Adhesive capsulitis, sometimes known as frozen shoulder, is a disorder that causes stiffness, discomfort, and a restricted range of motion in the shoulder. This ailment affects nearly 2% to 5% of the general population and can severely impact daily activities and quality of life. The shoulder is encased in a flexible capsule filled with a small amount of fluid, which, when inflamed, can cause the capsule to thicken and tighten around the joint. This reduces the shoulder’s mobility and results in the painful symptoms commonly associated with frozen shoulder.
While there are several treatments available – ranging from physical therapy to surgical interventions – addressing frozen shoulder often requires a multifaceted strategy. Just as one would use a combination of treatments to address complex medical issues, so too does frozen shoulder benefit from an integrative approach. Adopting a comprehensive treatment strategy allows for a more holistic healing process, tackling both the physical and underlying inflammatory aspects of the condition.
Over the years, nutrition has emerged as a pivotal element in the management and alleviation of various musculoskeletal conditions, and frozen shoulder is no exception. Nutritional interventions can play a significant role in supporting the body’s natural healing processes. A well-balanced diet, rich in specific vitamins and minerals, can potentially reduce inflammation, promote tissue repair, and speed up recovery. While nutrition might not replace conventional treatments, it complements them, offering patients an additional tool in their recovery arsenal. As we delve further into this article, we’ll explore how specific nutrients and dietary patterns can contribute to managing frozen shoulder symptoms and promoting overall joint health.
Understanding Frozen Shoulder: A Brief Recap
Frozen Shoulder and Its Causes
The exact cause of frozen shoulder remains a topic of research, but several factors can contribute to its onset. Often, it may arise after an injury or immobilization of the shoulder, leading to a lack of use and eventual stiffness. Additionally, certain medical conditions like diabetes, thyroid disorders, and even cardiovascular disease can predispose individuals to developing this ailment. The core issue is the inflammation and thickening of the shoulder capsule – a flexible sac filled with lubricating fluid – which results in the restriction of movement.
Recognizing the Symptoms and Their Progression
Frozen shoulder typically evolves in three stages:
1. Freezing (Painful) Stage: This is the initial stage where pain gradually increases, and range of motion starts to decrease. The pain is often more bothersome during the night and can last anywhere from 6 weeks to 9 months.
2. Frozen (Stiffness) Stage: Here, pain might decrease, but the stiffness remains or even worsens. Activities requiring overhead arm movement become notably challenging. This stage can persist for 4 to 6 months.
3. Thawing Stage: Gradually, the shoulder begins to “thaw,” and the range of motion starts to improve. This recuperative phase can take from 6 months to 2 years.
Traditional Treatments and Interventions
Management of frozen shoulder traditionally depends on the stage of the condition and the patient’s individual needs. Common interventions include:
Physical Therapy: Guided exercises and stretches to improve mobility and strength.
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation.
Steroid Injections: Corticosteroids injected into the shoulder joint can provide relief from severe pain and improve range of motion in the early stages.
Joint Distension: Injecting sterile water into the shoulder capsule to stretch it and improve range of motion.
Manipulation Under Anesthesia (MUA): The shoulder joint is manually moved while the patient is under general anesthesia to break up the adhesions and improve mobility.
Surgery: In rare cases, when other treatments don’t provide relief, surgical options might be explored to remove scar tissue and adhesions from inside the shoulder joint.
The Role of Nutrition in Musculoskeletal Health
Nutrition’s Influence on Joint Health, Inflammation, and Tissue Repair
The foods we consume play an instrumental role in the overall health of our musculoskeletal system. Nutrition directly influences the maintenance, repair, and optimal functioning of our joints, muscles, and bones.
Joint Health: Joints are complex structures made of bone, cartilage, ligaments, and synovial fluid. Nutrients like omega-3 fatty acids, found in fish and flaxseed, can help maintain the fluidity of the synovial fluid, reducing joint stiffness. Similarly, vitamin C and manganese are vital for the synthesis of collagen, a key component of cartilage and tendons. For instance, omega-3 fatty acids from fish oil have been shown to reduce symptoms in osteoarthritis patients (1).
Inflammation: Chronic inflammation is often the culprit behind many musculoskeletal disorders, including frozen shoulder. Foods rich in antioxidants, like berries, nuts, and dark leafy greens, combat oxidative stress and reduce inflammation. Simultaneously, avoiding pro-inflammatory foods like refined sugars, trans fats, and excessive red meat can further alleviate inflammation. Certain nutrients, like antioxidants and omega-3s, possess anti-inflammatory properties that mitigate this inflammatory response.
