Dr Denis Simons

Frozen Shoulder/Adhesive Capsulitis

What is “Frozen Shoulder”? :


Gradual or sudden painful loss of motion in one or both shoulders
Typical age of onset is 40-70 years of age
Majority of cases self resolve after 1-3 years of moderate to severe pain
Associated with Diabetes and Hypothyroidism
Affects more women than men


“Frozen Shoulder Syndrome ” (FSS) or “Adhesive Capsulitis” is a condition that affects approximately 3% of the population at any given time. People who suffer this debilitating condition experience a painful loss of motion in one or both shoulders (15%) 3.  This may occur after a fall or traumatic event to the head or shoulder, but in many cases occurs spontaneously with no preceding event. This painful loss of motion in most cases lasts from 1 to 3 years. Approximately 60% of those suffering from FSS will achieve full recovery within 4 years, while 30-35% will continue to report mild to moderate pain and reduced range of motion after the same period 1.  Frozen Shoulder affects more women than men, has a higher incidence amongst diabetics and people with hypo-thyroidism, and typically occurs in people between 40 and 70 years of age 3. Those afflicted usually experience moderate to severe pain in the shoulder which may radiate 1/3 of the way down the arm and is accompanied by a sudden or progressive loss of range of motion. In particular, those suffering from FSS will have dramatic reductions in shoulder abduction (the motion as you reach to the side and put your arm overhead) and both internal and external rotation of the upper arm. Abduction is typically limited to 90 degrees (shoulder level), or less1. Regular activities, like pulling on a shirt or reaching into the back seat of a care are typically impossible for sufferers of FSS and there are usually significant disruptions to sleep patterns. As outlined below, the condition has a typical course involving 3 distinct phases. 



Phases Chart


  1. Freezing/Painful Phase:  Painful and coincides with the dramatic loss of range of motion. Significant loss of ADLs and interference with sleep.

  2. Frozen Phase: the pain is no longer constant but can be severe with particular motions. Range of motion remains dramatically reduced.

  3. Thawing Phase:  Range of motion gradually improves and painful motions disappear.



Traditional Treatments for Adhesive Capsulitis:


Western Medicine categorizes and treats this condition as a physical joint problem theorizing the limitation in shoulder range of motion is due to scar tissue (adhesions) building up in the shoulder joint. This is why the condition is called  “Adhesive capsulitis” of the shoulder. Traditional treatments fall into four categories that are sometimes combined.  Patients often progress through these treatments as their condition becomes more chronic and other modalities fail. The types of treatment are: watchful waiting, physiotherapy/manual therapy with NSAID therapy, corticosteroid injections and finally surgical procedures. These traditional treatments can be extremely painful (physiotherapy and manual therapy, surgical recovery), frustrating and may weaken the joint or cause further injuries (corticosteroid shots, surgical procedures) 1 (E Maund, 2012). To add to an “adhesive capsulitis” patient’s dilemma, these treatments have mixed results and often have little or no effect in reducing the duration and severity of the frozen shoulder. The majority of cases self-resolve in a similar time period with or without treatment 3,2.


In other words, after significant expense and enduring much suffering treating this condition, the patient often finds themselves no further ahead. 





Dr. Francis Murphy, a chiropractor from Dallas, Texas has developed a new and innovative treatment technique for this stubborn and clinically frustrating condition. Rather than the traditional Orthopedic, or physical joint model of Frozen Shoulder, Dr. Murphy postulated and developed a specific alternative treatment based on a Neurological Model for the cause of Frozen Shoulder. He named the technique OTZ, which stands for One To Zero and reflects the on/off nature of neurons. Using the OTZ model, approach and procedure many FSS patients are getting significant, effective and often immediate relief from both the pain and the reduced range of motion that these frustrated patients typically endure. 


Effective where other treatments fail VS Doing nothing at all is as effective*   
Quick, often dramatic improvement in minutes VS Individual treatments produce minimal results  
Complete resolution in 1-6 months VS 1-3 Years or in many cases indefinite  
Often painless VS enduring extremely painful therapy  
Drug Free, non invasive VS varying degrees of both**  

*manual treatment, NSAID treatment

** except physio/manual therapy without painkillers and anti-inflammatories. 



The Big Picture. How does the OTZ approach work? :  


If the following description doesn’t have enough technical detail to satisfy you, please click HERE for a description of OTZ more suitable for people trained as Health Care Practitioners.


Abnormal position and motion of the bones in the upper neck can affect the function of certain important neurological structures. Among these neurological structures is the Spinal Accessory Nerve. This nerve is vital to coordinate efficient and healthy motion of the shoulder. Specifically, without proper function of this important nerve the shoulder cannot be raised above 90 degrees in abduction or be significantly internally or externally rotated. If the joints at the top of the neck become stuck and misaligned from acute injury (even years later), or due to chronic postural changes, the function of this and other neurological structures can be compromised. The combination of this reduced neurological function and postural degeneration lead to the changes that cause the inflammation, damage and reduced range of motion typical of FSS. The OTZ upper cervical adjustment acts to restore biomechanical function in the upper cervical spine and significantly reduce interference with the transmission of nerve impulses along these vital pathways. By correcting this specific dysfunction, the vital link between the brain and the muscles that coordinate shoulder function is restored. Range of motion and pain levels are often dramatically and immediately improved. Patients will usually have to undergo postural rehabilitation in conjunction with the specific OTZ adjusting protocols to acheive complete recovery.


Click HERE to see a YouTube video animation of this condition.



The OTZ adjustment, can anybody do it?


The adjustment for the specific dysfunction in the upper neck that leads to Frozen Shoulder Syndrome is a very specific and precise procedure. It should only be performed by a licenced chiropractor. Your chiropractor or Youtube may make it look easy, but please don’t attempt this at home. The structures in this area of the upper neck are very sensitive and important. As such, proper training is absolutely necessary.


If you or someone you know is potentially suffering from FSS, contact Dr. Denis Simons to arrange a consultation and determine if you/they are a good candidate for the OTZ procedure. 


1  E Maund, D. C. (2012). Management of frozen shoulder: a systematic review and cost effectiveness analysis. Health Technology Assessment.

2  Filip Struyf, M. M. (Dec 2013). Current evidence on physical therapy in patients with adhesive capsulitis: what are we missing? Clinical Rheumatology.

3  LORI B. SIEGEL, M. N. (1999). Adhesive Capsulitis: A Sticky Issue. American Family Physicia