Frozen Shoulder and Physiotherapy: Can it Help?

Frozen shoulder is a painful and limiting condition that commonly impacts women after the age of 40. It is a frustrating condition as it often persists over time, moving through various stages, but most of all limiting the simplest of daily activities.

What is Frozen Shoulder?

Frozen shoulder or Adhesive Capsulitis is a condition in which the shoulder joint becomes increasingly painful and stiff over time. It often takes 1-3 years to resolve.

Frozen shoulder typically moves through 3 stages, with each stage lasting a number of months, and is slow to resolve.

Stage 1: Freezing

This stage is characterised by more pain than stiffness. Small movements of the shoulder are painful and there is a gradual loss of range of motion as pain increases. Can last 6-9 months.

Stage 2: Frozen

During this stage, one will experience more stiffness than pain. Use of the shoulder becomes increasingly difficult as the joint stiffens. Pain may be more tolerable in this stage. Daily activities become increasingly difficult. May last 4-6 months.

Stage 3: Thawing

In this stage, the shoulder stiffness begins to ease and range of motion and pain levels improve. A full return of mobility and function may take 6 months to 2 years.

What causes a Frozen Shoulder?

Frozen shoulder occurs when the shoulder joint capsule thickens becoming stiff and tight, limiting movement. This occurs in part as the muscles of the shoulder (namely the rotator cuff) attach into the joint capsule, and as the capsule contracts, the muscles tighten with it.

There is no consensus on why it develops, but it commonly linked to:

• Diabetes
• Shoulder immobilisation (e.g. arm/shoulder surgery, fracture, stroke)
• Parkinson’s disease
• Cardiovascular disease
• Hypo- or hyperthyroidism

Can you prevent Frozen Shoulder from developing?

There are steps you can take to lead a healthy lifestyle to avoid developing conditions such as Diabetes and Cardiovascular disease, but for some this is often not the case, and you cannot predict who will develop a frozen shoulder.

If you have an injury that makes it difficult to move your arm (one of the biggest risk factors), it is recommended that you talk to your Physiotherapist or Doctor about what exercises will be suitable for you.

How is Frozen Shoulder Diagnosed?

Your doctor or Physiotherapist can assess your shoulder mobility.

A comparison between both active and passive movements (those performed by the Physio) will often reveal decreased range of motion, notably in forward and sideways raising of the arm and rotational movements (hand behind back or internal rotation and external rotation, moving the hand away from the body with the elbow at your side).

With Frozen shoulder, there is both a loss of active and passive range of motion, where in conditions such as arthritis or rotator cuff tears, active movements may be more limited than passive.

Do I Need to Get a Scan?

Imaging is not necessary, but may rule in or rule out other pathology.

X-Rays reveal any changes to your bony anatomy, such as arthritis, which may also limit shoulder mobility.

An MRI shows more detail in your soft tissues, which may reveal rotator cuff pathology such as small tears. Rotator cuff tears can also result in shoulder pain and a loss of range of motion.

What is the best treatment for Frozen Shoulder?

As mentioned previously, this is a condition that may take 2-3 years to resolve, so it is often just a matter of time.

However there are measures that can help reduce pain, gradually help to restore mobility and regain strength. In our slightly biased opinion, physiotherapy is the best option which can be used at various stages throughout the process.

Other options include:

• Massage Therapy. Message to the muscles of the shoulder and surrounding areas can be beneficial for increasing blood flow to the area to help muscles relax and offer some respite from the pain of frozen shoulder.
• Non-steroidal Anti-Inflammatory medications recommended by your doctor to reduce pain and swelling (e.g. Nurofen, Ibuprofen)
• Steroid injections. An injection of cortisone, a stronger anti-inflammatory, into the shoulder joint. See our previous blog for more on this.
• Surgery. There are various procedures to assist one regain shoulder mobility, such as hydrodilation where the capsule is injected with sterile fluid to stretch the capsule; arthroscopy or manipulation under anesthesia. Surgical options would always be supported with physiotherapy.

How Does Physiotherapy Help with Frozen Shoulder?

Physiotherapists can prescribe exercises to restore mobility by gently stretching the shoulder. Applying heat to the shoulder can make these exercises more comfortable, as heat can help relax the surrounding shoulder muscles.

It is also beneficial to assess whether other areas of the body are contributing to restricted shoulder mobility, such as the neck or thoracic rings (ribcage). This can be done through a full body assessment, whereby your therapist assesses the impact of other body regions on your shoulder. Treatment of those other regions, such as the neck or thoracic rings may result in more comfort, more mobility and less pain.

Have a specific question about your shoulder pain? Please get in contact here.