Marian De Jongh Swemer – March 2014
I am an enthusiastic scuba diver and regularly holiday in Playa Blanca, a resort on the Canary Island of Lanzarote. On my visit of March 2014 I found that Marian, a PADI Master Instructor had considerable pain in her left shoulder with severely reduced range of movement. Her GP diagnosed possible ligament damage. Marian’s very physical job requires her to lift heavy compressed air tanks, help novice divers in and out of the water and getting in and out of a tight fitting neoprene dive suite several times a day. Her shoulder problem rendered many of these tasks impossible.
Marian asked for my help to see if I could offer her any exercises to speed her recovery. On examination Marian’s symptoms presented much like a classic ‘Frozen Shoulder’. This condition is also referred to as adhesive capsulitis, and is characterised by stiffness, pain and greatly reduced range of movement in the shoulder joint. Marian’s symptoms began a few months prior to my visit and were gradually getting worse. The pain was so intense she was unable to sleep at night and it was affecting her ability to do her job. It was important to get Marian back to work as soon as possible.
I started working with Marian, immediately teaching her self myofascial release (SMR) techniques to release tightness in her neck and shoulders. Taking a ‘whole body’ approach, I chose exercises and stretches to release tightness in her spine, re-educate scapula stability, improve rotation and lateral flexion movements. I taught her to connect with her breath when moving, to aid the relaxation response and reduce pain. I designed an exercise programme suited to Marian’s work commitments, split into day one and day two. My approach considered the connective tissue (referred to as the myofascial web), that surrounds muscles, ligaments, joints and internal organs. Tightness in this web in one area of the body, will often lead to referred pain in another, and lead to the development of chronic holding patterns which then contribute to pain and stiffness.
After daily one hour session for the 14 day duration of my holiday, Marian was feeling much better, she was sleeping well and had her pain under control. She was able to perform light duties, and the exercises were working well for her. To follow up on her progress, about six weeks after my return home, we had a ‘face time’ consultation. I was pleasantly surprised to see how Marian’s range of movement had improved, in both flexion and external rotation at the shoulder. There was still a lot of improvement required to re-gain full range of movement, but she was making good progress. Marian was very motivated to continue her exercises to make even more progress, so I gave her a few more exercises to practice and progressed some of the ones she was already doing. My next trip would be in June.
Progress report – June/July 2014
My visit in June found Marian to have further improved range of movement for flexion, abduction and external rotation of the shoulder joint. She was no longer having to take tablets to reduce the pain in her shoulder. Over the course of the following two weeks I progressed her exercise programme to challenge core and upper girdle stability and improve strength. I continued to take a whole body approach and introduced exercises to increase range of movement in extension, rotation and in saggital and lateral flexion of the spine.
Progress report – August 2014
To check on Marian’s progression, we had a second face time consultation. I was gratified to see that she had an almost full range of normal movement in her shoulder. She had improved shoulder blade stability and her spinal rotator cuff muscles were working in a more co-ordinated fashion, supporting shoulder and arm movement. She had no pain and the exercises continued to work well for her. I progressed her exercises further and included movements to challenge the upper body stability through weight bearing, strengthening for the rotator cuff muscles, and exercises to challenge core stability.
It has only taken four to five months of bespoke Clinical Pilates exercises to rehabilitate Marian’s frozen shoulder. Most research concerning adhesive capsulitis indicates a resolution time of eighteen months to two years, and even then, range of movement can remain limited. I believe Marian’s speedy recovery is due in part to the whole body bespoke exercise rehabilitation approach I have adopted, and to her motivation and dedication for practicing her exercise programme daily.
Marian de Jongh Swemer - www.divecollegelanzarote.com
