Ep 268 – Frozen Shoulder with Diane Matkowski: “I Have a Client Who . . .” Pathology Conversations with Ruth Werner

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0:01:41.9 RW: Hi, and welcome to I Have A Client Who pathology conversations with Ruth Werner, the podcast where I will discuss your real life stories about clients with conditions that are perplexing or confusing. I'm Ruth Werner, author of A Massage Therapist's Guide to Pathology, and I have spent decades studying, writing about and teaching about where massage therapy intersects with diseases and conditions that might limit our client's health. We almost always have something good to offer even with our most challenged clients, but we need to figure out a way to do that safely, effectively and within our scope of practice. And sometimes, as we have all learned, that is harder than it looks.

0:02:28.6 RW: Hey, I Have A Client Who listeners, this week's episode is really special. My friend, Diane Matkowski from Massage Mentor Institute came for a visit. So we took the opportunity to do an in-person I Have A Client Who podcast, and for that reason, it's going to sound a little different because we were recording in a different kind of space and there's some background noise, and you can tell that I'm just not sitting here at my usual mic, and I hope that's not too distracting. In this podcast, Diane describes a reluctant client who really didn't wanna be there and who had a condition that was a bit intimidating: Frozen shoulder.

0:03:07.5 RW: With patience and good touch and great sensitivity, the situation was resolved and the client became an enthusiastic promoter of Diane's business. Now, we've already done an episode on frozen shoulder, but for the sake of new listeners and people like me who forgot that we've done this already, here's a quick overview of this frustrating and often mysterious condition taken from that earlier podcast.

0:03:33.8 RW: In that, I said, so let's talk a little bit about frozen shoulder, which is also called adhesive capsulitis. This is a condition that's pretty common. It affects mostly women and mostly people between 45 and 65 years old. About 2% of the adult population in this country develops frozen shoulder at some point. And while it's usually just on one side, some unlucky people may develop it on the opposite side as well. What makes this happen? Good question. Next question? No, truly, we actually don't know why some shoulders go through this process.

0:04:11.8 RW: Sometimes, there's a recent shoulder injury that might precipitate the whole thing, but often it appears to be completely spontaneous. What we have observed is that the capsular ligament at the shoulder joint becomes inflamed, that's capsulitis. We think that activated fibroblasts and myofibroblasts cause that capsule to thicken and stick to the anterior side of the ball of the humerus. Some people develop connective tissue bands that link the head of the humerus to the front portion of the joint capsule. What we know for sure is that people end up with a smaller joint space and a radically limited range of motion, especially in abduction and external and internal rotation of the shoulder.

0:04:57.7 RW: The research about massage therapy and frozen shoulder is mixed. There's a study that showed a specific kind of friction was helpful for some patients, and there's a study that showed massage was specifically unhelpful. Interestingly, we see similar kinds of inconsistent findings with other interventions for frozen shoulder, including various types of physical therapy, medications and surgery. The upshot is that healthcare providers are encouraged to find ways to help patients with this problem get through a long, frustrating, painful process, with appropriate analgesics as necessary and to individualize treatments because no single approach seems to work for a majority of patients. And now, let's hear Diane tell her I Have A Client Who story, and in our show notes for today, you'll find out more about Diane Matkowski and how to connect with the Massage Mentor Institute.

0:05:57.2 RW: This week on I Have A Client Who, I have a very special episode to bring you, so Diane, you have one that we just barely began to talk about, and I said, "Stop, stop, stop, because this is exactly what I want." So, tell me your I Have A Client Who story.

0:06:11.9 Diane Matkowski: Well, we were... When you said, "Tell me a little something. Tell me a story. Do you have a story?" And I was sitting here thinking about this client that I had years ago, and she was diagnosed with a frozen shoulder. And I hadn't had a ton of cases with that, we're talking several years ago. And when she came in, she was very hesitant. She was almost anti-massage. In fact, she let me know that she didn't wanna be there.

0:06:39.9 RW: [laughter] Don't we love those?

0:06:41.4 DM: She had no desire to have a massage, and that she was really uncomfortable with the whole idea. But her only option besides me was surgery, and she didn't wanna do the surgery. So she said, against every bone in her body, she was there to get a massage from me, which really geared me up for a... I mean, I was thrilled. In some ways, I was, because I did always like a little bit of a challenge. So yes, she was very anti-massage. She came in with a frozen shoulder, as I said. And one of the first things that I noticed was just how she was carrying herself, how she was holding her body, and how...

0:07:22.5 RW: I wanna back you up for just a moment to get a little bit of client background. Alright, how old was she, do you think?

0:07:28.6 DM: I wanna say she's 48, 49...

0:07:31.7 RW: Alright, so in her older 40s.

0:07:32.9 DM: Yeah.

0:07:33.3 RW: So I just wanna say, as a tiny bit of background, that frozen shoulder or adhesive capsulitis is a condition that occurs most frequently in women within that age range. That is the population that has it more than anybody else. And she had it just on one side?

0:07:49.3 DM: Just on one side.

0:07:50.3 RW: And you noticed that she carried herself in a certain kinda way?

0:07:54.6 DM: You could tell that she was visibly annoyed by the frozen, right? Of course.

0:07:58.2 RW: Okay. Oh, by the frozen shoulder or by having to be with you?

0:08:00.9 DM: By the frozen... All of it.

[laughter]

0:08:01.3 DM: I could tell there was just something, that she was carrying the weight of the world, almost, on that shoulder. And I think she seemed very frustrated. So that's what I would say I noticed right away.

0:08:13.6 RW: What did you discover about working with her?

