Frozen shoulder, or adhesive capsulitis, is a condition that results from inflammation or degeneration of the shoulder joint capsule, leading to pain and restricted movement. This condition typically affects individuals over the age of 45. If it occurs in younger individuals, it is usually not termed frozen shoulder.
There are four stages of frozen shoulder:
- Painful stage: Lasting up to 3 months, characterized by increasing pain and inflammation, limiting shoulder movement.
- Freezing stage: Lasting from 3 to 9 months, where shoulder movement becomes significantly restricted, along with persistent pain.
- Frozen stage: Lasting from 9 to 15 months, where shoulder movement is severely restricted but pain begins to decrease.
- Thawing stage: Lasting from 15 to 24 months, where shoulder movement gradually improves, pain diminishes, and symptoms may completely resolve by 20-24 months.
The progression of frozen shoulder reveals that the condition can indeed resolve on its own without treatment, but it can take more than two years. While some patients can endure and pass through all stages, more than 80% of patients find the pain during the freezing stage unbearable as it disrupts their daily lives. This includes difficulties like fastening a bra, combing hair, sleeping on the affected side, lifting objects, or raising the arm above the head. When daily activities are impacted, patients often go to see a medical doctor or physical therapist immediately.
In fact, seeing a physical therapist early on is beneficial. Treatment should begin early, while the joint is not yet frozen or still in the inflammatory stage, to reduce inflammation, alleviate pain, and maintain range of motion. This can help patients recover faster than if they were to wait for the condition to resolve on its own.
In my experience treating patients with frozen shoulders, the duration of treatment typically ranges from 1 to 6 months, with therapy sessions occurring 1-2 times per week, depending on the severity and stage of the condition. It’s important to start physical therapy early, ideally during the inflammatory stages, to minimize inflammation and pain, and to maintain or improve range of motion.
Physical therapy treatments include:
- Muscle relaxation through massage: Massaging helps to relax tightened or stiff muscles, reducing tension and enhancing blood circulation in affected areas.
- Pain reduction using physical therapy modalities: such as ultrasound, electrotherapy are employed to alleviate pain and aid in controlling muscle tightness.
- Muscle stretching: Stretching muscles that have become tight due to frozen shoulders helps increase range of motion and reduce muscle tension.
- Stretching the shoulder’s ligaments and capsule: Stretching the ligaments and capsule around the shoulder helps improve flexibility and facilitate shoulder joint movement.
- Joint mobilization techniques: Using mobilization techniques to move the shoulder joint helps increase its range of motion and improve flexibility.
- Exercises to increase shoulder movement: Activities focused on shoulder movement, such as rotational exercises and arm lifts, aim to enhance range of motion and flexibility.
- Exercises to strengthen the muscles around the shoulder: Strengthening exercises target the muscles around the shoulder to improve strength and flexibility, aiding in the prevention and management of recurring symptoms.
The crucial aspect in treating frozen shoulder is exercise to increase shoulder mobility. When the shoulder joint can move more freely, the surrounding muscle function can return to normal more quickly. As the muscles regain normal function, the patient’s pain tends to decrease. Therefore, patient cooperation is essential.
However, before engaging in any exercise, physical therapists like myself typically prioritize pain reduction first. If patients are in significant pain, they may be reluctant to exercise or, worst-case scenario, may avoid treatment altogether due to fear of exacerbating the pain. Therefore, during treatment, both physical therapists and patients need to remain patient and persistent.
If you’re reading this and suspect you might have a frozen shoulder, I have some simple exercises that you can do on your own to improve shoulder mobility.
The climbing wall exercise.
This is a simple one to increase shoulder range of motion. Start by using your fingers to climb up the wall until you feel some discomfort. Once you begin to feel this, try to move a bit further to increase the range of motion.
Do this 10 times, 1-2 times a day.
Abduction Climbing Wall.
Start by using your fingers to climb up the side wall until you feel some discomfort. Once you begin to feel this, try to move a bit further to increase the range of motion of your shoulder abduction.
Do this 10 times, 1-2 times a day.
Pendulum Exercise.
Stand and bend forward. Rotate the affected arm in a circular motion, starting with a radius of approximately 10 centimeters and gradually increasing the diameter.
Repeat this 10 times, 1-2 times a day.
Shoulder Flexion with Stick.
This exercise helps increase shoulder flexion using a stick. You can use simple household items like a broomstick, PVC pipe, or similar.
Start by slowly lifting the arm until you feel maximum movement at the painful side, then move further to increase normal range of motion.
Do this 10 times, 1-2 times a day.
Shoulder Extension with Stick.
Begin by slowly moving the arm backward. Once you feel maximum movement at the painful side, continue to move it backward a bit further to increase the range of motion.
Do this 10 times, 1-2 times a day.
Shoulder Hand Behind Back with Stick.
Start by slowly moving the affected arm behind your back. Gradually reach higher above your head to increase the range of motion at the painful side.
Do this 10 times, 1-2 times a day.
Shoulder Abduction with Stick.
Start by slowly moving the arm sideways. Once you feel maximum movement at the painful side, move it sideways a bit further to increase the range of motion.
Do this 10 times, 1-2 times a day.
Shoulder Flexion on Lying.
This exercise increases shoulder flexion using gravitational assistance.
Start by lying face up in a comfortable position. Slowly lift the arm upwards until you feel maximum movement at the painful side, then press a bit further to increase normal range of motion.
Do this 10 times, 1-2 times a day.
Shoulder Horizontal Adduction on Lying.
Start by lying face up in a comfortable position. Slowly move the arm across the body until you feel maximum movement at the painful side, then press a bit further to increase normal range of motion.
Do this 10 times, 1-2 times a day.
If you can exercise to improve shoulder mobility regularly, frozen shoulder symptoms can resolve faster, rather than taking more than 2 years. Therefore, if you suspect you have this condition, don’t forget to exercise regularly to increase shoulder range of motion.
Q&A
Q: I hardly use my arms or shoulders, why did this condition develop?
A: This condition arises from inflammation of the shoulder capsule due to compression, excessive use, or degeneration. Therefore, even if you haven’t used your shoulders much, changes in skeletal structure such as rounded shoulders or forward head posture can easily cause compression on the shoulder capsule.
Q: Can this condition resolve on its own if left untreated for two years?
A: Yes, it can resolve on its own. The adhered capsule gradually dissolves after the inflammation subsides. However, if you continue heavy shoulder use without rest, inflammation may persist, and adhesions may continue to form, potentially prolonging the body’s self-healing process.
Q: Can exercises to increase shoulder mobility be done safely in the second and third phases without increasing inflammation?
A: Yes, it can be done. It depends on the physical therapist’s discretion after assessment. Physical therapists assess the number and intensity of exercises based on symptoms to ensure they do not interfere with the body’s self-healing process or exacerbate inflammation.
Q: How can shoulder freezing be prevented?
A: Regularly exercise to increase shoulder mobility, avoid unnecessary shoulder strain such as lifting heavy objects, prolonged use of arms and shoulders, and avoid repeating the same posture for long periods. Regular stretching of muscles and adjusting shoulder structure can help avoid compression on the shoulder capsule. Sufficient rest allows the body to repair itself effectively.
PT Similan Insawang
Physical therapist
