Physio for Frozen Shoulder

In this blog, we hope to bring you the latest research about frozen shoulder and how physio can help.

Frozen shoulder or “adhesive capsulitis”

Frozen shoulder or “adhesive capsulitis” is the development of a very stiff shoulder which can be very painful in the initial stages.  It typically affects those in there 40’s-60’s.  As yet an understanding we don’t totally understand how frozen shoulder occurs.  The capsule around the shoulder becomes highly painful and then contracts to become stiff.  

Contributing factors to the cause of frozen shoulder

These include:

genetics, 

aging (from 40s-60s) 

lifestyle (there are strong links to adiposity, meaning increased body fat)

metabolic (there are strong links with diabetes, thyroid and hyperlipideamia)

How do you know if you have frozen shoulder?

If you have any of the above contributing factors then this places you at great risk of having frozen shoulder.  Typically the condition begins with considerable constant shoulder pain.  The actual reason for the pain remains unclear. The shoulder becomes restricted in movement as the capsule contracts, typically in movements reaching the arm outwards, behind you or overhead. This is known as the “freezing phase”.

Over many months the shoulder will become less painful but remain very stiff and restricted in movement – this is know as the “frozen phase”.  Over yet more months the shoulder will slowly improve with the range coming back, know as the “thawing phase”.

Diagnosis of frozen shoulder can be confirmed on imaging, together with your symptoms and the range of movement you have available in the shoulder joint.  Xray can be a very useful scan to have to rule out several other possible causes of your shoulder pain.

How can physio help my frozen shoulder.

In the initial phases of frozen shoulder, the disabling affects of this condition can be helped with a corticosteroid injection actually into the shoulder joint itself, and we are now learning that this may be better still when coupled with a corticosteroid injection into the bursa (a small pocket of fluid that helps with friction and heat production in the shoulder) (1).  Early detection is everything. An experienced physio will help diagnose this condition early on, and work with your GP or specialist to confirm diagnosis on imaging, thus facilitating the early intervention of corticosteroid injections. These injections are currently thought to be best when coupled with mobilisation and exercise of the shoulder which your physio will help you with.

Physio in the early stages of frozen shoulder

Massage and hands on physio might both help you manage your pain in the “freezing” phase.  The physio will help advise you on movements that might help with some pain relief, together with advice on ways to sleep and position your arm day to day that might provide more comfort. They will also help you with strategies to maintain your fitness, and keep the rest of your body healthy, fit and strong. They can help with advice and strategies for improving sleep and pain through mindfulness or meditation. Keeping your body as healthy as possible through this time is key. 

 

Physio in the later stages of frozen shoulder

Previous thought was that over 12-18 months frozen shoulder would completely resolve.  Sadly new research is quite clearing showing that this is not the case. At 7 years up to 50% of participants still had mild symptoms and 60% had reduced range of movement  (2).  The average duration of the condition was 30months (ranging from 12-42 months). 

It is really in this “thawing” or “unfreezing phase” that physio become most important.  Physios will use hands on techniques to help mobilise and stretch your shoulder to regain the lost movement.  They will help you strengthen and rebuild your functional use of your arm.

Other interventions

Other interventions are available for frozen shoulder including hydrodilitation, surgical release and manipulation under anaesthetic – currently corticosteroid injections coupled with physio to mobilise and exercise the shoulder have been shown to be on equal par to these other alternatives (3)

Frozen shoulder is a complex condition which is poorly understood.  Constant research is helping us understand better interventions all the time.  There is no magic fix sadly. But over time and with medical support your physio and doctor can help you through this journey.

References:

(1) Cho CH, Kim du H, Bae KC, Lee D, Kim K. Proper site of corticosteroid injection for the treatment of idiopathic frozen shoulder: Results from a randomized trial. Joint Bone Spine. 2016 May;83(3):324-9. doi: 10.1016/j.jbspin.2015.06.014. Epub 2016 Feb 10. PMID: 26875065.
(2) Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder. A long-term follow-up. J Bone Joint Surg Am. 1992 Jun;74(5):738-46. PMID: 1624489.
(3) Rangan A, Brealey SD, Keding A, Corbacho B, Northgraves M, Kottam L, Goodchild L, Srikesavan C, Rex S, Charalambous CP, Hanchard N, Armstrong A, Brooksbank A, Carr A, Cooper C, Dias JJ, Donnelly I, Hewitt C, Lamb SE, McDaid C, Richardson G, Rodgers S, Sharp E, Spencer S, Torgerson D, Toye F; UK FROST Study Group. Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. Lancet. 2020 Oct 3;396(10256):977-989. 

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