Introduction:
Adhesive capsulitis (also known as frozen shoulder) is characterized by pain and restricted range of motion at the shoulder joint. The cause is often unknown and can take longer than a year to resolve. Treatment usually involves physical therapy and anti-inflammatory medication, often cortisone injections are prescribed.1
Dr Vodder’s Manual Lymph Drainage (MLD) uses gentle, repetitive skin movements to bring about change in the connective tissue. MLD stimulates the meissner’s corpuscles (mechanoreceptors that are sensitive to light touch) and may facilitate a reduction in pain by interrupting the pain signals being sent to the brain as described by the Gate Control Theory.3
The Vodder techniques use very precise hand movements to create a two-way stretch of the skin. This two-way stretch opens the initial lymph vessels which then draws the lymph obligatory load* out of the tissues and into the lymphatic system. Inflammatory chemicals, such as histamines, being taken up by the lymphatic system leads to a reduction in inflammation.
The shearing forces and repetition of the Vodder techniques also add energy to, and affect the viscosity of, the ground substance due to it’s thixotropic properties. The addition of energy causes the ground substance to change from a gel-like to a more fluid state. This allows freer movement of fluid which aids in reducing congestion in the tissues.4
*The lymph obligatory load (LOL) is everything that must be removed from the interstitium by the lymphatic system and includes water, proteins, cells, lipids, dust, dyes, pathogens and cellular debris.2
Case Presentation and History:
A female client, 77 years old presented for the treatment of pain and restricted movement of her left shoulder.
The client reported restricted range of motion and pain of her left shoulder. She was experiencing constant pain, described as an ache, in her anterior upper arm which increased in intensity to severe when attempting to reach above her head or behind her back. She described the pain as having an intensity of up to 8 out of ten.
The client, who was left handed, had been undertaking home renovations involving scraping paint, particularly using an upward motion, and suspected overuse to be the cause of her injury. She began to develop shoulder pain two months prior to our appointment which had been increasing in intensity and did not resolve with rest.
Topical application of anti-inflammatory gel provided some relief. She had not sought any other treatment.
The client was physically active and attended gym 2 x per week. She had a history of breast cancer and underwent two separate surgeries for partial mastectomy of her left breast in 2018. No lymph nodes were removed and no radiotherapy.
Post recovery from the surgeries she experienced pain and restriction in her left shoulder and was referred for cortisone injections by her doctor. She received 2 x cortisone injections and shoulder pain was resolved to her satisfaction. Otherwise, she reported that she was physically fit and in good health.
Examination revealed reduced range of motion of the shoulder joint in abduction, internal and external rotation due to pain experienced with these movements. See photo 1.
I discussed the treatment with her and she agreed to undergo a course of treatment with the aim to reduce pain and increase range of motion.
Management and Outcome:
Treatment adhered to fundamental MLD treatment principles of starting at the neck, clearing proximal pathways, performing superficial clearance before the special techniques, and finishing with some additional superficial techniques (pumps and rotaries) to the area treated.
Treatment was made up of two x 1 hour sessions, 11 days apart. The sessions consisted of applying basic MLD sequences to the neck, shoulders and upper left arm prior to applying the special techniques to the shoulder and upper arm. The palpation techniques taught in Dr Vodder’s Applied MLD were used to precisely locate areas, and depth, of pain and inflammation.
Treatment using basic MLD techniques was applied, superficial to the depth of located pain, and continued until a change could be felt in the tissues. Once change was evident, the area was retested using firm palpation to assess if there was a decrease in pain. The palpation and treatment cycles continued until a reduction in pain was achieved on the re-test. Mobilisation techniques for the shoulder blade and glenohumeral joint were carried out, as taught in Dr Vodder’s Applied MLD, and ensuring client comfort.
A reduction in pain and increase of mobility following the first treatment session was noted, particularly reaching behind the back as shown in photo 2.
Gains from the first session were maintained (see photos 3 and 4 below) and some further improvement in range of motion was achieved at the second treatment session as shown in photos 5 and 6. The client said her shoulder felt good and freer and she had no pain following the second session.
Feedback received from the client by text message one week post treatment was that she was still pain free and improved shoulder ROM achieved in second session had been maintained.
Discussion:
This case demonstrates a classical presentation of adhesive capsulitis which responded quickly to treatment using the Dr Vodder Method of MLD.
The techniques taught in Dr Vodder’s Applied MLD can replace many deep, painful remedial techniques with excellent results. This offers clients an effective and pain-free treatment alternative for many inflammatory conditions.
Dr Vodder’s MLD may facilitate a reduction in pain by interrupting the pain signals being sent to the brain through stimulating the meissner’s corpuscles as described by the Gate Control Theory.3 A further reduction in pain may be attributed to inflammatory chemicals, such as histamines, being taken up by the initial lymphatic vessels resulting in a reduction in inflammation and, therefore, pain.
Increased ROM is most likely due to softening of the joint capsule and thixotropic changes in the ground substance of the connective tissue brought about by the shearing forces of MLD.2,4
In addition, MLD has a calming effect on the sympathetic nervous system which is conducive to healing. In his research, Prof. Dr. P Hutzschenreuter, called this a sympathicolytic reaction.5
Early intervention is preferrable. Treatment commenced in the acute stage has been shown to require less treatments than if treatment is not sought until a condition becomes chronic. The effects of MLD are cumulative, with each treatment building on from the previous one. Scheduling subsequent treatments before a decline in the condition is recommended. An intensive treatment program started in the acute stage will require less treatments and resolve in a shorter time.
Normal treatment protocol would ideally have 2 treatment sessions within the first week with a follow up session a week later and further sessions scheduled as necessary.
Treatment sessions for this case study were scheduled around the client’s other commitments and were further apart than I would have liked however a good outcome was achieved in the two sessions. A follow up session will be scheduled when the client returns from travelling.
Successful outcomes such as this and other cases of adhesive capsulitis treated with this non-invasive and relatively pain-free method suggest a good treatment option for this condition and support further research into the role the Dr Vodder Method of MLD can play in resolving other inflammatory conditions.
- PEARSALL, ALBERT W.; SPEER, KEVIN P. Frozen shoulder syndrome: diagnostic and treatment strategies in the primary care setting, Medicine & Science in Sports & Exercise: April 1998 – Volume 30 – Issue 4 – p 33-39
- Textbook of Dr Vodder’s Manual Lymph Drainage A Practical Guide, Wittlinger 2011. Georg Thieme Verlag
- Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; ISH: 971±9
- Cowman MK, Schmidt TA, Raghavan P, Stecco A. Viscoelastic Properties of Hyaluronan in Physiological Conditions. F1000Res. 2015 Aug 25;4:622. doi: 10.12688/f1000research.6885.1. PMID: 26594344; PMCID: PMC4648226
Hutzschenreuter P, Ehlers R. [Effect of manual lymph drainage on the autonomic nervous system]. Z Lymphol 1986 12;10(2):58-60
*Clicking this link will open the Vodder School website in another tab.
