Managing Frozen Shoulder: A Physiotherapist’s Guide

Frozen shoulder, also known as adhesive capsulitis, is a condition where the shoulder joint becomes stiff, painful, and difficult to move. It often develops gradually, progresses through stages, and can take months or even years to fully resolve. As a physiotherapist, I often encounter patients with frozen shoulder, and I understand how frustrating it can be. Here’s what you need to know about frozen shoulder, along with some helpful tips for managing symptoms and speeding up recovery.

Understanding Frozen Shoulder

Frozen shoulder typically goes through three stages:

1. Freezing Stage: This is the initial stage, where pain begins and gradually worsens. Movement becomes limited as the shoulder “freezes.” This stage can last anywhere from 6 weeks to 9 months.

2. Frozen Stage: Pain may begin to decrease, but stiffness remains and can be severe. Daily tasks involving shoulder movement, such as reaching or dressing, can feel very difficult. This stage can last 4-6 months.

3. Thawing Stage: The final stage involves gradual improvement in shoulder mobility as stiffness starts to ease. This can last from 6 months to 2 years.

   
   

The exact cause of frozen shoulder isn’t fully understood, but it’s often linked to periods of immobility, shoulder injury, diabetes, and sometimes hormonal changes, particularly in women around the age of 40-60.

Tips for Managing Frozen Shoulder

1. Gentle Stretching and Range of Motion Exercises

   • Movement is important, but remember to work within your pain limits. Aim for slow, gentle stretching rather than pushing through pain.

   • Pendulum Swings: Lean forward, letting your arm dangle freely. Gently swing your arm in small circles for about 1 minute.

   • Wall Walks: Stand facing a wall and use your fingers to "walk" your arm up the wall as far as you comfortably can. Hold briefly, then slowly walk back down.

   • Passive External Rotation: Using a cane or stick, hold it in both hands with elbows at your sides. Gently push the cane outward to rotate the affected arm until you feel a stretch, then return to the starting position.

   
   

2. Heat Therapy

   • Apply a warm pack to your shoulder for 10-15 minutes before exercising. Heat helps to relax muscles, improve blood flow, and reduce stiffness, making it easier to perform exercises and stretches.

     
     

3. Ice Therapy for Pain Relief

   • If you’re experiencing pain after activity or at the end of the day, apply a cold pack for 10-15 minutes to help reduce inflammation and discomfort.

     
     

4. Maintain Shoulder Mobility

   • Avoid total immobility, as this can worsen stiffness. Engage in gentle shoulder movements throughout the day, even if it’s simply reaching a little farther with each movement. Small but frequent movements can help prevent further stiffness.

     
     

5. Over-the-Counter Pain Relief

   • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen can help with pain and inflammation. Consult with your doctor to ensure these are safe for you.

     
     

6. Physical Therapy

   • Regular sessions with a physiotherapist can help guide your recovery with safe exercises and techniques to improve range of motion, manage pain, and speed up the healing process.

   • Manual therapy techniques, such as joint mobilization, can help improve shoulder mobility, though it may only be appropriate once pain is manageable.

     
     

7. Posture Awareness

   • Maintaining good posture can help reduce strain on your shoulder and other muscles that support it. Practice sitting and standing up straight, with your shoulders relaxed and your ears aligned with your shoulders.

     
     

Avoiding Common Mistakes with Frozen Shoulder

• Avoid Overstretching: While stretching is important, pushing beyond your pain tolerance can lead to more inflammation and potentially slow your progress. Stick to gentle, pain-free stretches.

• Don’t Ignore Pain: Frozen shoulder is already painful, so don’t push through severe pain thinking it will speed up recovery. Pain is your body’s way of telling you to ease up.

• Stay Patient: Frozen shoulder can take time to heal, and it’s common for progress to be slow. Set small goals, such as reaching a slightly higher point on the wall each week.

When to See Your Physiotherapist or Doctor

If you experience any of the following, it may be time to seek additional help:

• Increased Pain: If the pain becomes severe or is affecting your sleep and daily activities, speak with your physiotherapist or doctor.

• Significant Loss of Mobility: If you notice increased stiffness that prevents basic functions like dressing, it’s important to get a professional assessment.

• No Improvement: If after several months you’re not seeing any progress, speak with your healthcare provider about additional treatment options, such as corticosteroid injections or alternative therapies.

Treatment Options Beyond Physiotherapy

In more severe cases, frozen shoulder may require additional interventions. Here are a few options that may be recommended if your shoulder stiffness persists:

• Corticosteroid Injections: These injections can reduce inflammation and provide temporary relief, allowing for better participation in physiotherapy exercises.

• Hydrodilatation: This involves injecting fluid into the shoulder joint to stretch the capsule. It’s often done in a hospital setting and can help improve range of motion.

• Shoulder Manipulation or Arthroscopic Release: These procedures may be considered in rare cases where symptoms persist despite all other treatments.

Final Thoughts

Frozen shoulder can be a long, frustrating process, but with the right approach and a lot of patience, you can improve mobility and reduce pain. Take it one step at a time, focus on gentle movement, and don’t hesitate to reach out to your physiotherapist for support along the way.

Remember, while progress may be slow, most people eventually regain full use of their shoulder. Stay consistent with your exercises, take care of your shoulder, and trust the process