A New Approach to Frozen Shoulder:
Matrix Repatterning is a method of assessing and treating somatic dysfunction based on a model of organic structure elaborated by Ingber et al. and Levin. The method involves the use of tissue tension assessment and tracing to primary areas of restriction, which may include articular, muscular, fascial or intraosseous foci. Treatment involves the application of minimal force at the resistance barrier. This study is a clinical trial to determine the need for further evaluation under controlled conditions. Six cases of glenohumeral, adhesive capsulitis (“frozen shoulder”) were selected from the author’s caseload. The cases were uncomplicated by other major health-related conditions, such as diabetes. These patients had experienced significant restriction of motion, namely 90°, or less, of passive shoulder abduction for a period of not less than 6 months previous to intervention using Matrix Repatterning. Treatments were administered and the patients were re-evaluated to determine the extent of change in active and passive ranges of motion. The results demonstrated a mean improvement of passive abduction of 60°, of internal rotation of 25° and of external rotation of 30°. Eighty percent of patients reported a significant reduction of pain and an improved range of active motion as well as the ability to carry on the activities of daily living.
Key terms: Tensegrity, Frozen Shoulder, Adhesive Capsulitis, Intraosseous, Resistance Barrier
“Frozen shoulder”, according to many authors is a clinical disorder rather than a diagnosis. It is considered to be the final stage of a number of disorders which affect the shoulder.2 Synonyms include adhesive capsulitis,1,3,4 periarthritis,2,3 pericapsulitis,3,4 scapulocostal syndrome7 and degenerative tendinitis of the rotator cuff.2,3 It affects females more often than males and is predominantly seen in the 40-70 year age range. It is unilateral in 90% of cases.2,3,9 It usually follows a course of clinical development which involves 1) pain, 2) stiffening, 3) thawing. This course may last from 6 months to several years.5,9 No definitive diagnosis is available, however capsular fibrosis, thickening and contraction of the synovial membrane and protective periarticular muscle spasm are the hallmarks of the condition at the tissue level.2,7
Matrix Repatterning is a new approach to the understanding of the mechanism of injury, and the manner in which the human body responds to these forces. It is based on a new model of the underlying structure of organic tissue – the Tensegrity Structural Model – which appears to explain the complex interrelationship of all the structural components of the body. It extends the basic concept of the primacy of restriction, beyond the level of joint, muscle and ligament, to include all of the tissues of the body, as potential sources of dysfunction. Symptoms, especially in chronic conditions, are often the result of the compensatory tensions and stresses created within the body in response to the primary lesion. The source of the compensatory pattern is usually asymptomatic.
The connective tissue-fascial system forms a complex web, which provides stability, flexibility and mobility. A dynamic balance is continually maintained within this extensive system to allow for adaptation to the demands of different activities and to the restrictions, which may be imposed by traumatic lesions within these tissues. The connective tissue system is organized into three layers. The superficial fascia is associated with subdermal tissues, muscles and joints. The deep fascia surrounds and supports the viscera. The meninges form the membrane system around the brain and spinal cord. Mechanoreceptors and pain receptors are present within the fascial system and help to continually monitor the changing tensions and metabolic conditions, which may influence this system. The Tensegrity Structural Model (TSM) of the body, as elaborated by Stephen Levin, M.D. and Donald Ingber, M.D., Ph.D., holds that the body tissues are composed of interconnected tension icosohedra (complex triangular trusses) which inherently provide a balance between stability and mobility.5,6
This structural model explains many of the observed phenomena related to body support, movement, response to stress and trauma, as well as the effects of various therapeutic interventions. This theory has been verified by several studies in recent years. According to Ingber, a key investigator who has proven the existence of this structural model:
“That nature applies common assembly rules is implied by the recurrence – at scales from the molecular to the macroscopic – of certain patterns, such as spirals, pentagons and triangulated forms. These patterns appear in structures ranging from highly regular crystals to relatively irregular proteins and in organisms as diverse as viruses, plankton and humans. After all, both organic and inorganic matter are made of the same building blocks: atoms of carbon, hydrogen, oxygen and phosphorus. The only difference is how the atoms are arranged in three-dimensional space.
…an increase in tension in one of the members results in increased tension in members throughout the structure – even ones on the opposite side.
