimulation, massage) and manipulation, this approach incorporated Lucy’s goals and values. She was reassured and directed to focus on the key movement deficits in a specific order, using serial static stretching with a pacing guide so she could control her pain without the use of dependency-forming medication. She performed this entire rehab at home by following the guidance instructions Mike provided.
The approach, which consisted primarily of stretching exercises, caused no discomfort and Lucy was compliant with the guided home treatment protocol. After 3 months of self-care, Lucy regained full range of motion and function of her shoulder and was pain free.
Lucy’s story is an example of how a “guided self-care approach” with a keen focus on the key elements of shoulder functional movement and pain self-management can be effective, cost efficient, and congruent with patient goals and values – restoration of function and control of pain – without using dependency-forming medication or procedures.
In this case, Lucy was able to restore autonomy and self-efficacy (the ability to manage one’s own life function and challenges) WITH ONE PROFESSIONAL VISIT.