Understanding a Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition that causes shoulder joint stiffness and pain that can last for more than two years. The condition limits the shoulder’s range of motion and makes everyday activities challenging.

Physiotherapy is a highly recommended treatment to help manage and eventually overcome the symptoms of a frozen shoulder.

Understanding a Frozen Shoulder

Causes and Risk Factors

A frozen shoulder occurs when the capsule around the shoulder joint tightens and sticks to the humeral head or ball of the shoulder joint.

It mainly affects people aged 40 to 60, with women more commonly affected than men. Risk factors include diabetes, thyroid problems, and prolonged shoulder immobility.

Symptoms and Diagnosis

The main symptoms of a frozen shoulder are stiffness, pain, and limited motion in all directions. The shoulder may feel tight and very sore, making it hard to move the arm. The pain, in some cases, can be described as “nauseating”, “crippling”, “relentless”, or “bring you to tears”, all of which can severely impact sleep and quality of life.

The complex nature of a Frozen Shoulder means a diagnosis is made based on the patient’s symptoms and signs (clinical diagnosis), medical history, and physical exam.

Historical factors are important to consider, with things like diabetes, hypothyroidism and recent surgery being strongly correlated with the onset of Frozen Shoulder. Physically, there will be a reduction in both active and passive range of motion, which is most limited by combined abduction and external rotation. It is important to exclude other causes of stiffness, so an X-ray is essential to rule out things like arthritis, osteosarcomas and lock dislocations. MRI is less of a priority, although it can show features that are “suggestive” of a Frozen Shoulder, such as joint capsule thickening or biceps tenosynovitis.

Stages of Frozen Shoulder

It is generally accepted that a frozen shoulder typically progresses through three stages:

1. Freezing Stage: Pain increases, and range of motion starts to decrease.
2. Frozen Stage: Pain may lessen, but the shoulder remains stiff.
3. Thawing Stage: Movement gradually improves.

Initial Pain Relief Strategies

During a frozen shoulder’s initial painful, freezing phase, the main goal is to relieve pain. Avoiding movements that cause pain is crucial. Gentle shoulder movements are recommended, and more intensive physical therapy should be avoided at this stage.

Medications and Injections

1. Start with over-the-counter pain relievers like paracetamol. Take it at regular intervals, up to the recommended daily dose.
2. If paracetamol doesn’t work, try an oral painkiller such as ibuprofen. If it doesn’t help, stop using it.
3. A doctor may prescribe stronger painkillers or a steroid injection in your shoulder for stronger pain relief.

Precautionary Measures

• Avoid activities that cause pain.
• Only move your shoulder gently.
• Perform simple, pain-free exercises rather than intensive physical therapy.

Role of Heat and Ice

• To help with pain, apply an ice pack or a bag of frozen vegetables to the shoulder for 10 to 15 minutes several times a day.
• Heat can also be beneficial. Use a warm towel or heating pad on the shoulder to relax the muscles and reduce pain.

The initial phase, or painful, freezing phase as it’s known, should be focussed on pain relief. Avoid any activities that cause pain as the best results have been found in patients who performed simple pain-free exercises rather than intensive physical therapy.

Physiotherapy Techniques for Frozen Shoulders

Physiotherapy is a key treatment for frozen shoulder as it targets reducing pain and improving mobility, combining various techniques to help patients regain shoulder function.

Effectiveness of Physiotherapy

Success Rates

Physiotherapy has shown promising results in treating frozen shoulder. Many people experience a significant reduction in pain and improved mobility after consistent therapy sessions. Studies indicate that shoulder-specific exercise therapy effectively reduces pain and enhances function, leading to increased quality of life.

Compared with Other Treatments

Physiotherapy stands out compared to other treatments like medications or surgery due to its noninvasive nature and long-term benefits. While medications may offer quick pain relief, they often come with side effects. Surgery, on the other hand, involves risks and a longer recovery period. Physiotherapy, however, focuses on gradual improvement through targeted exercises and manual therapy, making it a safer and more sustainable option.

Patient Testimonials

Many patients have shared positive experiences with physiotherapy for frozen shoulders. They often highlight the personalised approach and their gradual but steady progress. One patient mentioned, “I continued with physiotherapy until my symptoms were completely resolved.” This sentiment is echoed by many who have found relief and regained their shoulder mobility through dedicated physiotherapy sessions.

Physiotherapy is most effective during the thawing phase of a frozen shoulder. As the patient’s tolerance level increases, more intense stretching and exercises can be performed to influence tissue remodelling.

Additional Therapies to Complement Physiotherapy

When dealing with a frozen shoulder, physiotherapy can be enhanced with other treatments to improve outcomes. These additional therapies can help reduce any pain and increase range of motion. Combining these therapies with physiotherapy can lead to better results.

Creating a Personalised Physiotherapy Plan

Assessment by a Physiotherapist

An assessment by a physiotherapist is the first step in creating a personalised treatment plan for individuals suffering from frozen shoulders. The physiotherapist will evaluate your shoulder’s range of motion, strength, and pain levels, helping identify your shoulder’s specific needs and limitations.

Setting Goals and Milestones

Track progress by setting clear and achievable goals. Goals should be specific, measurable, and time-bound. For example, you might aim to increase your shoulder’s range of motion by a certain degree within a month. Milestones help in keeping you motivated and focused on your recovery journey.

Monitoring Progress

Regularly monitoring and adjusting the treatment plan is essential. The physiotherapist will track your progress through follow-up sessions and make necessary changes to ensure continuous improvement. This might include modifying exercises or introducing new techniques to address any emerging issues.

Personalized treatment plans are key to effective recovery from a frozen shoulder as they utilise a range of evidence-based techniques, including manual therapy and resistance training exercises.

Long-term Management and Prevention

Maintaining Shoulder Mobility

To keep your shoulder moving well, it’s important to do regular exercises. Stretching daily can help keep your shoulder flexible. Simple activities like reaching up and across your body can make a big difference. If you stop moving your shoulder, it might get stiff again.

Preventing Recurrence

To avoid getting a frozen shoulder again, you should keep exercising even after feeling better. Avoiding activities that can hurt your shoulder is also a good idea. If you feel pain, stop and rest. A warm towel or ice pack can sometimes help ease the pain.

Lifestyle Modifications

To maintain healthy shoulders, focus on good posture and staying active. Avoid prolonged sitting whenever possible. If you have other health problems, like diabetes, managing them well can also help prevent shoulder issues.

Remember, keeping your shoulder healthy takes time and effort, but avoiding pain and stiffness is worth it.

Conclusion

In summary, treating a frozen shoulder with physiotherapy can be highly effective. Working with a physiotherapist can reduce pain, improve mobility, and speed up recovery. The combination of exercises, manual therapy, and other treatments like heat pads and icing can make a big difference. Remember, following your physiotherapist’s advice and staying consistent with your exercises is important. With patience and dedication, you can regain full use of your shoulder and get back to your daily activities.

Frequently Asked Questions