Frozen Shoulder and Physiotherapy

Introduction

Frozen shoulder, also known as adhesive capsulitis, is a condition that causes pain and stiffness in the shoulder joint. This condition gradually limits the shoulder's range of motion, making everyday activities like reaching, lifting, or even dressing difficult. Frozen shoulder can occur without an obvious cause, though it is often associated with previous shoulder injuries, surgeries, or underlying health conditions.

Physiotherapy plays a central role in the treatment of frozen shoulder, helping to reduce pain, improve mobility, and restore function. This booklet explains what frozen shoulder is, its symptoms, and how physiotherapy can aid in managing and treating the condition.

What is Frozen Shoulder?

Frozen shoulder occurs when the connective tissue around the shoulder joint thickens and tightens, restricting the movement of the joint. The condition progresses in stages, typically lasting anywhere from one to three years.

Stages of Frozen Shoulder:

1. Freezing Stage:

○     Duration: 6 weeks to 9 months

○     Symptoms: Gradual onset of shoulder pain and stiffness. The pain becomes worse with movement, and range of motion starts to decrease.

2. Frozen Stage:

○     Duration: 4 to 6 months

○     Symptoms: Pain may decrease, but stiffness persists. The shoulder’s range of motion becomes very limited, and movements become difficult.

3. Thawing Stage:

○     Duration: 6 months to 2 years

○     Symptoms: Gradual improvement in range of motion and a decrease in stiffness. The shoulder gradually regains normal function.

Causes and Risk Factors

Frozen shoulder can develop for a variety of reasons. The precise cause is not always known, but several factors can increase the risk:

1. Injury or Surgery:

●     A shoulder injury or surgery (e.g., rotator cuff surgery) can lead to limited mobility, which may trigger the development of frozen shoulder.

2. Diabetes:

●     People with diabetes are more prone to frozen shoulder, as they may experience thickening of the shoulder joint capsule, which can lead to stiffness.

3. Age and Gender:

●     Frozen shoulder is most common in people aged 40 to 60 years, and it is more prevalent in women than men.

4. Inactivity:

●     Long periods of immobility, such as from an arm fracture or a stroke, can lead to frozen shoulder as the tissues around the shoulder joint stiffen from lack of movement.

5. Other Health Conditions:

●     Certain conditions such as thyroid disorders, cardiovascular disease, and Parkinson's disease can increase the risk of developing frozen shoulder.

Symptoms of Frozen Shoulder

Frozen shoulder symptoms typically progress through the stages mentioned above. The main symptoms include:

●     Pain: The pain is often felt deep in the shoulder and may radiate down the arm. It tends to worsen with movement and may affect sleep, particularly when lying on the affected side.

●     Stiffness: As the condition progresses, the shoulder becomes more stiff, and movements such as raising the arm, reaching behind the back, or lifting objects become increasingly difficult.

●     Limited Range of Motion: Reduced range of motion in the shoulder joint is a hallmark of frozen shoulder. Individuals often experience difficulty with overhead movements or reaching behind their back.

How Physiotherapy Can Help with Frozen Shoulder

Physiotherapy is one of the most effective treatments for frozen shoulder. Physiotherapists can guide patients through a structured rehabilitation program that focuses on reducing pain, increasing mobility, and restoring function to the shoulder joint. Here’s how physiotherapy can help:

1. Pain Management

●     Physiotherapists use various techniques to manage and reduce pain associated with frozen shoulder:

○     Heat or Cold Therapy: Heat packs can relax tense muscles, while cold therapy can reduce inflammation and numb the pain.

○     Electrotherapy: Techniques like Transcutaneous Electrical Nerve Stimulation (TENS) can help manage pain by stimulating nerves and blocking pain signals.

○     Manual Therapy: Hands-on techniques such as joint mobilizations and soft tissue massage can alleviate stiffness, reduce tension, and promote mobility in the shoulder joint.

2. Restoring Range of Motion

●     One of the main goals of physiotherapy is to restore the full range of motion to the shoulder. Physiotherapists will:

○     Stretching Exercises: Gentle, controlled stretches can gradually improve flexibility and increase the range of motion in the shoulder.

