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.

LISTEN: DO I NEED A CORTICOSTEROID INJECTION?

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.

Shoulder Pendulum

Sample Phase I of Shoulder Rehab Program

 

Pulleys

 

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.

Posterior Cuff Soft Tissue Mobilization

Read this article for the best posterior cuff mobility exercises.

 

The Prehab membership is the anti-barrier solution to keeping your body healthy. Access state-of-the-art physical therapy, fitness programs, and workouts online in the comforts of your own home or gym! Taking control of your health with exercise & education from the palm of your hand has never been easier. Get access to 50+ programs, 100+ unique workouts, and 3000+ exercises to build your own workout routines. Trial it for free, and learn how to get out of pain, avoid injury, and optimize your health with [P]rehab!

 

Supine Shoulder Flexion PROM

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.

Shoulder CARs

 

Standing Shoulder W – Band

Sample Phase III of Shoulder Rehab Program

 

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

1. 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
2. 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.

 

 

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.