Overview

What is a frozen shoulder?

Frozen shoulder, also known medically as adhesive capsulitis, occurs when there is stiffness and pain in your shoulder joint due to the connective tissue in your shoulder thickening and becoming inflamed. This pain in your shoulder typically worsens at night and can make it difficult to sleep. Typically, the overall symptoms of pain and stiffness begin slowly and then worsen as time goes on. Frozen shoulder is believed to affect 2-5% of the population.¹ (NHS, Mayo Clinic)

What causes frozen shoulder?

The definite cause of frozen shoulder is unknown. However, having diabetes or having undergone surgery/ injury to your shoulder joint may result in frozen shoulder. (NHS)

What are the classifications of frozen shoulder?

There are two classifications for frozen shoulder: primary and secondary. Primary frozen shoulder is associated with another disease, for example, diabetes. However, secondary frozen shoulder occurs after you have experienced an injury to your shoulder or immobilisation.¹

How is frozen shoulder treated?

Frozen shoulder is treated via the following:

• Using painkillers: To begin with, you may be advised to take paracetamol to help with the pain you are experiencing, and over time, you may start taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
• Using stronger pain relief: if paracetamol and NSAIDs are ineffective in managing your pain, you may also be prescribed stronger pain relief from your doctor
• Steroid injection: A steroid injection in your shoulder can help to provide pain relief by reducing the inflammation in the connective tissue in your shoulder joint. This can aid in providing pain-free movement in your shoulder
• Physical therapy: You may be referred to a physical therapist who will give you exercises to do at home to help you regain movement in your shoulder joint (NHS)

When do symptoms get better?

The symptoms you experience of frozen shoulder, typically pain and stiffness, tend to ease over time with treatment, typically in 1-3 years. (Mayo Clinic)

The different stages of frozen shoulder

Frozen shoulder has three different stages: freezing, frozen and thawing, which will be discussed in more detail below

Freezing

The freezing stage is painful, lasting approximately 2-9 months, where there is a gradual onset of severe shoulder pain. This shoulder pain worsens at night and when you are sleeping.¹

Frozen

During the frozen stage, you will notice the pain start to subside. However, you will lose movement in your shoulder joint and will be unable to do internal rotations with your shoulder (rolling your shoulder towards your torso) or external rotations (rolling your shoulder away from your body). The frozen stage lasts between 4-12 months.¹

Thawing

The thawing stage can last between 5-26 months, and is where you start to regain the lost range of movement in your shoulder joint.¹

Physical therapy for frozen shoulder

How can physical therapy help you?

Sports massage

A physiotherapist can give you a sports massage, targeting your frozen shoulder, helping to increase blood flow to the affected joint. A sports massage will reduce inflammation in the joint and will provide you with relief from the pain you are experiencing. It is important to note that a sports massage will not cure a frozen shoulder. Overall, sports massages are a great way of managing any pain you are experiencing due to having a frozen shoulder. However, if you want to regain more movement in your shoulder exercises, recommended to you by a physiotherapist are the way forward. (SN Clinic)

Exercises for you to do at home

Your physiotherapist can give you different stretching exercises to increase your range of motion in your shoulder joint. Stretching exercises will lengthen the muscles in your shoulder joint and provide you with greater flexibility, reducing any stiffness you are experiencing due to having a frozen shoulder. (SN Clinic)

Physical therapy for the different stages of frozen shoulder

Freezing stage

Physical therapy can be implemented during the freezing phase of frozen shoulder; however, due to this stage being the most painful, pain-relieving techniques are the most common.

Nevertheless, patients can begin with a different range of motion exercises that can be completed for 1-5 seconds. A physiotherapist will guide you through these exercises, and then you can do them at home. Please note that at this stage, it is important not to aggravate a frozen shoulder; therefore, you should avoid any aggressive stretching as this may worsen your condition

Exercises

Stretching exercises

These exercises, termed ‘range of motion exercises’, should be done for 1-5 seconds.

Active assisted shoulder forward flexion with a wand

For this exercise, you should be lying on your back. You should hold your wand in both hands, shoulder-width apart. You should raise the wand over your head, trying to reach the floor, in a semicircular motion with slow and controlled movements. You should then bring the wand back over your head towards the bottom of your torso, in a semicircular motion again.

Active assisted shoulder external rotation with a wand

For this exercise, you should hold the wand (this can be a walking stick or broom, for example) in both arms with the elbow on the same side as the affected shoulder tucked into the side of your body at a 90-degree angle. On the affected side of your body, place a tea towel between your ribs and elbow. Place the hand of the unaffected limb halfway down the wand, and push the wand towards the side of your body that is unaffected by frozen shoulder.¹ (NHS)

Pendulum exercise

For this exercise, you will be standing. Using a table, lean over and let the affected arm hang; use your other hand to support yourself on the table.

Pendular exercises for your shoulder have three variations. For the first exercise, you should swing the arm side to side and repeat this 20 times, 4 times a day. Another variation is that you can let the affected arm swing forward and backwards, again 20 times, 4 times a day.  The third pendular exercise is that you can swing your affected arm in a clockwise direction, then in an anticlockwise direction, and you do this 20 times, 4 times a day. These are 3 different variations of motion for the pendular exercise.¹ (NHS)

Before these exercises, you can apply a heat or ice pack to your affected shoulder to help relieve pain. Using moist heat with stretching has been demonstrated in studies to improve how much your muscles can be lengthened and stretched.¹

Frozen stage

As seen with the freezing stage, before commencing physical therapy exercises, you can use an ice pack or a heat pack on the affected shoulder to relieve pain.¹

Exercises

You can proceed with the exercises you did in the freezing stage, at home, but ensure that you are not overexerting yourself. At the frozen stage, your physiotherapist may introduce strengthening exercises to ensure that your shoulder muscles are maintaining their strength.  The exercises that may be introduced at this stage, for you to do, are listed in the following section

Scapular retraction

The scapular retraction is an exercise that will strengthen your shoulder blades. This exercise can be performed sitting down or standing up, and involves pulling your shoulder blades towards each other, without shrugging your shoulders upwards.¹ (South Gate Physio)

Posterior capsule stretch

For this exercise, you need to bend the elbow on the side of the affected shoulder, at 90 degrees, at an angle so that your hand is in front of your opposite shoulder. Extend your shoulder so that your forearm is in front of your body and parallel to the ground. Using your opposite hand, hold the elbow of the forearm that is extended, and pull the arm across your body.¹ (Up to Date)

Isometric shoulder external rotation 

For this exercise, you can be either sitting or standing. The arm on the side of your affected shoulder should be at your side and bent at a 90-degree angle. Place a rolled-up towel under the arm that is bent. Then start to bring your other arm across your body and place the hand of your unaffected arm against the forearm of the bent arm. You should then start to push the bent arm into the other arm.¹ (NHS)

Summary

• Frozen shoulder, also known medically as adhesive capsulitis, is when there is stiffness and pain in your shoulder joint
• Frozen shoulder can occur due to a medical condition, for example, diabetes, or due to a sports injury
• Frozen shoulder has three different stages: freezing (which is very painful), frozen and thawing
• Frozen shoulder can be treated using painkillers, which are common in the freezing stage
• Stretching and range of motion exercises, provided by your physiotherapist, can help with gaining some movement in your shoulder during the freezing stage
• To help manage the pain of frozen shoulder, your physiotherapist may do a sports massage to reduce inflammation and promote blood flow to the affected shoulder
• In the frozen stage, your physiotherapist may give you exercises that are more targeted towards maintaining the strength in your muscles