○     Passive Mobilization: In the early stages of frozen shoulder, a physiotherapist may gently move the shoulder joint to improve movement and reduce stiffness.

○     Joint Manipulations: In some cases, gentle manipulations may be used to help move the joint and relieve restrictions.

3. Strengthening the Shoulder Muscles

●     As the shoulder’s range of motion improves, strengthening exercises are introduced to rebuild muscle strength around the joint and improve stability.

○     Isometric Exercises: These exercises involve contracting the muscles without moving the joint, which can be helpful in the early stages of recovery.

○     Resistance Training: As strength returns, exercises using resistance bands or weights can be added to target the shoulder, upper back, and arm muscles.

4. Functional Movement and Activity Restoration

●     Once pain is under control and mobility is improved, physiotherapy focuses on restoring functional movements. This may involve:

○     Functional Training: Physiotherapists design exercises to help patients return to activities they enjoy, such as reaching overhead, lifting, or carrying objects.

○     Posture Training: Proper posture can reduce stress on the shoulder joint and improve long-term outcomes. Physiotherapists provide guidance on maintaining good posture to support the shoulder during daily activities.

5. Education and Prevention

●     Education is a key component of physiotherapy for frozen shoulder. A physiotherapist will educate you on:

○     Activity Modifications: How to modify movements and avoid positions that exacerbate pain.

○     Ergonomics: How to set up your environment (e.g., workstation or sleeping position) to reduce strain on the shoulder.

○     Preventing Recurrence: Physiotherapists teach exercises and habits to avoid future shoulder problems and minimize the risk of frozen shoulder returning.

What to Expect During Physiotherapy for Frozen Shoulder

Physiotherapy for frozen shoulder typically involves a combination of treatments. Your physiotherapist will begin by assessing your condition and creating a personalized treatment plan based on your needs and goals. Here’s what you can expect during a typical physiotherapy session:

●     Assessment: Your physiotherapist will assess your shoulder’s range of motion, strength, posture, and any areas of tenderness or swelling.

●     Hands-On Treatment: You may receive joint mobilizations, soft tissue techniques, or stretching to help alleviate pain and stiffness.

●     Exercise Program: Your physiotherapist will guide you through exercises to improve range of motion, strength, and functional movement.

●     Education: You’ll learn strategies for managing pain at home and modifying activities to protect your shoulder.

●     Ongoing Monitoring: Your progress will be regularly assessed, and your treatment plan will be adjusted as needed.

Additional Treatments for Frozen Shoulder

In some cases, physiotherapy may be combined with other treatments to manage frozen shoulder more effectively. These include:

●     Corticosteroid Injections: Injections may be used to reduce inflammation and pain in the shoulder joint.

●     Surgical Intervention: In rare cases, if physiotherapy does not provide sufficient relief, surgery (e.g., shoulder arthroscopy or manipulation under anesthesia) may be considered to release the tight joint capsule and restore mobility.

When to Seek Physiotherapy for Frozen Shoulder

It’s important to seek physiotherapy treatment as soon as you notice symptoms of frozen shoulder. Early intervention can help reduce pain and stiffness, speed up recovery, and prevent the condition from worsening.

●     Persistent Shoulder Pain: If you experience ongoing shoulder pain, especially with movement, physiotherapy can help relieve discomfort and improve mobility.

●     Limited Range of Motion: If you notice that you can’t raise your arm, reach behind your back, or perform everyday tasks, physiotherapy can help restore your shoulder’s function.

●     Increased Stiffness: If the shoulder is becoming progressively stiffer and more difficult to move, physiotherapy can prevent the condition from reaching the "frozen" stage.

Conclusion

Frozen shoulder can be a frustrating and debilitating condition, but with the right treatment, most people can regain full or near-full shoulder function. Physiotherapy is an essential part of managing frozen shoulder, focusing on reducing pain, restoring mobility, strengthening muscles, and preventing future problems. With the guidance of a physiotherapist, you can improve your quality of life, regain independence, and return to your regular activities.

If you are experiencing symptoms of frozen shoulder, don’t hesitate to seek help from a physiotherapist who can develop a treatment plan tailored to your specific needs.