Tissue Repair: After an injury, our body goes into a repair mode. For effective tissue regeneration, it requires an array of nutrients. Protein, for instance, provides the building blocks (amino acids) for tissue repair. Vitamins such as vitamin A, C, and zinc play a pivotal role in wound healing, collagen synthesis, and immune response.
Essential Vitamins and Minerals for Musculoskeletal Health
The musculoskeletal system’s health relies on a plethora of nutrients, each contributing uniquely to its strength and functionality:
Calcium: Predominantly known for its role in bone health, calcium, found in dairy, green leafy vegetables, and fortified foods, is vital for maintaining bone density and preventing disorders like osteoporosis (2).
Vitamin D: Working hand in hand with calcium, vitamin D aids in calcium absorption. The sun, oily fish, and fortified foods are some of the sources. A deficiency can lead to brittle bone conditions (3).
Magnesium: Crucial for muscle function and bone health, magnesium can be sourced from nuts, seeds, whole grains, and leafy greens. It also helps in muscle function.
Omega-3 Fatty Acids: As mentioned, these fatty acids are anti-inflammatory powerhouses, promoting joint health. They are abundantly found in fatty fish, walnuts, and flaxseeds.
Collagen: As the primary protein in connective tissues, collagen supplements and bone broths support joint and tissue health.
Vitamin K: Essential for bone mineralization, it supports bone health by assisting in the binding of calcium in the bones and bone matrix. Green leafy vegetables are rich in vitamin K.
Antioxidants (Vitamins C & E, Selenium, Beta-Carotene): These compounds neutralize free radicals that can damage musculoskeletal tissues. They are found in a variety of foods, with citrus fruits being a prime source of vitamin C and nuts providing selenium and vitamin E.
Read More: Physical Therapy Interventions for Dislocated Shoulder Patients
Specific Nutrients and Their Impact on Our Body
Vitamin C
Role in Collagen Formation and Tissue Repair: Vitamin C is an essential nutrient required for the synthesis of collagen, a key component of connective tissues in our body. Collagen plays a crucial role in maintaining the integrity of our tendons, ligaments, and skin. Moreover, vitamin C promotes the body’s healing processes, helping repair tissues faster after injury.
Recommended Sources and Dosage: Natural sources of vitamin C include citrus fruits (oranges, lemons), strawberries, bell peppers, guava, and broccoli. The recommended daily intake varies based on age, gender, and life stage, but for most adults, it lies between 65-90 mg/day, with an upper limit of 2,000 mg/day.
Omega-3 Fatty Acids
Anti-inflammatory Properties: Omega-3 fatty acids, particularly EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), exhibit potent anti-inflammatory effects, which can reduce joint swelling and pain.
Impact on Joint Mobility and Pain: Regular intake of omega-3s can lead to increased joint lubrication, reducing stiffness and enhancing mobility.
Sources: Good sources of omega-3 fatty acids include fatty seafood like salmon, mackerel, and sardines. Plant-based alternatives include flaxseeds, chia seeds, walnuts, and hemp seeds.
Vitamin D
Importance in Bone Health and Immune Modulation: Vitamin D is fundamental for calcium absorption in the gut, crucial for maintaining bone health. Additionally, it plays a role in immune system modulation, influencing the body’s inflammatory responses.
Connection between Deficiency and Chronic Pain: Several studies have found a link between vitamin D deficiency and chronic musculoskeletal pain. Ensuring adequate levels might reduce pain associated with conditions like frozen shoulder (4).
Magnesium
Muscle Relaxation and Bone Health: Magnesium is involved in various physiological processes, including muscle contraction and relaxation. Adequate magnesium levels can help prevent muscle cramps and stiffness. Additionally, it plays a role in bone formation and ensuring bone density.
Foods Rich in Magnesium and Recommended Intake: Foods abundant in magnesium include almonds, spinach, cashews, black beans, and avocados. The recommended daily intake for adults varies from 310-420 mg, depending on age and gender.
Antioxidants (e.g., Quercetin, Vitamin E)
Role in Reducing Oxidative Stress and Inflammation: Antioxidants neutralize free radicals, which can damage cells and contribute to inflammation. Quercetin, for instance, has shown potential in reducing inflammation and blood pressure. Vitamin E, another antioxidant, protects cells from oxidative damage and supports immune function.
