Frozen shoulder, also known as adhesive capsulitis, is a condition that causes pain and stiffness in the shoulder joint, affecting approximately 2-5% of the general population. It is more prevalent in individuals between the ages of 40 and 60, with women being at a higher risk. Alarmingly, up to 20% of people with diabetes may develop frozen shoulder, and the condition is more likely to occur in the non-dominant arm.

If left untreated, frozen shoulder can last anywhere from 1 to 3 years and has a recurrence rate ranging from 10% to 35% after successful treatment. This condition not only impacts an individual’s quality of life but also poses a significant economic burden, accounting for an estimated 2.4% of all primary care visits related to musculoskeletal conditions and costing the healthcare system over $4 billion annually in the North America.

Possible Causes of Frozen Shoulder

Here are some of the common causes and risk factors that can contribute to the development of frozen shoulder:

1. Injury or trauma: Injuries to the shoulder, such as a fracture, dislocation, or muscle tear, can lead to immobilization and subsequent freezing of the shoulder joint.
2. Surgery: Certain surgical procedures involving the shoulder, such as rotator cuff repair or breast surgery, can increase the risk of developing frozen shoulder due to the disruption of the joint capsule and prolonged immobilization.
3. Diabetes: People with diabetes, especially those with poorly controlled blood sugar levels, are at a higher risk of developing frozen shoulder. The exact reason is not fully understood, but it is believed to be related to the effects of diabetes on connective tissues.
4. Thyroid disorders: Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) have been associated with an increased risk of frozen shoulder, potentially due to the effects of thyroid hormones on connective tissues.
5. Immobilization: Prolonged immobilization of the shoulder, such as after a stroke, heart surgery, or due to conditions like Parkinson’s disease, can lead to the development of frozen shoulder.
6. Autoimmune diseases: Certain autoimmune disorders, such as rheumatoid arthritis, can increase the risk of developing frozen shoulder due to the inflammation and thickening of the joint capsule.
7. Cardiovascular disease: Individuals with cardiovascular diseases, such as heart disease or a history of heart attack, have a higher incidence of frozen shoulder, although the exact reason is not well understood.
8. Idiopathic causes: In some cases, frozen shoulder may develop without any apparent underlying cause, which is referred to as idiopathic frozen shoulder.

Stages and Symptoms

The severity and duration of symptoms can vary from person to person. Some individuals may experience a more rapid progression through the stages, while others may have a more prolonged course. Here are the stages and symptoms of frozen shoulder:

Stages:

1. Freezing Stage (6 weeks to 9 months):
   • This is the initial stage where the pain gradually increases and the range of motion starts to become limited.
   • Symptoms include a dull, achy pain that worsens at night and with movement.
   • The shoulder becomes increasingly stiff and difficult to move.
2. Frozen Stage (4 to 9 months):
   • This is the most disabling stage, with severe pain and significant limitation of motion.
   • The shoulder is “frozen” in place, and any attempt to move it results in intense pain.
   • Activities of daily living, such as dressing, grooming, and reaching, become extremely challenging.
3. Thawing Stage (6 months to 2 years):
   • During this stage, the pain gradually subsides, and the range of motion starts to improve.
   • The shoulder may still feel stiff, but the overall mobility improves over time.
   • Physical therapy exercises play a crucial role in regaining full range of motion and strength.

Symptoms of Frozen Shoulder

1. Pain:
   • The pain can range from mild to severe and is often described as a dull ache or throbbing sensation.
   • The pain may worsen at night, making it difficult to sleep.
   • Activities that involve shoulder movement can exacerbate the pain.
2. Stiffness:
   • The shoulder joint becomes increasingly stiff, making it difficult to move the arm in any direction.
   • Simple tasks like reaching behind the back or overhead become challenging.
3. Limited Range of Motion:
   • The range of motion in the affected shoulder is significantly reduced, especially with external rotation and abduction (raising the arm out to the side).
   • Daily activities that require reaching, lifting, or overhead movements may become impossible.
4. Swelling and Warmth:
   • In some cases, the affected shoulder may appear swollen or feel warm to the touch, indicating inflammation.
5. Muscle Weakness:
   • Due to disuse and lack of movement, the muscles surrounding the shoulder may become weak and atrophy over time.

