If you’re struggling with frozen shoulder, understanding how physiotherapy can help treat this condition is crucial. Physiotherapy treatment of frozen shoulder involves tailored exercises and techniques designed to relieve pain, restore mobility, and prevent further stiffness. This article will guide you through the stages of frozen shoulder and the specific physiotherapy treatments recommended for each phase.
Key Takeaways
- Frozen shoulder, or adhesive capsulitis, is characterized by pain and restricted movement, often occurring after immobilization due to injury or illness.
- The condition progresses through three stages: freezing, frozen, and thawing, each requiring tailored management strategies to improve shoulder mobility and reduce pain.
- Physiotherapy is essential for treating frozen shoulder, focusing on pain management, mobility exercises in the early stages, and strengthening exercises during recovery.
Understanding Frozen Shoulder
Frozen shoulder, medically termed adhesive capsulitis, is a painful affliction that targets the shoulder joint, leading to severe discomfort and restricted movement. This condition often develops gradually, making it hard to pinpoint the exact moment it began. Immobilisation due to injury, surgery, or illness often underpins its onset. As the shoulder capsule thickens and tightens, the restriction and pain associated with frozen shoulders increases.
The symptoms are unmistakable: an aching pain that makes lifting the arm or reaching behind the back a herculean (and often extremely painful) task. Affecting about 2% to 5% of the population, frozen shoulder can be very debilitating and can often take a long time to resolve completely, so having someone guide you through this process is of the utmost importance.
Distinguishing it from a rotator cuff tear is also important. At first glance, and upon assessment, they can present very similarly as they both cause severe pain and significant loss of shoulder function in everyday life. There are signs to differentiate the two conditions though, so it’s important your physio is experienced in the diagnosis of shoulder conditions.
Stages of Frozen Shoulder
Frozen shoulder progresses through three broad stages: the freezing stage, the frozen stage, and the thawing phase. Each stage presents unique challenges and frozen shoulder symptoms, requiring different management strategies. Typically, this condition spans one to three years, with symptoms building to a point before they eventually improve. The journey through these stages is marked by stiffness, severe pain, and loss of shoulder mobility, profoundly impacting daily activities, especially for those in the earlier stages of a developing frozen shoulder.
Recognising these stages helps in managing and treating frozen shoulder more effectively. Each stage presents unique characteristics and treatment approaches.
Freezing Stage
The freezing stage is the onset of frozen shoulder, marked by severe shoulder pain that limits mobility. Finding a comfortable position becomes challenging as the pain intensifies. At this early stage, pain relief methods such as medication and cortisone injections can be beneficial. Consultation with a physiotherapist during this stage helps in managing pain and preventing further deterioration.
There is some evidence around the benefits of early cortisone injections and the possibility of reducing the severity of the frozen shoulder progression meaning you may maintain greater range and have less pain through-out your time managing the condition. But, the adhesive capsulitis process has to be identified and the injection administered early on in the process for it to have a positive affect.
Gentle mobility exercises, like pendulum swings and passive external rotation exercises, are recommended to maintain some degree of shoulder mobility without aggravating the pain too much. Activities and positions that strain the shoulder should be minimised to avoid worsening the condition.
Frozen Stage
As the condition progresses into the frozen stage, shoulder movement becomes even more restricted, and stiffness remains despite some relief from the severe pain. This stage, which can last from nine to fifteen months, is characterised by a significant reduction in shoulder motion. During this period, lifting the shoulder often leads to discomfort due to the persistent stiffness.
Managing pain remains important, with methods like heat or ice pack application offering some relief. Gentle shoulder exercises are crucial to maintain some movement and prevent further muscle atrophy. Stretching exercises for the chest and back muscles should be incorporated to help manage stiffness.
Exercises like scapular retraction can be beneficial, but aggressive exercises should be avoided to prevent worsening the pain. Maintaining a careful balance between activity and recovery is key to managing symptoms effectively during the frozen stage.
Thawing Phase
The thawing phase shows the gradual return of shoulder mobility after months of stiffness. During this stage, symptoms such as pain begin to diminish, and improvements in shoulder stiffness are noticeable. This phase typically lasts from fifteen to twenty-four months, signalling the recovery from the frozen shoulder condition.
During the thawing phase, physiotherapy helps speed up recovery and restore shoulder function. Strengthening exercises become crucial to counteract muscle weakness caused by the previous inactivity. These exercises can evolve from isometric holds to the use of resistance bands and free weights, promoting better shoulder function and range of motion. We can’t stress how important it is to rebuild the strength and capacity of the muscles, ligaments and other tissues in your shoulder again to help you successfully return to your favourite activities, sports and social endeavours without complications or overuse injuries.
Diagnosing Frozen Shoulder
Diagnosing frozen shoulder involves a thorough physical examination where both active and passive range of motion tests are integral. Your physiotherapist will assess the shoulder’s condition by evaluating specific arm movements during the examination. While frozen shoulder can often be diagnosed based on symptoms alone, imaging tests like X-rays and ultrasound may be utilised to exclude other conditions such as rotator cuff tears or osteoarthritis.