Sources and Benefits: Quercetin can be found in foods like onions, apples, and berries. Vitamin E sources include almonds, sunflower seeds, and spinach. Regular intake can support overall health and potentially reduce the symptoms of inflammatory conditions.
Dietary Patterns Beneficial for Frozen Shoulder
Mediterranean Diet
Overview and Benefits: The Mediterranean Diet is renowned for its focus on whole foods, healthy fats, and an abundance of fruits and vegetables. Originating from the dietary patterns observed in countries bordering the Mediterranean Sea, this diet is known for its health benefits, especially concerning heart health and inflammation. This diet emphasizes fruits, vegetables, whole grains, fish, nuts, and olive oil, all of which have anti-inflammatory properties(5).
Rich in Omega-3s: Fatty fish, a staple of the Mediterranean Diet, provides ample amounts of omega-3 fatty acids which are instrumental in reducing joint inflammation.
Abundant in Antioxidants: Olive oil, nuts, fruits, and vegetables supply an abundance of antioxidants, which help counteract oxidative stress and inflammation.
Anti-inflammatory Foods: Olive oil, a primary fat source in the diet, is rich in polyphenols, which have strong anti-inflammatory effects. Furthermore, the regular consumption of legumes, whole grains, and lean proteins offers a balanced dietary approach that supports overall joint health.
Anti-Inflammatory Diet
Focus on Foods that Reduce Inflammation and Promote Healing: As the name suggests, the Anti-Inflammatory Diet emphasizes foods that naturally curb inflammation in the body, potentially assisting in the management of conditions like frozen shoulder.
Whole Grains: Foods like quinoa, brown rice, and oatmeal are rich in fiber which can help reduce inflammatory markers in the body (6).
Berries and Cherries: These fruits are rich in anthocyanins, which have potent anti-inflammatory effects (6).
Green Tea: Packed with polyphenols, green tea can reduce inflammation and slow cartilage destruction (7).
Turmeric and Ginger: Both are rich in compounds, curcumin for turmeric and gingerol for ginger, that have strong anti-inflammatory properties. Studies have found that they can help reduce pain in osteoarthritis and rheumatoid arthritis patients (8).
Bone Broth and Collagen Supplementation
Potential Benefits for Joint Health and Tissue Repair:
Bone Broth: Traditionally made by simmering bones and connective tissues, bone broth is rich in collagen, gelatin, and other nutrients beneficial for joint health. Regular consumption can provide the amino acids necessary for collagen synthesis, promoting tissue repair and joint flexibility.
Collagen Supplementation: Direct supplementation with collagen peptides has gained popularity for those seeking joint and skin health benefits. Clinical trials have indicated that collagen supplementation can improve skin elasticity and may support joint health, making it a potential supplementary option for those with frozen shoulder. Some studies suggest collagen supplementation can improve symptoms of osteoarthritis and reduce joint pain (9).
Read More: Rehabilitation Techniques for Frozen Shoulder Recovery
Potential Risks and Considerations
Overconsumption or Imbalance of Certain Nutrients
While aiming to integrate beneficial nutrients for frozen shoulder relief, one must exercise caution to avoid overconsumption or an imbalance. For instance:
Calcium and Magnesium: Excessive calcium supplementation can lead to kidney stones and hamper the absorption of other minerals, like magnesium. A balance between calcium and magnesium is essential as they often work in tandem in the body (10).
Vitamin D: Although crucial for bone health, excessive intake of vitamin D, usually from supplements, can lead to vitamin D toxicity, causing hypercalcemia and potential damage to the heart and kidneys (3).
Omega-3 Fatty Acids: Although beneficial in moderate amounts, excessive omega-3s can increase bleeding risk, impact cholesterol levels, and suppress immune function.
Interactions with Medications or Other Treatments
Nutritional supplements and certain foods might interact with prescribed medications or treatments:
Vitamin K: Found in green leafy vegetables, vitamin K can interfere with blood-thinning medications like warfarin (11).
Turmeric: While anti-inflammatory, turmeric can enhance the effects of blood-thinning medications, increasing bleeding risks. It may also interfere with medications for acid reflux and diabetes (12).
Supplements like St. John’s Wort: This supplement can interfere with the efficacy of various medications, including antidepressants, birth control, and anticoagulants (13).