Physiotherapy as an Effective Treatment for Frozen Shoulder

Physiotherapy interventions could tailored to each individual’s specific needs and stage of frozen shoulder. Physiotherapists will continuously evaluate progress and adjust the treatment plan accordingly, ensuring a comprehensive approach to restoring optimal shoulder function and preventing recurrence.

Pain Management Techniques:

1. Modalities:
   • Ultrasound: This uses high-frequency sound waves to generate deep heat within the tissues, promoting blood flow and reducing muscle spasms.
   • TENS (Transcutaneous Electrical Nerve Stimulation): This delivers low-voltage electrical currents to the affected area, helping to reduce pain perception.
   • Cryotherapy: The application of cold packs or ice can help manage acute pain and inflammation.
   • Shockwave Therapy: This involves the application of targeted, high-energy sound waves to the affected area, which can help break up adhesions and promote healing by increasing blood flow.
2. Manual Therapy:
   • Massage Therapy: Various massage techniques, such as Swedish massage, deep tissue massage, and trigger point therapy, can help relax tense muscles, improve circulation, and reduce pain and stiffness in the affected area.
   • Soft tissue mobilization: Techniques such as myofascial release can help reduce muscle tension and improve mobility.
   • Joint mobilization: Physiotherapists use skilled hands-on techniques to gently move the shoulder joint through its available range of motion, promoting improved flexibility.

Range of Motion Exercises:

1. Stretching:
   • Gentle stretching exercises are crucial for regaining mobility in the frozen shoulder.
   • These may include pendulum swings, wall walks, and other stretches targeting the shoulder’s limited ranges.
   • Physiotherapists can guide patients through proper stretching techniques and progressions.
2. Joint Mobilization:
   • Physiotherapists may use specialized techniques to apply graded oscillatory movements to the shoulder joint, helping to restore normal joint mechanics and range of motion.
   • These techniques can also help break up adhesions and scar tissue that may be limiting movement.

Strengthening Exercises:

1. Resistance Training:
   • As the shoulder regains mobility, physiotherapists will introduce strengthening exercises using resistance bands, weights, or other equipment.
   • Strengthening the rotator cuff and surrounding muscles is essential for stabilizing the shoulder joint and preventing future injuries.
2. Functional Training:
   • Physiotherapists will also incorporate exercises that mimic everyday activities, such as reaching overhead, lifting objects, and performing work-related tasks.
   • This functional training helps patients regain strength and confidence in using their affected arm in daily life.

Postural Education:

1. Proper Posture:
   • Physiotherapists will assess and provide guidance on maintaining good posture, as poor posture can contribute to shoulder pain and dysfunction.
   • Exercises and strategies for improving posture may be recommended.
2. Ergonomic Advice:
   • Physiotherapists may suggest ergonomic modifications for work, home, or leisure activities to reduce strain on the shoulder and prevent further aggravation.

Benefits of Physiotherapy

Physiotherapy plays a vital role in the management and rehabilitation of frozen shoulder, offering numerous benefits that can significantly improve a patient’s quality of life. The primary benefits of physiotherapy for frozen shoulder include:

1. Pain reduction:
   • Through the use of modalities like ultrasound, TENS, cryotherapy, and manual therapy techniques, physiotherapists can effectively reduce pain and discomfort associated with frozen shoulder.
   • Proper pain management is crucial for facilitating further therapeutic interventions and improving overall function.
2. Improved range of motion:
   • One of the main goals of physiotherapy for frozen shoulder is to restore the full range of motion in the affected joint.
   • Physiotherapists use a combination of stretching exercises, joint mobilization techniques, and manual therapy to gradually increase flexibility and mobility.
   • Regaining range of motion is essential for performing daily activities and preventing long-term complications.
3. Increased strength and function:
   • As the shoulder regains mobility, physiotherapists incorporate strengthening exercises to rebuild muscle strength and endurance.
   • Functional training exercises mimic everyday activities, helping patients regain confidence and independence in performing tasks like reaching overhead, lifting objects, and engaging in work or leisure activities.
4. Prevention of further complications:
   • Physiotherapy can help prevent further complications associated with frozen shoulder, such as muscle atrophy, joint stiffness, and permanent loss of mobility.
   • By addressing the underlying issues and promoting healing, physiotherapy can reduce the risk of long-term disability and improve overall shoulder health.
5. Education and self-management strategies:
   • Physiotherapists provide valuable education on proper posture, ergonomics, and self-management strategies to prevent recurrence and maintain the gains achieved through therapy.
   • Patients learn techniques for self-stretching, exercises, and activity modifications to incorporate into their daily routines.
6. Improved quality of life:
   • By effectively managing pain, restoring mobility, and improving function, physiotherapy can significantly enhance a patient’s overall quality of life.
   • Regaining independence in activities of daily living, work, and leisure pursuits can positively impact mental and emotional well-being.

