Dealing with a frozen shoulder? You’re not alone. Adhesive Capsulitis, more commonly known as Frozen Shoulder can affect 1 in 12 women or 1 in 10 men of working age. It is a debilitating condition that can affect your quality of life.
Physiotherapy can stand as a beacon of hope. In this article, we are going to explore the ways that it can help you to manage your symptoms and make progress in helping you to overcome it.
Why does a Shoulder Freeze?
Phases of Frozen Shoulder
Freezing/Painful Phase
- Duration 6 weeks to 9 months.
- The main symptom is a slow onset of pain.
- As the pain progresses the shoulder starts to stiffen.
- The pain can be intense and worsen at night.
Frozen/Adhesive Phase
- Duration: 4-12 months.
- The pain may begin to diminish although the shoulder may become stiffer.
- There may be significant disruption to activities of daily living.
Thawing/Recovery Phase
- Duration: 5 months to 24 months.
- Gradual return to range of motion.
- Pain starts to resolve.
physiotherapy: the unfreezing process begins
Physiotherapy can be effective in managing and potentially shortening the duration of symptoms associated with a frozen shoulder. Physio treatment aims to:
1. assessment and diagnosis
The start of the physiotherapy journey is a thorough assessment.
Your physio will take a detailed history and conduct a physical exam. This helps to confirm the diagnosis. At this stage pain levels and joint range of motion are recorded.
2. Pain Management
- NSAIDS
- Heat Therapy
- TENS Machine
- Acupuncture
- Taping
NSAIDs – One of the main aspects of managing a Frozen Shoulder, particularly during the freezing stage, is reducing the pain. Whilst not specifically solving the condition directly, Non-steroidal anti-inflammatories (NSAIDs) can help reduce inflammation and pain.
Heat Therapy – Heat Packs and compresses can help manage pain by increasing the blood flow to the area.
3. Mobilization Techniques
- Glenohumeral Mobilization: This involves gentle movement of the ball and socket joint to improve mobility.
- Scapular Mobilization: The shoulder blade plays a pivotal role in shoulder health. Techniques to manage it can significantly reduce pain and increase range.
- Soft Tissue Mobilization: This focuses on the muscles and the tendons around the shoulder, increasing blood flow and reducing tension.
4. Targeted Exercises
Examples of these could include:
- Pendulum Stretch – Stand and lean slightly forward, letting the affected arm hang down. Swing the arm in a small circle, gradually widening the circle over time. Use clockwise and anti-clockwise circles, circling for 30 seconds in each direction.
- Towel Stretch – Hold a towel behind your back with both hands as if you’re about to dry your back. Pull upwards with the good arm to stretch the affected one and bring the hand up to the centre of your back or as far as the arm can go. Hold the stretch for about 20 seconds at a time.
- Cross-body Stretch – Use the unaffected arm to lift the frozen arm at the elbow, stretching it across the body. Hold the stretch for 10-20 seconds.
- Passive Flexion – Stand facing the back of a chair, your hands resting lightly on it. Slowly walk away leaving your hands on the chair until your arms are straight out in front of you. Bend forwards so that your head drops between your arms, or as far as you can manage. Hold the stretch for 10-20 seconds.
But for now, use the above four stretches to make a start.
5. Education and Prevention
Knowledge is power. Your physio will guide you on posture, ergonomics and everyday activities to make sure that you’re not only treating but preventing future occurrences.
SUCCESS STORIES
Julia - Freezing Stage
Julia is a 45-year-old mum of two and an avid tennis player. Following a fall onto her elbow playing tennis, she slowly started to develop the signs of a frozen shoulder. She booked an appointment after two weeks of increasing pain.
A thorough assessment was completed and a diagnosis of Frozen Shoulder (Freezing Stage) was given.
Her symptoms were characterised by intense pain especially when performing overhead activities or when reaching behind her back. Although stiff in all ranges the shoulder still maintained a reasonable (if not very painful) range of motion.
Treatment started with some gentle Glenohumeral and Scapula Mobilisations. This improved her range of motion and made it less stiff. A thorough exercise programme was designed which she was asked to complete twice a day.
Following this treatment strategy, we were able to completely resolve the condition within 4 sessions spaced over 6 weeks and she was back enjoying her tennis shortly after.
Duncan - Frozen Stage
Duncan is a 65-year-old retired Police Officer who presented with a one-year history of Frozen Shoulder. He had tried Physiotherapy unsuccessfully and had been referred to see an Orthopaedic specialist. The specialist had trialled an unsuccessful cortisone injection and had also recommended a Hydrodilation technique to forcibly break the adhesions with the shoulder. Duncan wanted to give conservative therapy another go before undertaking the procedure.
Duncan's pain was well managed. He revealed that he'd not previously been fully engaged with the Physiotherapy that he'd undertaken at another clinic and he was keen to make a start.
His range of motion was significantly reduced, particularly when moving his arm overhead or sideways away from his body. His pain had been improving and the pain was only now an issue when moving his arm in those directions or when lying on it for prolonged periods. It was preventing him from enjoying his gardening and spending time with his grandchildren.
During the assessment not only was his shoulder stiff but so was his thoracic spine. Treatment focused on some Scapula Mobilisations, Spinal Adjustment and soft tissue techniques. It was incredibly successful and after two weeks his flexion was almost full but remained limited away from the body.
Working hard with his home exercise programme for 6 weeks together with a total of 4 sessions of Physiotherapy he had regained almost full range of motion and he had transitioned strongly into the thawing stage.
He is no longer having to consider the additional Hydrodilation
Nigel - Thawing Phase
Nigel is 56 and is a plasterer. He had been struggling with a Frozen Shoulder for about 18 months.
He'd seen a doctor after 6 months of pain who had given him some generic exercises to do which he'd been doing intermittently as the shoulder naturally worked through the stages.
His pain was easing and his range of motion was improving steadily.
He had been unable to work for 18 months and came to me to help him to achieve this now his shoulder was easier.
After a few sessions of postural education, correction and exercise, he was able to return to work on a phased return initially but after 4 weeks of this, he is now back to work full-time.
To Wrap it up…
The journey of a frozen shoulder can be long and winding, but with the help of an experienced physiotherapist, it doesn’t have to be.
The holistic approach addresses not just the symptoms but also the root cause. It matches the correct therapy with the correct stage of the frozen shoulder.
This optimises recovery.
Remember that the goal isn’t just to melt the ice away but to try to prevent it from refreezing again in the future!