Early medical intervention can lessen the severity and duration of symptoms. In some cases, seeing an orthopedic surgeon may be necessary, especially if there are concerns about underlying health issues related to the frozen shoulder.
Timely diagnosis and intervention can significantly impact recovery, so seeking professional help when symptoms first appear is vital.
Physiotherapy Treatment Options
Physiotherapy is the cornerstone of treating frozen shoulder, particularly for increasing shoulder mobility and reducing pain. A physiotherapist ensures safe progression and can help guide you through the more difficult parts of managing with a frozen shoulder including activity modifications and advice on sleeping positions – something that can be quite challenging during the early to mid stages. Physiotherapy treatments are tailored to the stage of frozen shoulder, with specific techniques and exercises designed to address the unique challenges of each phase.
During the frozen stage, mobility exercises performed under the guidance of a physiotherapist are crucial. In the thawing phase, mobilisation and strengthening exercises help restore shoulder function and improve overall range of motion.
Let’s explore the different physiotherapy treatment options available.
Pain Management Techniques
Managing pain is a significant aspect of treating frozen shoulder, especially during the freezing stage when severe pain can limit mobility. Pain relief methods such as heat or ice pack application can be effective. Patients should apply these packs before starting exercises for frozen shoulder treatment to relieve pain and make movement easier.
Anti-inflammatory medications are often advised during the freezing phase to reduce pain and inflammation. Corticosteroid injections can also be used to reduce inflammation and improve symptoms in the shoulder joint, especially if administered early in the condition’s onset.
Another technique, hydrodilatation, involves injecting a saline solution to stretch the joint capsule and relieve pain.
Mobility and Stretching Exercises
Mobility and stretching exercises are vital in the initial stages of recovery to enhance shoulder movement without causing pain. Some specific exercises are active assisted shoulder forward flexion and active assisted shoulder external rotation. The pendulum exercise is also included in this list. These exercises help improve shoulder mobility and reduce stiffness.
Educating patients on the gradual progression in exercises is important to avoid exacerbating symptoms. Patients should focus on performing these exercises within a pain-free range, gradually increasing intensity as their condition improves.
Consistent practice of these stretches can significantly enhance recovery and restore shoulder function.
Strengthening Exercises
Strengthening exercises are essential during the thawing phase to restore shoulder function and prevent recurrence. Incorporating strength-building exercises into the recovery process is recommended once initial pain subsides and mobility improves. Exercises such as scapular retraction and resistance band workouts can help strengthen shoulder muscles and improve overall shoulder stability.
These exercises should be performed under the guidance of a physiotherapist to ensure they are done in a way that avoids aggravation of your pain and discomfort. Increasing the intensity and resistance of these exercises over time helps build muscle strength and supports long-term recovery.
Role of Physiotherapy in Recovery
Physical therapy is instrumental in providing pain relief and helping patients regain functional motion in the shoulder. Regular physiotherapy can significantly enhance the recovery for frozen shoulder patients. The therapeutic exercises and techniques used in physiotherapy are tailored to the individual’s needs, ensuring optimal recovery.
Recovery from frozen shoulder can be a slow process, often taking up to a year or more to fully regain shoulder mobility. Patience and adherence to prescribed exercises are crucial for successful recovery. It’s very important you find a physio who will pay attention to you as an individual and tailor your rehab program to make sure it’s optimised to your activities and goals.
Patient Education and Self-Help Strategies
Self-management plays a very important role due to the elongated time-frame of frozen shoulder. It’s often helpful to see your physio more regularly at the start of your condition to ensure your understanding of your condition and your individual plan of management and rehab is complete. As the condition progresses and you become more confident in your self-management and exercises, your physio visits become less frequent and the focus will often shift towards progressing your mobility and exercise routines as your strength, range of motion and function increase.
Self-management strategies can also include the use of over-the-counter pain relievers to help manage symptoms during recovery. Informing patients about risk factors and the importance of consistent exercise empowers them to take an active role in their recovery.
Summary
Frozen shoulder can be a challenging condition, but understanding its stages and the appropriate treatments can make a significant difference in recovery. Early intervention, consistent physiotherapy, and patient education are key to managing and overcoming frozen shoulder. By following a structured treatment plan and staying committed to prescribed exercises, patients can regain their shoulder mobility and improve their quality of life.
Remember, recovery from frozen shoulder is a journey that requires patience and perseverance. With the right knowledge and support, you can navigate this journey successfully and emerge stronger.
Frequently Asked Questions
What are the early signs of frozen shoulder?
The early signs of frozen shoulder include aching pain in the shoulder, difficulty lifting the arm, and challenges reaching behind the back. Recognising these symptoms early can help in seeking timely treatment.
How is frozen shoulder diagnosed?
Frozen shoulder is diagnosed primarily through a physical examination that evaluates both active and passive range of motion, often supplemented by imaging tests like X-rays or ultrasound to exclude other conditions.
What are the most effective treatments for frozen shoulder?
The most effective treatments for frozen shoulder include physiotherapy, pain management with heat or ice, anti-inflammatory medications, and specialised stretching and strengthening exercises. Implementing these strategies can significantly improve mobility and reduce discomfort.