0:08:16.4 DM: Well, one of the things that I always notice about someone that I... I feel like there's more to the matter than what I see, meaning her shoulder was frozen, that was the diagnosis, but there was, I think... It almost felt like there was more to it. So when she laid on the table, I noticed when she was face down, for instance, that her hands were kinda clenched. Just everything about her seemed tense and nervous. And I just thought, I think the first thing for her is to be comfortable. We're not gonna get anywhere, the shoulder's never gonna move until she's comfortable and feels safe. So there was a lot of prep for her feeling safe with me.

0:08:53.8 RW: And was she able or willing to take that in?

0:08:58.5 DM: At first, she wasn't.

0:09:00.1 RW: Yeah, because you'd think... I could see her saying, "I'm here for my shoulder. Why are you touching me in my feet," or whatever.

0:09:02.9 DM: "I'm just here for my shoulder. I don't really... I don't know what you're saying, but I'm not really listening." [chuckle] And then, for me, what I did was I tried to... One of the things that I love about massage is I describe my massage as, when you're on my table, you're so relaxed that you're not sure if you're drooling, alive, what's going on, that... I want my touch to override your thought process and put you in another world. So what I was trying to do was put her somewhere else. So through my touch, I was trying to relax her, get her out of her head a little bit, get her to stop thinking about her shoulder for a minute, before we even went near her shoulder and addressed it in any kind of way.

0:09:41.0 RW: And did that... Was that successful?

0:09:42.9 DM: She was like, "Oh my god, this feels so good!"

[laughter]

0:09:46.5 DM: All of a sudden, and was like, "I didn't know that this would feel so good." Massage feels so good, because I just did some simple strokes, as they say now, and just got her relaxed. Did her scalp, started with her feet, just really tried to wind her down a little bit so we could get to the point where she was calm enough to even have me, like I said, address her shoulder. I find that sometimes, people come in worked up. It just takes a minute. Give them a minute. Give them a minute and help them feel safe.

0:10:16.3 RW: Right, so... It's very interesting hearing you say this, 'cause I know that you don't come at this from a super academic background. The people who are paying attention to what's going on in pain science and stuff will talk about manual therapy as a way to just turn down the volume of all those incoming signals in a way, also to help people experience their bodies in a positive way, where the pain becomes... It might not go away, might not go to zero, but simply becomes less important, because there are more interesting and fun and delightful things to pay attention to. And that's essentially exactly what you did. And then what happened?

0:10:57.0 DM: Well, when she noticed that she actually did like being touched in a noninvasive, professional way that put her out of her mind and into her body, that she might like her body. I really feel like we went there. We went from her coming in, not wanting... Being annoyed by her body, wondering... When our body is doing great, we don't really... You know, we take it for granted. We're like, "Yeah, this is... You're doing what you're supposed to do." When it stops doing what it's supposed to do, all of a sudden, it's an inconvenience. And in those moments, her body went from an inconvenience to a place of great sensation.

0:11:33.6 RW: To a gift.

0:11:34.2 DM: To a gift, to a thing where, "Wow, I didn't know it could feel this good." So I feel like once we got her there, she realized that, "Maybe this massage thing isn't so bad. Maybe this could help me."

0:11:48.6 RW: And did she see some improvement in her shoulder?

0:11:51.6 DM: The first session, I didn't, say, focus on the shoulder a ton, because I... Honestly, I'll be completely vulnerable on this. I was a little hesitant, a little nervous. We're talking several years ago. And I just... I didn't wanna do too much either, I didn't wanna irritate it. So just kind of getting her comfortable, getting her mind to ease down. She noticed enough of a difference that she wanted to come back next week and continue working on it. She noticed it enough that she wanted to keep doing the massage and started asking questions about things that she could do, movements she could do. She kept coming long enough where she never got the surgery that the doctor suggested. And that's a gift. I mean, that's a great case. I mean, sometimes, I guess surgery is necessary, but in her case... And guess who's one of my biggest advocates?

0:12:44.7 RW: Oh, that's wonderful.

0:12:45.9 DM: Yes.

0:12:46.4 RW: The person who didn't want massage.

0:12:47.9 DM: The person who didn't want massage, because what happens is that person can relate to people who don't want massage, and she can share her story about how she was nervous, afraid, and was annoyed by her body. And after she got that touch, she was like, "Wow, I'm really glad I have one." I feel like it turned into a win for everybody 'cause she was empowered. She began to realize that she could be comfortable in her own body. She began to realize that she did enjoy the sensations that touch provided. And then she was able to kind of learn about herself and avoid surgery altogether in this case.

0:13:26.3 RW: What a gift that we bring to our clients to help them relearn themselves as a place that feels good to live in, so... Hey, thank you so much, Diane. When I go back to edit this, I will add a little more background information on adhesive capsulitis, because it's actually a complex topic with a lot of controversy about best practices. Certainly seems like you found the best practice for this client, and I'm sure she's really glad that she found you.

0:13:54.5 DM: And I'm really glad that she did too.

0:13:57.8 RW: There you go. So thanks once again, Diane Matkowski from Massage Mentor Institute, and in our show notes, I will have links to all kinds of things that you do.

0:14:07.2 DM: Woohoo!

0:14:07.8 RW: Woohoo! Thank you.

0:14:08.5 DM: Thank you, Ruth.

0:14:09.8 RW: Hey, everybody, thanks for listening to I Have A Client Who: Pathology Conversations with Ruth Werner. Remember, you can send me your I Have A Client Who stories to ihaveaclientwho@abmp.com. That's, ihaveaclientwho, all one word, all lowercase, @A-B-M-P.com. I can't wait to see what you send me, and I'll see you next time.

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