The principles of tensegrity apply at essentially every detectable size scale in the human body. At the macroscopic level, the 206 bones that constitute our skeleton are pulled up against the force of gravity and stabilized in a vertical form by the pull of tensile muscles, tendons and ligaments. In other words, in the complex tensegrity structure inside every one of us, bones are the compression struts, and muscles, tendons and ligaments [and all, interconnected fascial structures] are the tension-bearing members.”5
This structural model explains the physiologic changes, which manifest in injured or strained tissue. The apparent fibrosis of muscle and fascia can be seen as an altered electro-mechanical relationship at the molecular level. The tensegrity structure is thus converted from a neutral, flexible form to a strained, high-energy, linearly-stiffened mode as shown below in Figure 1.5
Matrix Repatterning incorporates several specific manipulative techniques. These approaches focus on primary areas of involvement and can quickly and effectively release the source of tension. The principle of treatment is the release of fascial restrictions within the tensegrity structure – at the molecular level. It is theorized that compression of tissues results in a piezo-electric effect. This causes the electrons, which are associated with the chemical bonds in the involved tissues, to generate a form of intrinsic current. This effect has been demonstrated in bone repair and occurs when it is placed under compression. The resulting flow of electrons may allow for a change in the relationship of cross-linkages, which form at the level of the collagen matrix and which maintain the state of restriction at the site of the primary lesion. A gentle, gradual pressure, referred to as induction, or a sudden movement, referred to as directional recoil, may be utilized. The traditional chiropractic adjustment may also accomplish this change, when applied to the appropriate site of involvement. Careful consideration is given to all of the tissues of the body, since fascial structure is inherently interconnected.8
It should be noted that post-traumatic studies of pigs, found that internal organs (heart, kidneys, liver and spleen) were almost always injured in simulated motor vehicle accidents. These structures are fluid-filled and are therefore very dense, in relation to other tissues of the body. In the event of a traumatic blow to the body, these structures and their intervening fascia will absorb the force of impact most readily. The potential for intraosseous lesions is also recognized as an important factor in many dysfunctional patterns. It has been our experience that these tissues are often the sites of primary lesions in, otherwise, resistant cases.8
Case files were assessed for individuals who had demonstrated a clinical presentation of restriction of abduction of the shoulder of no greater than 90°. As this was a retrospective study, the number of treatments were not uniform, however they averaged at 6 treatments with a range of 2 to 10 treatments in this group. Measurements were noted in the case files for abduction, while some contained measurements for internal and external rotation. The latter were performed at the limit of the passive range of the shoulder, or at 90°, whichever was less. The assessment was visual and/or goniometric.
The data for this group was then analyzed for the rate and degree of resolution of restriction of motion and tabulated accordingly.
Matrix Repatterning is administered entirely on the basis of tissue compliance as determined by the established protocols elaborated by the author. The primary foci of involvement in the above cases often involved the fascial structures within the torso, namely the investing fascia of the dense, water-filled viscera (heart, liver, kidneys and spleen). Other areas included the pelvis and long bones of the lower quadrant as well as the spine and local structures within the upper limb including the shoulder girdle. In general, treatment involves an application of gentle force to the restriction barrier with the aim of normalizing the intramolecular dynamics of the tensegrity structure. In most cases, spontaneous release of the primary lesions is noted and any one lesion is resolved with one treatment. Several layers may need to be treated for clinical resolution. The presence of adhesive pathology in the form of surgical scars and post-inflammatory adhesions often requires adjunctive therapy in order to address these tissues.
Matrix Repatterning represents a significant departure from the established protocols for the treatment of musculoskeletal disorders. It incorporates the newly confirmed structural characteristics of tissue to assess and treat primary foci of involvement. This process frees the practitioner from the tyranny of symptoms and focuses attention on the source of tissue dysfunction, which is seen as a manifestation of molecular forces rather than simply local tissue properties. Many practitioners who have incorporated this form of treatment into their practices have found similarly profound results in a wide range of conditions. It is recommended that further research be developed to determine the effectiveness of these approaches. It is the opinion of the author that Matrix Repatterning may represent a new horizon in our understanding of structural pathophysiology and our ability to address many resistant conditions, in a more deliberate, scientific and successful manner.
1. Annexton M: Arthrography can help free “frozen shoulder.” JAMA 241:875-876, 1979.
2. Bateman JE: The Shoulder and Neck, W.B. Saunders, Philadelphia, 1972.
3. Caillet R: Soft Tissue Pain and Disability, F.A. Davis, Philadelphia, 1977.
4. Caillet R: Shoulder Pain, F.A. Davis, Philadelphia, 1966.
5. Ingber DE: The Architectre of Life. Sci Am 48-57, January, 1998.
6. Levin SM: The Importance of Soft Tissues for Structural Support of the Body; in D’Ambrogio KJ, Roth GB: Positional Release Therapy: Assessment & Treatment of Musculoskeletal Dysfunction, Mosby-Harcourt, St. Louis, 1997.
7. Neviaser JS: Adhesive capsulitis of shoulder: study of pathological findings in periarthritis of shoulder. J Bone Joint Surg 27:211-222, 1945.
8. Roth GB: Matrix Repatterning®: Study Guide, Wellness Systems, Tottenham, ON, 1999.
9. Thompson WAL, Kopell HP: The components of the frozen shoulder. Bull NY Acad Med 36:501-509, 1960.
Dr. George Roth, D.C., N.D. is a practitioner with over 25 years experience in the field of energy medicine. He has developed a number of leading-edge technologies to assist individuals in the achievement of optimal wellness. He lectures extensively to various groups and educational institutions and is a published author.
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