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Do you have shoulder pain and are progressively losing your range of motion or ability to reach, lift, or generally use your arm? You may be experiencing adhesive capsulitis, better known as frozen shoulder! There are many reasons why a frozen shoulder can occur, but there is also a lot that can be done to help improve symptoms and resolve pain from this condition. A lot of people think frozen shoulder will simply "improve on its own", but that is usually not the case. Before you resign yourself to your pain and not being able to enjoy activities, let us help you! In this article, we will discuss what frozen shoulder is, what causes it, as well as frozen shoulder exercises and rehab implications.
What is frozen shoulder?
Adhesive capsulitis, more commonly known as 'frozen shoulder', is characterized as progressive pain and stiffness of the shoulder joint. It usually comes on slowly and worsens over time, making things like lifting and reaching very difficult.
There are many reasons why frozen shoulder can occur, including, but not limited to:
- recovering from a medical procedure such as a scope or rotator cuff surgery
- recent mastectomy
- traumatic fall
- a medical condition that prevents speedy healing, such as diabetes
- prolonged periods of shoulder immobilization
- those over age 40, particularly women
READ: THE LINK BETWEEN DIABETES AND FROZEN SHOULDER
In some cases, frozen shoulder can develop idiopathically (no known cause).
The condition is characterized by scarring and thickening of the structures that hold the shoulder joint together. These can include the bursae, tendons, or cartilage in between the ball and the socket of the shoulder joint itself. Normally, the ball and socket are tightly fit together with the surrounding structures. However, when inflammation starts to occur, the structures swell and take up space around the shoulder, preventing normal gliding and range of motion of the joint. It doesn't take long for the person to feel pain and have trouble moving the shoulder!
Overcome Your Frozen Shoulder and Maximize Your Function
This Rehab is designed to take you through the process of fully recovering from shoulder problems, such as frozen shoulder, with step-by-step guidance, and taking out the guessing game. This program is meant to be done in a way that is most conducive to your daily demands, within a time that works best for you! Click HERE to get started with us today.
Diagnosis and Stages of Frozen Shoulder
A person is usually diagnosed with a frozen shoulder by their healthcare provider, doctor, or physical therapist. The most common symptoms are pain, tightness, and lack of range of motion of the joint. In particular, we often see what is called a "capsular pattern". This means we will see the most loss of range of motion in external rotation (difficult to reach up to your head), followed by loss of range into flexion/abduction (lifting the shoulder), and then internal rotation (reaching behind your back).
Diagnosis may also be confirmed with imaging, such as an x-ray or MRI, which would visualize the thickening of the tissues in the shoulder, or altered joint position.
When a person is diagnosed with a frozen shoulder, there are several "stages" that they may experience. These "stages" may last one to several months apiece and include:
- Freezing stage: any movement of your shoulder causes pain, and movement starts to become progressively limited.
- Frozen stage: pain starts to diminish, however, range of motion is virtually none.
- Thawing stage: the arm starts to slowly be able to move again, and the range of motion steadily improves.
Treatment for Frozen Shoulder
Treatment is important and beneficial in any stage of frozen shoulder. Sometimes, your doctor may prescribe an anti-inflammatory to cut down on the symptoms of pain and decrease irritation to your shoulder structures. They may also recommend a corticosteroid injection for the same reason. In severe cases and with failed conservative measures, surgery or manipulation under anesthesia may be recommended. In one study by Yip et al, it was demonstrated that early operative treatment is not considered effective, and should be reserved for when conservative treatment methods fail to improve pain and symptoms (1). It is widely accepted that non-operative treatments can be used to improve symptoms in a large population of people affected by frozen shoulder.
Exercises for Frozen Shoulder
Physical therapy can be very beneficial in the treatment of the frozen shoulder. Physical therapists often use modalities such as e-stim, ice, and/or heat, manual (hands-on) therapy, and exercise to help improve pain and promote a better range of motion. In fact, in a systematic review conducted by Nakandala, Piumi, et al that examined 33 interventional studies for the treatment of patients with frozen shoulders, all studies demonstrated improvements in pain, range of motion, and functional arm use with physical therapy interventions (2). The treatments in these studies were varied and included various types of modalities, range of motion and stretching exercise, manual therapy, acupuncture, and biofeedback techniques, to name a few.
The moral of the story - physical therapy works!
Exercises for Frozen Shoulder
Listed below are some beneficial exercises and stretches that you can use to help improve symptoms of frozen shoulder, and assist you through the rehab process. We have organized the exercises by stage, as discussed above. No matter what stage your shoulder is in, exercise can benefit you!
Stage 1: Painful/Freezing
This stage is characterized by pain, and therefore rehab exercises should be performed gently, so as not to flare up pain further. Work within your available, pain-controlled range of motion with exercise.
Exercise 01 of 06
Exercise demonstration
Shoulder Pendulum - AROM
View exercise instructions
- HOW: Begin with the non-affected arm on an elevated surface. While hinging over at your hips dangle the affected arm. You will move your arm in circles in this position. If this is irritating your shoulder you can stand upright, the less you hinge over the less stress on your shoulder.
- FEEL: You will feel the muscles in your shoulder working without you contracting them. Should feel like a gentle stretch.
- COMPENSATION: Don’t actively move your shoulder, make sure to let the motion of your body move your arm.
Exercise 02 of 06
Exercise demonstration
Shoulder Flexion - PROM, Pulley
View exercise instructions
- HOW: Begin in a seated position underneath a pulley system. With one hand, hold onto the pulley with your palm facing you and your arm out in front of you. Make sure that arm is completely relaxed. Use the opposite arm to pull that arm up as much as you can tolerate. Let gravity and the weight of your arm pull it back down to the starting position. Repeat for as many reps as prescribed.
