Frozen shoulder is characterised by significant shoulder pain and stiffness. In Frozen shoulders the normally loose joint capsule and ligaments surrounding the joint become inflamed and thickened preventing free flowing movement in the shoulder joint. Hence why it is scientifically known as adhesive capsulitis -> the shoulder capsule becomes adhesed and stuck to itself.
Frozen shoulder is an extremely frustrating condition that tends to last anywhere from six months to three years and can really impact your life. Seeking early treatment can really help to get you on the path to recovery as quickly as possible.
The Frozen shoulder condition has three distinct stages that will determine exactly what symptoms and level of function you have. These three stages and signs and symptoms of each stage are:
- Stage One: The freezing stage: Gradual onset of diffuse severe shoulder pain
- This stage usually lasts for 2-9 months
- Pain is most severe during this stage, generally achy or burning pain
- Pain is worse at night, with pain often interrupting sleep
- Pain slowly gets worse over time, often pain extends into upper arm
- Pain is worse with movement
- Stage two: The frozen stage: The pain will begin to subside but with the progressive loss of shoulder movement
- This stage tends to last anywhere from 4-12 months
- Pain slowly improve and keeps you up at night less and less
- Shoulder range of motion tends to “freeze” less. You start to recover shoulder movement above your head, reaching behind back and out to the side
- Stage three: The thawing stage: Gradual return in range of motion back to normal
- This stage takes anywhere from 5-26 months
What causes Frozen Shoulder?
Frozen shoulder involves the contraction of tendons, ligaments, joint capsules and other soft tissues surrounding the shoulder joint. One way to think about it is that the soft tissues around the shoulder is transformed into a tough, thickened, contracted band. It is important to note that this is not a repetitive strain injury and actually no-one knows the precise causal mechanism behind frozen shoulder.
What we do know is that there are two main types of frozen shoulder, and we can identify certain risk factors of people likely to get this condition.
Primary Frozen shoulder: “out of the blue” frozen shoulder occurs without any obvious connection to any other condition.
Secondary Frozen shoulder: These frozen shoulder cases tend to follow other medical problems e.g. the onset of diabetes or even a surgery that as nothing to do with the shoulder. Some triggers tend to be more obvious than others.
Of all common musculoskeletal problems Frozen shoulder seems to be most obviously linked to being poor health and lifestyle factors. The main risk factors for developing Frozen shoulder include:
- Diabetics (30% of people having frozen shoulder also have diabetes)
- Metabolic syndrome
- Women are more likely to develop frozen shoulder especially women between 40-60 years of age
- Thyroid problems
- Other shoulder injuries
How does Physiotherapy help with frozen shoulder?
Frozen shoulder is a self-limiting condition and there is no magic bullet cure for it. However, our physiotherapy team have seen countless patients in the exact same stage of frozen shoulder as you. There are many treatments open to us and we will do everything in our power to help manage your symptoms and speed up recovery time so you can get back to doing what you love.
Physiotherapy treatment for frozen shoulder will depend on the exact stage of your condition. For instance, if you are in the freezing painful stage, we will look at treatments such as:
- Heat or ice therapy to reduce pain
- Gentle pain free range of motion exercises to reduce the shoulder stiffness
- Dry needling (link) for pain relief
- Scapula and thoracic to minimise contributing postural pain
- Utilising analgesics (in conjunction with your G.P)
Physiotherapy treatment during the frozen stage of frozen shoulder, when the pain has lessened but the shoulder remains very stiff, will focus more on regaining movement by treatments such as:
- Shoulder mobilisations – helping to break down adhesions in the shoulder joint
- Passive stretching
- Shoulder strengthening exercises
- Advice regarding if referral to a specialist is needed. This will be required for more invasive treatments such as:
- Corticosteroid injections
- Manipulation under anaesthetic: forced movement of the shoulder joint while under anaesthetic to stretch and tear the contracted capsule
It’s easy to think that frozen shoulder will just go away with time but seeking early treatment can reduce recovery time by months, so come in and let’s get started.