MANAGING A FROZEN SHOULDER THROUGH PHYSIOTHERAPY

Adhesive capsulitis is known more colloquially as a “Frozen Shoulder”. A condition that may limit physical movement and feel debilitating, if left untreated. It is characterised by stiffness and, sometimes, severe pain in the shoulder joint. It’s a condition that could have developed gradually over time, so you may not even notice the change until the condition has become chronic. By then, it could have started to significantly impair your range of motion and impact your day-to-day activities.

Management through physiotherapy is a cornerstone of treatment for a Frozen Shoulder. Applied physiotherapy can help restore function in the shoulder area and alleviate discomfort. In this article, we explore effective treatment strategies:

So, what exactly is a “Frozen Shoulder”?

This particular condition occurs when the protective capsule surrounding the shoulder joint becomes inflamed and thickened. This process leads to a restriction of movement and increased pain, often without a clear trigger, and may last for several months to years, without treatment.

Cause & effect

While the exact cause remains unclear, several factors may contribute to the development of a stiff and painful shoulder:

INJURY OR SURGERY: A shoulder injury or surgery can lead to immobility, increasing the risk of developing frozen shoulder.

CHRONIC MEDICAL CONDITIONS: Conditions such as diabetes, thyroid disorders, and cardiovascular diseases have been associated with higher occurrences of a frozen shoulder.

AGE & GENDER: The condition tends to be more prevalent in individuals aged 40 to 60 and is generally more common in women than men.

PROLONGED IMMOBILISATION: Keeping the shoulder immobile for an extended period – due to fractures or other injuries – could increase the risk of developing a painful and stiff shoulder.

Understanding adhesive capsulitis

A frozen shoulder typically progresses through three stages:

FREEZING STAGE: Gradual onset of shoulder pain that worsens over time. Range of motion begins to decrease.

FROZEN STAGE: Pain may diminish, but stiffness remains. The shoulder’s range of motion is significantly restricted.

THAWING STAGE: Shoulder mobility gradually improves, and pain diminishes.

How Physiotherapy could help

Physiotherapy plays a vital role in the conservative (cautious) management of frozen shoulder. The objectives of physiotherapy are to alleviate pain, restore motion, and ultimately regain function in the joint. Below is a possible treatment plan (depending on the initial diagnosis):

STAGE 1. ASSESSMENT & DIAGNOSIS

A thorough assessment by an experienced physiotherapist is crucial. This may include:

• A physical examination to assess pain levels, muscle strength, and range of motion
• Identifying the specific movements that trigger pain or discomfort
• Evaluating functional limitations in daily activities

STAGE 2. PAIN MANAGEMENT

In the initial stages, managing any pain you may be experiencing, is essential. We may advise:

• Manual Therapy: Mobilisation techniques to decrease stiffness and improve range of motion. This includes manual joint mobilisation and soft tissue release.
• Ice Therapy: Applying ice packs to manage inflammation and pain, especially after exercises.
• Ultrasound Therapy: This could help reduce pain and promote tissue healing.

STAGE 3. EXERCISE THERAPY

A tailored exercise programme is vital for restoring a full range of motion and to strengthen the shoulder joint and muscles. Exercises often include:

• Range of Motion Exercises: Gentle stretching and movement to prevent stiffness. Active-assisted movements can help engage the surrounding muscles.
• Strengthening Exercises: Once the pain subsides, strengthening exercises should be introduced. Emphasis is placed on the rotator cuff and shoulder blade muscles.
• Functional Activities: Gradually incorporating typical activities associated with daily life, to ensure proper use of the shoulder in everyday scenarios.

STAGE 4. EDUCATION & SELF-MANAGEMENT

Patient education is critical in managing expectations and understanding the rehabilitation process. Important topics include:

• Understanding the condition and timeline of recovery
• Techniques to avoid aggravating the condition during your day-to-day activities
• The importance of adhering to the prescribed exercise regimen

STAGE 5. COLLABORATIVE CARE

In some cases, it may be necessary to coordinate with other healthcare professionals, such as orthopaedic specialists or primary care physicians, especially if additional interventions like corticosteroid injections or surgical options need to be considered. However, if conservative treatments do fail, then surgical intervention may be necessary. Procedures can include:

Capsular release: Releasing the tight capsule surrounding the shoulder joint.

Arthroscopic surgery: A minimally invasive procedure to remove adhesions and scar tissue.

CONCLUSION

A “Frozen Shoulder” can be a frustrating and painful physical condition however, with the appropriate physiotherapy management, individuals can achieve significant improvements in their symptoms and quality of life. A targeted and personal approach, focusing on pain relief, gradual exercise progression, and education, will pave the way for successful recovery.

If you suspect you have a frozen shoulder, consulting with a qualified physiotherapist could help guide
you on the path to recovery. With patience and consistency, regaining shoulder functionality and being able to return to your usual, everyday activities is entirely achievable.

If you suspect you may have a stiff, painful or uncooperative shoulder, then don’t hesitate to seek professional advice. Call us now on 020 8876 5690 to book an appointment with Vedika or any member of our experienced team of physiotherapists.

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About the author: Vedika Rathi is a resident physiotherapist at Physio on the River. MSc in Advanced Musculoskeletal Physiotherapy.