Prevention and Self-Management Strategies

While frozen shoulder can be a debilitating condition, there are several strategies that individuals can employ to help prevent its occurrence or recurrence, as well as manage the symptoms effectively. These strategies include:

1. Maintaining shoulder mobility:
   • Regular stretching and gentle exercise routines can help maintain the flexibility and range of motion in the shoulder joint.
   • Physiotherapists can recommend specific exercises and stretches tailored to an individual’s needs and risk factors.
2. Postural awareness:
   • Poor posture can contribute to muscle imbalances and strain on the shoulder joint, increasing the risk of developing frozen shoulder.
   • Practicing good posture, especially during prolonged sitting or standing activities, can help reduce the risk.
3. Stretching and exercise routine:
   • Incorporating a regular stretching and exercise routine can help maintain shoulder mobility and strength.
   • Gentle exercises like pendulum swings, wall walks, and resistance band exercises can be beneficial.
4. Activity modification:
   • Modifying activities or using proper ergonomic techniques can help reduce strain on the shoulder joint and prevent further aggravation.
   • Physiotherapists can provide guidance on activity modifications, posture correction, and proper body mechanics.
5. Cold and heat therapy:
   • Applying cold packs or taking anti-inflammatory medication can help manage inflammation and pain during the early stages of frozen shoulder.
   • Gentle heat application can also help relax muscles and improve range of motion before stretching exercises.
6. Stress management:
   • Stress and tension can contribute to muscle tightness and exacerbate shoulder pain.
   • Incorporating stress management techniques like deep breathing, meditation, or yoga can help promote relaxation and improve overall well-being.
7. Compliance with physiotherapy program:
   • Adhering to the prescribed physiotherapy program, including exercises, stretches, and modalities, is crucial for achieving optimal results and preventing recurrence.
   • Consistent and diligent participation in the rehabilitation process is key to long-term success.

Treat Your Frozen Shoulder At Our Physiotherapy Clinic In Milton and Pickering

Frozen shoulder can be a debilitating condition that significantly impacts an individual’s quality of life. However, with the right physiotherapy intervention from an experienced physiotherapist, the symptoms can be effectively managed, and full recovery is achievable.

At Pro Fusion Rehab, our team of highly trained physiotherapists is dedicated to providing comprehensive and personalized treatment plans for individuals suffering from frozen shoulder. We utilize a wide range of evidence-based techniques, including manual therapy, mobilization exercises, modalities, and strengthening programs, to address the specific needs of each patient.

If you or someone you know is experiencing the symptoms of frozen shoulder, don’t hesitate to contact one of our Physiotherapy clinics in Milton, and Pickering. Our compassionate and knowledgeable physiotherapists will work closely with you to develop a tailored treatment plan and provide the support you need throughout your recovery journey.

References:

1. “Frozen Shoulder (Adhesive Capsulitis).” Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15165-frozen-shoulder-adhesive-capsulitis
2. “Frozen Shoulder.” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684
3. Kelley, Michael J., et al. “Shoulder Pain and Mobility Deficits: Adhesive Capsulitis.” Journal of Orthopaedic & Sports Physical Therapy 43.5 (2013): A1-A31. https://www.jospt.org/doi/10.2519/jospt.2013.0302
4. “Physical Therapy Guide to Frozen Shoulder.” American Physical Therapy Association. https://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=85e1b10e-36d4-4a1a-b762-8624aeab0b0d
5. “Frozen Shoulder: Physiotherapy Treatment.” Physio Works. https://physioworks.com.au/injuries-conditions-1/frozen-shoulder