Treatment of Frozen Shoulder
Frozen shoulder (also known as adhesive capsulitis) is a condition that causes pain and stiffness in the shoulder and can significantly interfere with daily activities.
Frozen shoulder typically has a sudden onset, often people literally wake up with it, and it is sharply painful to move with almost all shoulder movements. There may be some pre-warning signs such as the feeling a mild ache in the shoulders or some mild stiffness. It can also develop from a shoulder injury especially if you have been too afraid to move your shoulder after the injury.
It is suspected that an auto-immune reaction in the body causes joint capsule of the shoulder to literally “shrink wrap” the joint and a chemical reaction of inflammatory indicators invades the joint.
After the onset of frozen shoulder, it can be broken up into three phases; the freezing phase, the frozen phase, and the thawing phase.
Stage 1: Freezing
The “freezing” stage typically lasts from 6 weeks to 9 months. During this stage, pain increases and your shoulder loses range of motion. Sleeping can also be quite painful during this stage.
Stage 2: Frozen
The “frozen” stage typically lasts from 4 to 6 months. During this stage, painful symptoms may actually improve but stiffness remains. Daily activities may become very difficult to complete.
Stage 3: Thawing
During the “thawing” stage, shoulder motion will slowly improve and pain will be gone. It can take from 6 months to 2 years to return to normal strength and motion.
Who gets Frozen Shoulder?
Frozen shoulder is most common for individuals between the ages of 40 to 60 and occurs more commonly in women compared to men.
The exact cause of frozen shoulder is unknown, however there are few known factors that may make you more susceptible to it. Frozen shoulder often occurs as a result of a shoulder injury, such as a rotator cuff tear, shoulder surgery, or a bone fracture affecting the shoulder joint. It is also more common in individuals who have been immobilized for prolonged periods of time, post-menopausal women, individuals who have had a stroke, Parkinson disease, people who have diseases affecting the thyroid gland and individuals with Diabetes.
Treatment of Frozen Shoulder
If you suspect a frozen shoulder you should seek treatment from a physiotherapist or chiropractor as soon possible. Here they can assess your shoulder, gauge what stage your shoulder is in and form the best treatment plan to suite your individual goals.
One distinguishing feature of frozen shoulder is that the physio or chiro are unable to move the shoulder any further than the patient is able to, even when the patient is fully relaxed. The movement is just simply blocked and there is a very unique feeling that the physiotherapist or chiropractor will be able to recognize.
The rehabilitation treatments will vary depending on what stage you are in:
The Freezing Stage
Physiotherapy, chiropractic and massage therapy will focus on pain relief during this stage. They may choose to use some pain-relieving modalities such as, ultrasound, interferential current, acupuncture or gentle mobilizations. It is important to gently move the shoulder in pain free ranges as much as possible with range of motion exercises prescribed.
Sometimes cortisone injections administered by a Sports Medicine doctor are recommended in this stage to make the pain more tolerable. You may also be referred to a specialist who can perform hydrodialation which has proven to be quite successful at this stage of the disease.
The Frozen Stage
The frozen stage is more stable, with persistent pain levels and unchanging stiffness. Patients are often quite frustrated by this point but it is important to stay positive and continue to move the shoulder through range of motion exercises. Physiotherapy, chiropractic and massage treatments focus on stretching the shoulder joint and other adjacent joints, managing pain as needed, using acupuncture or other modalities more aggressively than earlier and starting to teach gentle stabilization exercises to build muscle control around the joint.
The Thawing Stage
During the thawing stage, there is less and less pain and the shoulder once again starts to move. Therapeutic interventions such as physiotherapy, chiropractic treatment, and massage therapy can help to progress through this stage faster and it is highly recommended at this time. Most people eventually regain full or nearly full movement, but some have residual stiffness that persists for several years. During this stage, your physiotherapist and chiropractor will use more aggressive manual therapy, mobilization and stretching techniques around the shoulder and adjacent joints. They will also advise you on exercises that will build strength and get your shoulder back to functioning the way it did before this condition developed.
By seeing a trained professional, you will learn exercises to help your shoulder condition, you will learn pain management strategies and they will use hands on techniques that will speed up the recovery process and help prevent a secondary frozen shoulder from developing
Best Exercises to Help with Frozen Shoulder?
With your body bent forward at your hips, let your sore shoulder fall limp with gravity. From here use the initial momentum to let your shoulder swing forward/back, side to side and in small circles. This will help lubricate the joint and provide pain relief.
Perform these for up to 1 min several times a day.
Active Assisted Range of Motion
Move your sore shoulder slowly using the assistance from a wall, stick or your other hand to help move. Move in the forward, side and rotational directions. Perform 10 reps in all directions 3x/day.
Isometric Rotator Cuff Strengthening
With your arm at your side and elbow bent 90 degrees in front, place your other hand first on the inside to apply resistance out, then on the outside to apply resistance in. As you do this keep your arm in the starting potion, do NOT let your arm move, and feel the muscles that surround your shoulder become engaged to keep it in place.
Warning- Do not perform this maneuver if painful or scale back on the amount of pressure until it is pain free.
Preform 10x 5sec holds 3x/day.
What Should be Avoided with Frozen Shoulder?
It is important that you listen to your body and symptoms. You want to work within movements that are challenging for your shoulder but not above your pain threshold. Pushing through too much pain will only lead to a longer recovery.
How can you Treat a Frozen Shoulder from Home?
It is very important that you keep moving you shoulder daily within its pain free range, it will prevent a prolonged recovery.
Performing a daily rehab exercise routine, like the one above, will help your shoulder to progress, be forewarned it will be slow. Your patience will be tested.
How Long Does It Take to Recover from Frozen Shoulder?
Frozen shoulder is a stubborn condition to treat and can take several months for each of the three phases to fully resolve. The “freezing” stage typically lasts from 6 weeks to 9 months. The “frozen” stage typically lasts from 4 to 6 months. The thawing phase can take from 6 months to 2 years to return to normal strength and range of motion. The average total time for recovery from frozen shoulder is 24 months. It is important to note, that if you do nothing at all, you will still get better from the frozen shoulder-it will just take longer to reach full recovery.
If you are experiencing a painful and/or stiff shoulder joint we recommend that you have a qualified professional look at it to determine the best course of action. Our physiotherapists, chiropractors, massage therapists and sports medicine doctor will all work together to help you with your frozen shoulder if that is your diagnosis. Each practitioner has unique strategies that can help you manage the pain and will help you progress through each stage faster. Contact us today to book your initial consultation. Rebalance Sports Medicine has two locations in Toronto in the Financial District of Toronto.
Laurie Bickerton, FCAMPT Physiotherapist
Laurie Bickerton is a FCAMPT physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.