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Physiotherapy For Frozen Shoulder

Frozen shoulder is a painful condition that most commonly occurs in adults between the ages of 40 and 60 years old.  Technically known adhesive capsulitis, it is characterized by pain in the shoulder, poor range of motion and stiffness in the joint.  While often misdiagnosed as other conditions such as a rotator cuff injury, there are some key factors to identifying and treating frozen shoulder.

What Causes Adhesive Capsulitis?

Adhesive capsulitis is defined by inflammation in the joint with both pain and stiffness from the irritated connective and neurological tissues.  There are differing opinions on the contributing factors for the condition, but some individuals may be more prone to developing frozen shoulder.  These include patients with a history of:

  • Injury to the Area
  • Immobility (due to surgery, stroke or other reasons)
  • Diabetes
  • Parkinson’s Disease
  • Hyper or Hypothyroidism

What are the Symptoms of Frozen Shoulder?

Frozen Shoulder develops in stages, presenting with different symptoms depending on how far along your condition has progressed.

First stage:  The initial stage of frozen shoulder can be defined by pain that develops around the shoulder area and worsens over time.   In this phase, which can last as long as six months, patients often report difficulty sleeping due to intense pain.  Over the counter medications may help with pain relief, but prescription medication may be required in order to effectively manage symptoms. Over time, range of motion is affected as well.

Second stage:  The second stage of frozen shoulder is the freezing phase.  This stage can last anywhere from 4 months to a year. Pain may have diminished significantly at this point, but the adhesions in the shoulder joint can cause debilitating stiffness and severely impacted range of motion.  This can affect patients with day to day activities such as meal prep, dressing and cleaning, but may also impact one’s ability to work as well.

Third stage:  In this last phase, the shoulder begins to relax, or “thaw”.  Symptoms, including pain and stiffness, begin to dissipate, and range of motion returns – although rarely to the same degree as before experiencing Adhesive Capsulitis.  This recovery stage can last up to 2 years, depending on the patient and their tolerance for activity and therapy.

How Is Adhesive Capsulitis Diagnosed?

Your doctor or physiotherapist can diagnose frozen shoulder with a thorough examination.  Key indicators include:

  • Pain in and around the shoulder
  • Difficulty sleeping due to pain in shoulder and surrounding areas
  • Inability to pass simple range of motion tests such as throwing a ball or reaching overhead

In some cases, an MRI may be completed in order to obtain a definitive diagnosis, although this is often not required since an experienced practitioner can assess the distinctive range of motion challenges associated with frozen shoulder.

How is Frozen Shoulder Treated?

The treatment for frozen shoulder depends largely on the stage of the condition.

In Phase 1 – Treatment can consist of over the counter or prescription pain relievers, and possibly cortisone injections to relieve pain and improve range of motion.  Your physiotherapist may choose a number of treatment options at this point, including:

  • Gentle massage or manipulation
  • Acupuncture
  • Application of Kinesiology Tape
  • At home stretches and exercises

In Phase 2 – Treatment focuses more on improving stiffness and range of motion.  Patients benefit from strengthening techniques in this phase, in order to reduce pain and inflammation, and to decrease recovery time.

  • Carefully monitored manipulations
  • Gradually increased stretches and exercises
  • Acupuncture
  • Kinesiology tape
  • At home exercises

In Phase 3 – Patients will work with their physiotherapist to maximize range of motion and decrease stiffness in their joint.  The focus at this point in treatment is to improve strength and minimize long term effects of frozen shoulder.

  • Tailored mobilizations and stretches
  • Musculoskeletal manipulations
  • At home exercises

If you have stiffness or pain in your shoulder, and you suspect that you might have Adhesive Capsulitis, it’s important to get a clear diagnosis and a treatment plan in place as soon as possible.  Physiotherapy can decrease recovery time, relieve pain and improve range of motion for patients suffering with Frozen Shoulder.