Frozen shoulder, also known as adhesive capsulitis, is a condition that causes stiffness, pain, and limited range of motion in the shoulder joint. This condition develops gradually, often without a clear cause, and can significantly impact daily activities, from dressing and grooming to reaching for objects.
Understanding Frozen Shoulder
Frozen shoulder occurs when the capsule of connective tissue surrounding the shoulder joint thickens and tightens, restricting movement. This process is often accompanied by inflammation and the formation of scar tissue, which further limits the joint’s mobility. The condition typically progresses through three stages:
1. Freezing Stage: This initial phase is marked by a gradual onset of shoulder pain. As the pain worsens, the shoulder’s range of motion becomes increasingly restricted. This stage can last anywhere from six weeks to nine months.
2. Frozen Stage: In this phase, pain may begin to diminish, but the shoulder becomes stiffer, and movement is more restricted. Daily tasks, such as reaching behind your back or lifting your arm, become increasingly difficult. This stage can last from four to six months.
3. Thawing Stage: The final phase is characterized by a slow improvement in shoulder mobility. Over time, the pain lessens, and the range of motion gradually returns. Full recovery can take anywhere from six months to two years.
Causes and Risk Factors
The exact cause of frozen shoulder is not fully understood, but it is often associated with prolonged immobility of the shoulder, such as after an injury, surgery, or a medical condition like a stroke. It is more common in individuals between the ages of 40 and 60, and women are more likely to be affected than men.
Certain medical conditions, such as diabetes, thyroid disorders, and cardiovascular disease, increase the risk of developing frozen shoulder. Additionally, people with a history of shoulder injuries or surgeries are more susceptible to this condition.
How Physiotherapy Can Help
Physiotherapy is a highly effective treatment for frozen shoulder, helping to relieve pain, restore mobility, and accelerate recovery. The approach to physiotherapy will vary depending on the stage of the condition, with the primary goals being to reduce pain, improve shoulder movement, and eventually restore full function.
1. Pain Management
In the early stages of frozen shoulder, managing pain is crucial to allow for gentle movement and prevent further stiffness. Physiotherapists may use a combination of techniques to alleviate pain, including:
Heat and Cold Therapy: Applying heat before exercises helps to relax the muscles and improve flexibility, while cold therapy after exercises can reduce inflammation and pain.
Ultrasound Therapy: This treatment uses sound waves to penetrate deep into the tissues, promoting blood flow and reducing inflammation.
Electrotherapy: Techniques such as TENS (Transcutaneous Electrical Nerve Stimulation) can be used to manage pain by stimulating the nerves and blocking pain signals.
2. Restoring Range of Motion
As the condition progresses, restoring shoulder mobility becomes the primary focus. A physiotherapist will guide you through a series of gentle stretching and range-of-motion exercises designed to increase flexibility and gradually improve movement. These exercises target the shoulder joint capsule, as well as the surrounding muscles and tendons.
Some common exercises may include:
Pendulum Exercises: These involve gently swinging the arm in small circles while bending at the waist, allowing gravity to assist in the movement.
Passive Stretching: A therapist may assist in moving your arm through its range of motion to stretch the shoulder capsule.
Shoulder Flexion and Rotation Exercises: These exercises aim to improve both the forward and backward movement (flexion) and the rotational movement of the shoulder.
3. Strengthening Exercises
Once mobility begins to improve, strengthening exercises are introduced to help support the shoulder and prevent future stiffness. Strengthening the muscles around the shoulder joint, particularly the rotator cuff and scapular stabilizers, is essential for maintaining stability and function.
Physiotherapists will prescribe exercises that are appropriate for your stage of recovery, ensuring that the shoulder is not overloaded, which could exacerbate the condition.
4. Manual Therapy
Manual therapy, including joint mobilizations and soft tissue techniques, can be highly effective in improving shoulder mobility and reducing pain. These hands-on techniques are performed by a physiotherapist and may include:
Joint Mobilizations: Gentle movements applied to the shoulder joint to increase mobility and reduce stiffness.
Soft Tissue Manipulation: Techniques such as massage can help release muscle tension, improve blood flow, and promote healing.
5. Education and Self-Care
Education plays a key role in the management of frozen shoulder. Physiotherapists provide guidance on how to manage pain, perform exercises correctly, and avoid activities that could worsen the condition. They may also recommend modifications to your daily routine to minimize strain on the shoulder and promote healing.
Conclusion
Frozen shoulder is a painful and limiting condition, but with the right approach, recovery is possible. Physiotherapy offers a structured, evidence-based treatment plan that addresses pain, stiffness, and loss of function. By working with a physiotherapist, you can regain your shoulder mobility, reduce pain, and restore your ability to perform everyday activities. If you suspect you have a frozen shoulder, seeking early intervention from a physiotherapist can help accelerate your recovery and prevent long-term complications.