- FEEL: You should feel a stretch in your shoulder. It may be uncomfortable - that is normal!
- COMPENSATION: Keep the arm you are working relaxed, let the other arm do all of the work!
Stage 2: Frozen
In this stage, the range of motion may be very small, so we are looking to improve that. Exercise in this stage is focused on the improvement of range of motion.
Exercise 03 of 06
Exercise demonstration
Posterior Cuff Soft Tissue Mobilization
View exercise instructions
- HOW: Stand up leaning the back of your shoulder against a lacrosse ball or mobility ball into the wall. Cradle your arm against the ball with your opposite arm to keep it relaxed, from here you can work on the muscle. You have the option of going up and down or side to side, whichever feels more productive for you. Two options you have to make this mobilization more aggressive include bringing your feet away from the wall so that you are applying more pressure into the ball OR stretching the muscle by bringing your arm across your body as you perform this mobilization.
- FEEL: It is common for the soft tissue in this area to be sensitive. You shouldn’t be putting pressure on any bones in this area, make sure it is soft tissue (such as muscles and tendons).
- COMPENSATION: Don’t roll the ball too fast or too slow, find the right speed that fits your best needs.
Read this article for the best posterior cuff mobility exercises.
Exercise 04 of 06
Exercise demonstration
Supine Shoulder Flexion - PROM
View exercise instructions
- HOW: Begin laying face up with your fingers interlocked or held onto by the opposite arm. Initiate the motion with the non-affected arm, bring both arms as far overhead as possible. Keep the involved shoulder as relaxed as possible.
- FEEL: You may feel the stretch in your shoulder or the muscles surrounding the shoulder.
- COMPENSATION: Avoid arching your back as you perform this exercise. Avoid using your affected arm, this stretch is designed to be passive.
Stage 3: Thawing
In this stage, the shoulder is starting to "thaw' or improve in terms of pain and range of motion. Rehab in this stage is focused on functional use of the arm as well as progressive strengthening.
Exercise 05 of 06
Exercise demonstration
Shoulder CARs
View exercise instructions
- HOW: Standing with your arms at your side, bring one arm up in front of you as high as you can, palm facing in. Once you have your arm as high as you can, rotate your arm around to where your palm is facing out. As you rotate your arm out, rotate your arm and shoulder back until you can’t. At that point, rotate your hand back to the starting position and reverse the motion.
- FEEL: You should feel the muscles in your shoulder working.
- COMPENSATION: Keep your chest facing forward. Don’t twist back towards the moving arm. Slow and controlled motion, this is not about how fast you move your shoulder.
Exercise 06 of 06
Exercise demonstration
Standing Shoulder W - Band
View exercise instructions
- HOW: Anchor a band at about shoulder height. Face the band and grab one in each hand. Have your arms in front of you at chest height with your palms facing down. Pull your shoulder blades back, then bring your elbows back and rotate your arms back to end in a “W” position. Allow your arms to come back and repeat.
- FEEL: You should feel your shoulder muscles working, especially between your shoulder blades
- COMPENSATION: Keep your upper trap muscles relaxed, don’t shrug your shoulders.
Closing Thoughts
Frozen shoulder can be a challenging condition to deal with. Losing your shoulder range of motion while dealing with pain is a tough combination to come to terms with. However, knowing that with exercises you can perform on your own, it will get better over time, will keep you in the right mindset! Know that it does take time, but consistency will lead to great outcomes, with a great team behind you.
Take Ownership Of Your Shoulder Health
Movement from the shoulder girdle is what allows you to start to have access to feeding, grooming, and moving things around in your environment. Not that we like to play favorites or place one joint's importance over another one but I think it's safe to say, the shoulder is pretty dang important! It's gifted with movement in all planes of motion which then burdens the joint to have stability and strength to control the mobility that it has. You will learn to use isometrics as a natural painkiller and utilize safe and effective strategies to restore function to the shoulder!
REFERENCES
- Yip, Michael MD1; Francis, Anna-Marie BS1; Roberts, Timothy MLS, MPH1; Rokito, Andrew MD1; Zuckerman, Joseph D. MD1; Virk, Mandeep S. MD1 Treatment of Adhesive Capsulitis of the Shoulder, JBJS Reviews: June 2018 - Volume 6 - Issue 6 - p e5 doi: 10.2106/JBJS.RVW.17.00165
- Nakandala, Piumi et al. "The Efficacy of Physiotherapy Interventions in the Treatment of Adhesive Capsulitis: A Systematic Review'. 1 Jan. 2021: 195-205
About The Author
Taryn Beaumont, PT, DPT, CLT, CF-L1, CNC
[P]rehab Writer & Content Creator
Taryn was born and raised in Maine and still resides there with her boyfriend and son. Taryn received her Doctorate in Physical Therapy from Husson University in 2010, and also carries a Bachelors in Kinesiology and Human Movement Science. She is a Certified Lymphedema Therapist, a Certified Crossfit Level 1 Trainer, and a NASM Certified Nutrition Coach. Taryn has 10+ years of experience in many different realms of PT, from the young athlete to the geriatric patient. Taryn considers herself a ‘lifelong learner’. She has special interests in oncology care and breast health, dry needling, and Crossfit training. In her free time, Taryn enjoys fitness, spending time with her family, continuing education, writing and reading, and is very excited to be a part of The [P]rehab team to educate and empower others to take control of their own health and wellness.