Read More: Is There a Connection Between Frozen Shoulder and Tremors?
Foods We Must Avoid with Frozen Shoulder
The following are foods that are generally considered to be pro-inflammatory and might be worth reducing or avoiding if you’re looking to follow an anti-inflammatory diet:
Sugary Foods and Beverages: Excessive sugar intake can contribute to increased inflammation in the body (14). This includes candies, pastries, sodas, and many processed foods.
Refined Carbohydrates: Similar to sugary foods, refined carbs can elevate blood sugar rapidly, fostering inflammation (15).
Trans Fats: These are found in many processed foods and some margarines. They’re known to promote inflammation.
Processed Meats: Sausages, hot dogs, and other processed meats have been shown to be pro-inflammatory.
Fried Foods: Regularly consuming fried foods can contribute to inflammation.
Excessive Alcohol: Moderation is key. Excessive alcohol intake can lead to inflammatory reactions in the body.
Certain Vegetable Oils: Some oils, like sunflower and safflower oil, can be high in omega-6 fatty acids without a corresponding balance of omega-3s, potentially promoting inflammation when consumed in large amounts (16).
Artificial Additives and Preservatives: Some people may react negatively to certain additives, which can promote inflammation in sensitive individuals.
Importance of Personalized Nutritional Guidance
Nutrition is not a one-size-fits-all approach. Several factors, including age, gender, health status, and activity levels, influence nutritional needs and how one’s body responds to specific foods or supplements.
Consulting a Nutritionist or Dietician: It’s advisable for those considering dietary changes or supplements for frozen shoulder to seek guidance from a registered nutritionist or dietician. They can provide personalized advice, taking into account medical history and current health conditions.
Regular Monitoring: Especially for those taking high doses of supplements, regular blood tests and check-ups can ensure that nutrient levels remain within the optimal range and detect potential complications early.
Conclusion
As we journey through the complexities of our body’s response to injury and inflammation, it’s paramount to be well-informed. There’s no one-size-fits-all solution, and individual responses to treatment can vary. Hence, a personalized approach, tailored to one’s unique needs and circumstances, is crucial.
For anyone seeking to integrate nutritional interventions or make dietary changes, it’s a call to action: Always consult with a healthcare or nutritional professional. Their guidance can ensure that your strategies are not only effective but safe, allowing you to navigate the path to recovery with confidence and clarity.
FAQ’s
1. What is a frozen shoulder?
A: Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain and stiffness in the shoulder joint. It typically progresses in three stages: the freezing stage (where pain increases and range of motion decreases), the frozen stage (where pain might diminish but the stiffness remains), and the thawing stage (where movement begins to improve).
2. Can diet play a role in managing frozen shoulder symptoms?
A: Yes, while diet alone cannot cure frozen shoulder, certain nutritional approaches, especially those emphasizing anti-inflammatory foods, may help alleviate some symptoms and support the overall healing process.
3. Which foods are considered anti-inflammatory and may benefit those with frozen shoulder?
A: Foods such as fatty fish (rich in omega-3s), berries, green tea, turmeric, ginger, and whole grains have anti-inflammatory properties that may help in managing the symptoms.
4. Are there any foods or supplements I should avoid with a frozen shoulder?
A: It’s recommended to limit sugary foods and beverages, refined carbohydrates, processed meats, fried foods, excessive alcohol, certain vegetable oils high in omega-6 fatty acids, and foods with artificial additives and preservatives, as they may exacerbate inflammation.
5. How do Omega-3 fatty acids help in managing frozen shoulder?
A: Omega-3 fatty acids, found in fatty fish like salmon, have anti-inflammatory properties that can help reduce inflammation in the body, potentially offering relief from symptoms of frozen shoulder.
6. What are the potential risks of overconsumption of supplements while trying to manage frozen shoulder symptoms?
A: Overconsumption of certain nutrients like calcium, magnesium, vitamin D, or omega-3 fatty acids can lead to various side effects. It’s essential to maintain a balanced intake and consult with a healthcare professional before starting any supplementation.
7. Can turmeric and ginger supplements help with frozen shoulder pain?
A: Both turmeric and ginger are known for their anti-inflammatory properties. Some studies have shown that they can help reduce pain in conditions like osteoarthritis. They might be beneficial for frozen shoulder, but always consult with a healthcare provider before starting any new supplement.
