Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Frozen Shoulder Physical Therapy Guide

What is Frozen Shoulder?

A frozen shoulder is a capsulitis of the shoulder joint which causes pain and stiffness. The tissues around the joint “freeze”, scar tissue forms, and shoulder movements become very difficult and painful. The condition usually comes on gradually, and then goes away slowly over the course of a year or more. Pain and stiffness can normally affect the patient for up to 18 months in some cases, causing significant functional impairments, such as getting dressed and difficulty sleeping at night. Frozen shoulder more commonly affects the left shoulder and is more prevalent in women than men!

Progression Of Injury

Stage 1: Freezing

A frozen shoulder is a capsulitis of the shoulder joint which causes pain and stiffness. The tissues around the joint “freeze”, scar tissue forms, and shoulder movements become very difficult and painful. The condition usually comes on gradually, and then goes away slowly over the course of a year or more. Pain and stiffness can normally affect the patient for up to 18 months in some cases, causing significant functional impairments, such as getting dressed and difficulty sleeping at night. Frozen shoulder more commonly affects the left shoulder and is more prevalent in women than men!

This continues for 3 to 9 months, most likely with a progressive loss of shoulder movement and an increase in pain (especially at night). The shoulder still has some range of movement, but this is limited by both pain and stiffness.

Stage 2: Frozen

Symptoms have typically persisted for 9 to 14 months, and you now have greatly decreased range of shoulder movement in all directions. During the early part of this stage, there is still a substantial amount of pain. Toward the end of this stage, however, pain decreases, with the pain usually occurring only when you move your shoulder as far you can move it. This loss of movement can have a severe impact on the functionality of the affected arm, affecting patients jobs, hobbies and sleep!

Stage 3: Thawing

You’ve typically had symptoms for around 12 to 15 months, and there is a big decrease in pain, especially at night. You still present with a limited range of movement, but your ability to complete your daily activities involving overhead motion is improving at a rapid rate. Your symptoms improve for the next 6 months and most people make a full recovery!

What Causes Frozen Shoulder?

The shoulder is one of the biggest and most complex joints within the human body, compromising of the humeral head, clavicle, and scapula. Is remains one of the most unstable and most commonly injured joints in the body. Its instability is its key to success when performing functional activities. However, there is still no known reason why frozen shoulder commences, it is argued that people who work manual jobs involving overhead reaching are more likely to develop the condition. 

Symptoms

Pain and stiffness of the shoulder can always be felt throughout the course of this injruy. Sometimes, in acute stages, pain can also refer down the arm but rarely goes past the elbow.

During the initial freezing stage, any movement of your shoulder causes pain, and your shoulder’s range of motion slowly starts to become limited.

Once in the frozen stage, pain may begin to diminish, however your shoulder becomes stiffer, and using it becomes more difficult. In a typical frozen shoulder, flexion is limited to 90º.

Treatment Options

Frozen shoulder is a self limiting condition that resolves, on average, over 18 months in a healthy individual. One management option (and the easiest!) therefore, is to wait for it to resolve on its own. This conservative treatment coupled with low grade exercises however shows the greatest benefits.

The mainstays of treatment for these types of frozen shoulder include activity modification, Physical Therapy and home exercises, non-steroidal anti-inflammatory medications and most importantly, patience.

Exercises

Exercise is most important component for your recovery and one that must not be avoided.  The exercises detailed below are a great starting point for patients who suffer from frozen shoulder. These exercises should be done daily; they will take approximately 30 minutes, but will greatly improve your pain, prognosis and recovery time.

The exercises below are placed in order of recovery time, with the easiest exercises being the first to use during stage 1 and 2 of the injury, progressing to stage 3 towards the end. However, you should continue to complete all stage 1 and 2 exercises even if you are nearing the end of your rehabilitation program.

Frozen Shoulder Exercises

1) The Pendulum

This is the number one exercise that Physical Therapists prescribe to increase range of movement in the shoulder joint. It slightly pulls the ball & socket joint apart and facilitates an increase in mobility between the joint structures.

How to do it:

  • Hold a small weight in your injured arm
  • Whilst standing, lean forward on a immovable object and let your injured arm hang down towards the floor
  • Slowly swing your arm forwards and backwards in a gentle circular motion.

Repeat 20 times each direction, multiple times per day.

2) Wall Walking

An exercise to increase the forward flexion of your shoulder, you should not be trying to push through pain, but gradually increasing range of motion as you feel comfortable.

How to do it:

  • Standing in front of a wall
  • Place the fingers of your affected arm on the wall staring at the bottom. 
  • Slowly walk your fingers up the wall as far as you can, before walking them back down again

Repeat 10 times, 3 times per day.

3) Doorway Stretch

A great exercise to stretch the anterior structures of your shoulder and chest. These structures often get very tight and can cause more pain and poor posture.

How to do it:

  • Stand next to an object (ie. a door)
  • Place your palm against the door frame keeping your shoulder and elbow at approximately 90 degrees.
  • Move forwards through the diorite gradually increase the stretch.

Repeat 5 times, twice daily.

4) Shoulder shrugs

A simple yet fantastic exercise to loosen up the upper trapezius and rhomboid muscles, whilst opening up the upper cervical spine joints.

How to do it:

  • Sit with good posture
  • Raise your shoulders up towards your ears; holding for 2 seconds
  • Repeat 20 times, every hour, aiming for 5 or more sets per day.

5) Passive Shoulder Movements

Once shoulder movement starts to return you can progress and push into the different ranges using a stick. The aim is not to push through pain but to gradually increase range of movement safely.

How to do it:

  • Standing whilst holding a stick in both hands. The end of the stick placed in the palm of your affected arm. 
  • Using your non-injured arm push the stick in various directions, which in turn moves your injured arm.
  • Lift arm in different directions and planes, pushing it into minimal resistance. 

Repeat for 60 seconds, 3 times daily

6) Isometric Shoulder Squeezes

Isometric exercises aim to increase strength in the muscles without actually moving the muscle through range, and thus limiting the pain caused by moving an injured structure. The aim of these exercises is to complete all shoulder movements against a non moving resistance.

How to do it:

  • Flexion: Stand facing a wall. With a straight arm put your hand on the wall. Push upwards towards the ceiling and hold this contraction for 10 seconds.
  • Extension: Standing facing away from the wall. With a straight arm behind you touch the wall. Try and push your arm backwards against the wall, holding the contraction for 10 seconds.
  • Abduction: Standing parallel to the wall. Move your straight arm to the side of your body towards the wall and place the side of your fist against the wall. Try and push your arm up towards the ceiling and hold this contraction for 10 seconds.

Prognosis

Most frozen shoulders do resolve by themselves over a period of 18 months. Anti-inflammatory medications can help to reduce the pain and inflammation, gentle Physical Therapy manipulations can help restore movement faster, however the key component of recovery is low grade exercises to maintain strength and range of movement. Sometimes, conservative care cannot reduce the pain. The key to success with frozen shoulder is patience! Unfortunately, there is no such thing as a quick fix unless you want to undergo surgery. Follow these treatment modalities and you will see fantastic results in months.

2017-05-22T17:21:27+00:00