Frozen Shoulder Treatment: How Physiotherapy Unlocks Mobility

Adhesive capsulitis, more commonly known as frozen shoulder, is a painful and often debilitating condition that affects the shoulder joint. It is characterized by stiffness, limited range of motion, and significant pain, making even simple daily activities challenging. Fortunately, physiotherapy offers effective treatments to help manage symptoms and restore shoulder function.

What is Frozen Shoulder?

Frozen shoulder occurs when the connective tissue surrounding the shoulder joint, known as the shoulder capsule, becomes thickened and inflamed. This inflammation leads to the formation of adhesions, causing the shoulder to stiffen and restrict movement. The condition typically progresses through three stages:

1. Freezing Stage: This initial phase is characterized by a gradual onset of pain and stiffness in the shoulder. The pain often worsens at night and can last for six weeks to nine months.
2. Frozen Stage: During this stage, pain may begin to decrease, but the shoulder remains stiff. This phase can last from four to six months.
3. Thawing Stage: In this final stage, shoulder movement gradually improves, and pain continues to diminish. Recovery can take six months to two years.

Causes and Risk Factors

The exact cause of frozen shoulder is not fully understood, but several factors can increase the risk of developing the condition:

• Age and Gender: Frozen shoulder is most common in people between the ages of 40 and 60 and is more prevalent in women.
• Diabetes: People with diabetes are at a higher risk of developing frozen shoulder.
• Immobilization: Prolonged immobilization of the shoulder, such as after surgery or injury, can lead to frozen shoulder.
• Other Medical Conditions: Conditions like thyroid disorders, cardiovascular disease, and Parkinson’s disease can increase the risk.

Symptoms of Frozen Shoulder

The primary symptoms of frozen shoulder include:

• Persistent pain in the shoulder joint
• Stiffness and limited range of motion
• Difficulty performing daily activities such as reaching overhead, dressing, or lifting objects
• Pain that worsens at night, affecting sleep quality

How Physiotherapy Can Help

Physiotherapy plays a crucial role in the management and treatment of frozen shoulder. A physiotherapist will develop a personalized treatment plan to address your specific needs, focusing on pain relief, improving mobility, and restoring function. Here are some key physiotherapy interventions for frozen shoulder:

1. Pain Management: Initial treatment often focuses on managing pain and inflammation. Physiotherapists may use modalities such as heat or ice therapy, ultrasound, and electrical stimulation to reduce pain and promote healing.
2. Manual Therapy: Manual therapy techniques involve hands-on treatments to improve joint mobility and reduce stiffness. Techniques such as joint mobilizations, soft tissue massage, and stretching can help break down adhesions and improve range of motion.
3. Stretching Exercises: Gentle stretching exercises are essential for improving flexibility and restoring movement in the shoulder joint. A physiotherapist will guide you through specific stretches tailored to your condition, such as:
   • Pendulum Exercises: These exercises involve gently swinging your arm while bent at the waist, using gravity to help loosen the shoulder joint.
   • Cross-Body Stretch: This stretch involves reaching the affected arm across your body and using the opposite hand to gently pull the arm further.
   • Towel Stretch: Holding a towel behind your back with both hands, gently pulling it upward with the unaffected arm to stretch the shoulder.
4. Strengthening Exercises: Strengthening exercises help improve the stability and function of the shoulder. Targeted exercises may include:
   • Isometric Exercises: These exercises involve contracting the muscles without moving the joint, such as pressing your hand against a wall.
   • Resistance Band Exercises: Using resistance bands to perform movements like shoulder abductions, external rotations, and rows helps build strength.
   • Scapular Stabilization Exercises: Strengthening the muscles around the shoulder blade, such as the rhomboids and serratus anterior, enhances overall shoulder stability.
5. Range of Motion Exercises: Range of motion exercises aim to gradually increase the movement of the shoulder joint. These exercises may include:
   • Wall Climbing: Using your fingers to “climb” up a wall as high as you can reach, then slowly lowering your arm back down.
   • Stick Exercises: Holding a stick or broom handle with both hands, using the unaffected arm to assist in moving the affected arm through various motions.
   • Pulley Exercises: Using a pulley system to gently move the affected arm through a full range of motion.
6. Posture Correction: Poor posture can contribute to shoulder pain and stiffness. Physiotherapists will assess your posture and provide exercises to improve alignment and reduce strain on the shoulder joint.
7. Education and Self-Management: Education is a vital part of physiotherapy for frozen shoulder. Your physiotherapist will teach you about the condition, provide advice on activity modification, and offer strategies for managing symptoms at home. This may include:
   • Activity Modification: Adjusting your daily activities to avoid aggravating the shoulder, such as using ergonomic tools or avoiding overhead movements.
   • Home Exercise Program: A tailored home exercise program to complement your in-clinic treatment and promote ongoing improvement.
   • Pain Management Techniques: Tips for managing pain at home, such as using heat or ice, practicing relaxation techniques, and maintaining a healthy lifestyle.

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Additional Treatment Options

While physiotherapy is a cornerstone of frozen shoulder treatment, other interventions may also be beneficial:

1. Medications: Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help manage pain and inflammation. In some cases, your doctor may prescribe stronger pain medications or corticosteroid injections.
2. Hydrodilatation: This minimally invasive procedure involves injecting a large volume of saline solution into the shoulder joint to stretch the capsule and improve range of motion. It is typically performed under imaging guidance, such as ultrasound or fluoroscopy.
3. Surgery: In severe cases of frozen shoulder that do not respond to conservative treatments, surgical intervention may be considered. Surgical options include manipulation under anesthesia (MUA) or arthroscopic capsular release. Surgery is usually a last resort after other treatments have failed.

Preventing Frozen Shoulder

While it may not always be possible to prevent frozen shoulder, certain strategies can reduce the risk of developing the condition:

1. Maintain Shoulder Mobility: Regularly perform shoulder stretches and range of motion exercises to keep the joint flexible and prevent stiffness.
2. Avoid Prolonged Immobilization: After an injury or surgery, follow your healthcare provider’s advice on rehabilitation to avoid prolonged immobilization of the shoulder.
3. Manage Underlying Health Conditions: If you have diabetes, thyroid disorders, or other medical conditions that increase the risk of frozen shoulder, work with your healthcare provider to manage these conditions effectively.
4. Practice Good Posture: Maintaining good posture can help reduce strain on the shoulder joint and prevent muscle imbalances that contribute to frozen shoulder.
5. Gradually Increase Activity Levels: When starting a new exercise program or increasing physical activity, gradually build up intensity and duration to avoid overloading the shoulder joint.

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Frozen shoulder can be a frustrating and painful condition, but with the right treatment and support, recovery is possible. Physiotherapy plays a crucial role in managing frozen shoulder by addressing pain, improving mobility, and restoring function. Through a combination of manual therapy, stretching and strengthening exercises, and education, physiotherapists help individuals regain their shoulder mobility and quality of life. If you’re experiencing symptoms of frozen shoulder, consult with a physiotherapist or healthcare professional for a comprehensive assessment and personalized treatment plan. With dedication and the right guidance, you can conquer frozen shoulder and return to pain-free living.