8. Should I consult with a nutritionist if I have frozen shoulder?
A: Absolutely! A nutritionist or dietician can provide personalized guidance tailored to your needs, ensuring you’re getting the right nutrients to support your recovery while avoiding potential pitfalls.
9. Does consuming sugar impact frozen shoulder?
A: Excessive sugar consumption can promote inflammation, which might exacerbate the symptoms of frozen shoulder. Reducing sugar intake may help in managing the condition better.
10. Are there any dietary patterns particularly beneficial for frozen shoulder?
A: The Mediterranean diet, rich in omega-3s, antioxidants, and other anti-inflammatory foods, is often recommended. Similarly, an anti-inflammatory diet emphasizing whole grains, berries, green tea, and other nutrient-dense foods can also be beneficial.
Reference
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2. Weaver, C.M. and Heaney, R.P. eds., 2007. Calcium in human health. Springer Science & Business Media. https://books.google.com/books?hl=en&lr=&id=il8rmEAZoW8C&oi=fnd&pg=PR13&dq=9.%09Weaver+CM.+Calcium+in+Human+Health.+Nutrition+Today.+2000%3B35(6):244-292.&ots=gk7qqFE1Tz&sig=uJO2jXdXcDVk8GywQTHoATVryzo
3. Holick, M.F., 2007. Vitamin D deficiency. New England journal of medicine, 357(3), pp.266-281. https://www.nejm.org/doi/full/10.1056/nejmra070553
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6. Kelley, D.S., Adkins, Y. and Laugero, K.D., 2018. A review of the health benefits of cherries. Nutrients, 10(3), p.368. https://www.mdpi.com/2072-6643/10/3/368
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8. Daily, J.W., Yang, M. and Park, S., 2016. Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: a systematic review and meta-analysis of randomized clinical trials. Journal of medicinal food, 19(8), pp.717-729. https://www.liebertpub.com/doi/abs/10.1089/jmf.2016.3705
9. Zdzieblik, D., Oesser, S., Baumstark, M.W., Gollhofer, A. and König, D., 2015. Collagen peptide supplementation in combination with resistance training improves body composition and increases muscle strength in elderly sarcopenic men: a randomised controlled trial. British Journal of Nutrition, 114(8), pp.1237-1245. https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/collagen-peptide-supplementation-in-combination-with-resistance-training-improves-body-composition-and-increases-muscle-strength-in-elderly-sarcopenic-men-a-randomised-controlled-trial/9426E375742D094F91029FD0364815C4
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11. Booth, S.L., Centi, A., Smith, S.R. and Gundberg, C., 2013. The role of osteocalcin in human glucose metabolism: marker or mediator?. Nature Reviews Endocrinology, 9(1), pp.43-55. https://www.nature.com/articles/nrendo.2012.201
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13. Izzo, A.A., 2012. Interactions between herbs and conventional drugs: overview of the clinical data. Medical Principles and Practice, 21(5), pp.404-428. https://karger.com/mpp/article-abstract/21/5/404/203103
14. Johnson, R.J., Nakagawa, T., Sanchez-Lozada, L.G., Shafiu, M., Sundaram, S., Le, M., Ishimoto, T., Sautin, Y.Y. and Lanaspa, M.A., 2013. Sugar, uric acid, and the etiology of diabetes and obesity. Diabetes, 62(10), pp.3307-3315. https://diabetesjournals.org/diabetes/article-abstract/62/10/3307/17686
15. Giacco, F. and Brownlee, M., 2010. Oxidative stress and diabetic complications. Circulation research, 107(9), pp.1058-1070. https://www.ahajournals.org/doi/abs/10.1161/CIRCRESAHA.110.223545
16. Simopoulos, A.P., 2008. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Experimental biology and medicine, 233(6), pp.674-688. https://journals.sagepub.com/doi/abs/10.3181/0711-MR-311
Assistant professor, Dhaka College of Physiotherapy
Chief Consultant(Ex): Popular Medical college Hospital, Dhanmondi- 2.
Chairman and Chief Consultant: ASPC Manipulation Therapy Centre, Nurjahan Road, Mohammadpur.
Founder and conceptual inventor: Structural Diagnosis and Management (SDM) concept.
Secretary: Centre for the Rehabilitation of Autism and Person with Disabilities (CARD).
Secretary-General: Bangladesh Physiotherapy Association (BPA).
Phone +88 01712-867364
Email aspc.dhaka@gmail.com
Website https://aspc.com.bd
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