By Adhesive Capsulitis’, more commonly known as “frozen shoulder” is a condition that is known to limit the movement of the shoulder as it becomes painful and stiff. As a result of this, movements can get restricted in some directions. It might develop as a result of injury, overuse, or as a collateral effect of diseases like diabetes or even stroke which forms scar tissues. This condition takes time to get diagnosed and goes away even more slowly.
What is a Frozen shoulder?
Frozen shoulder (adhesive capsulitis) is a common condition where the shoulder becomes gradually difficult to move and increasingly painful. It is associated with the inflammation of the joint capsule lubrication (synovium) and the capsule contracture (thickening and tightening scar tissue). Patients mostly complain about difficulty sleeping on the affected shoulder and have a reduction in raising their arm above their head or getting dressed (e.g., wearing a shirt or reaching your bra strap). Frozen shoulder is common during the sixth decade of life, the peak age is between 50-60, and occurs slightly more in women than men.
Most often, a frozen shoulder occurs after trauma, such as fractures, dislocation, and soft tissue injuries. Nontraumatic incidences could be related to osteoarthritis, rotator cuff tendinopathy, and calcific tendinitis. Commonly it is associated with conditions like diabetes, thyroid diseases, and cardiopulmonary (heart and lung) diseases. However, at Surrey Physio, the most common time we see a frozen shoulder is post-surgery.
Stages of frozen shoulder
Research mostly divides frozen shoulder into 3 stages which include:
- Freezing (an onset of shoulder pain with increased difficulty in moving)
- Frozen (pain improves with stagnation of movement)
- Thawing (improvement of motion and relief from symptoms)
Although these stages are reported in research there are variations and stages can differ in duration and symptoms. There are also questions raised by several therapists (including ourselves) on the actual validity of the three stages, as frozen shoulders can, in some cases, get very stiff very quickly.
Treatment
Suitable treatment is required to ensure patients make a good recovery and reduce the burden on their daily activities. Conservative treatments include oral medication, physical therapy, exercise, steroid injection, and hydro dilatation all of which have positive outcomes. Treatment varies in different stages, in the freezing stage pain is mostly prominent. Therefore, a steroid injection and anti-inflammatory pain relief can help with symptoms. Applying heat to the shoulder can also help with pain. The frozen phase benefits from therapy focusing on improving the range of movements such as mobilization techniques exercise prescription and education. The thawing stage benefits from introducing further functional movements and restoring strength through physiotherapy.
Other treatments include:
The surgical procedure occurs only when all other non-operative options have not worked as well. The decision to operate is the last outcome and you should discuss it along with your doctor’s surgery as an option. This commonly includes manipulation under anesthesia or arthroscopic capsular release. Manipulation under anesthesia involves being under general anesthesia while the surgeon firmly moves and rotates your arm to mobilize the scar tissues. However, if the scar tissue is too thick, an electrical knife may be used to cut both the capsule and scar tissue during a keyhole procedure called capsular release.
In most cases, a frozen shoulder can last up to one year with some lasting over 2 years. It is important to get seen early in one of our Surrey Physio clinics to ensure adequate knowledge and to start the rehabilitation process. It is also recommended that you discuss with your doctor the potential for recovery using conservative treatments, as well as the risks associated with surgery.
At Surrey Physio, we provide a personalized approach to each stage of this condition. At our initial appointment, we will thoroughly examine and talk about your shoulder pain. We provide education on the diagnosis, and prognosis and provide a hands-on approach using various manual techniques along with a personalized exercise program sent to your email.
1. Arm circle
It is one of the most common fitness exercises that are advised often to athletes to improve their overall range of motion.
- Place either of your hands on the corresponding shoulder and make small circles in the air.
- Begin by making small circles and gradually increase the radius and circumference of the circle by using the elbow joint as the focus.
- After making at least 18-20 clockwise circles, make 18-20 counter-clockwise circles as well.
- Repeat the activity with the other side.
2. Cross body stretch:
This frozen shoulder exercise can be performed in either a sitting or a standing position. Choose what makes you feel comfortable and bring the arm across the chest to the other side with the help of the other arm. In extreme cases, you can make a fist to push the affected arm from the elbow. It is necessary to hold this position for 10-15 seconds for optimum results.
3. Back Clasp
- Back clasp is another common exercise that aims primarily at the improvement of the flexibility of shoulder muscles. It ensures pain-free movements and restoration of full range of motion.
- Stand straight with your legs wide apart.
- The next step is to use your hands and clasp on your back.
- Stabilize your arm and slowly raise those arms over your head.
- Stop the arm movement at the point of maximum resistance and hold your position for 30 seconds. Repeat in sets of three for best results.
4. Pendulum Stretch
Pendulums are a gentle exercise that can help to loosen up the shoulder joint and increase shoulder mobility. They are usually one of the first exercises prescribed for frozen shoulders as they are typically well-tolerated and are an effective way to start regaining movement in the shoulder. The low-impact exercise can help gently re-introduce movement to the shoulder.
To perform this exercise:
- Stand with your feet shoulder-width apart and lean forward from the waist.
- Rest your unaffected arm on a table or chair for support.
- Let your affected arm hang down towards the floor and relax. There should be no tension in the shoulder or arm, if possible.
- Gently swing your affected arm back and forth in a circular motion, like a pendulum.
- After a few repetitions, switch to a side-to-side motion.
The exercise can be adjusted, depending on the goal of the treatment. It’s important to remember to keep the movements gentle and avoid any sudden or jerky movements. If there is any discomfort during the exercise, stop immediately and consult the physical therapist.
5. Finger Walk
This exercise gets the little tissues and muscles that connect through the shoulder in motion. At 3 quarters of an arm’s distance, face a wall, extend your arm, and touch the wall at waist-level height with the fingertips of the arm which is affected by a frozen shoulder. Keeping the elbow slightly bent in a V, slowly walk your fingers up along the wall, just the way you used to play as children.
Keep walking the fingers till you’ve raised your arm as far as you can without causing any pain. Do not try to exert any more pressure on yourself. Try shifting the pressure of the shoulder muscles to the fingers as frequently as possible. Lower the arm and repeat this exercise with both arms around 15-20 times a day.
6. Doorway external rotation:
External rotation is an effective exercise that targets the muscles in the back of the shoulder. As one of the main movements that is lost with a frozen shoulder is external rotation, this is an important exercise for regaining strength and movement in the shoulder. The exercise is designed to strengthen the shoulder muscles, which can improve overall stability and reduce the risk of further injury.
To perform this exercise:
- Start by standing or sitting in a comfortable position.
- Bend the elbow of the affected arm to 90 degrees.
- Keep your elbow close to your body and rotate your arm outward.
- Hold for a few seconds, then slowly return to the starting position.
The range of this exercise may only be small to start with. However, with time and direction from the physical therapist, there can be a noticeable change in the flexibility of the shoulder. Additionally, the physical therapist may use a light resistance band to start with, and gradually increase the resistance as the strength improves. If there is any discomfort during the exercise, stop immediately and consult the physical therapist.
7. Armpit Stretch
This exercise aims to stretch the muscles around the armpit of the affected arm. If you need support from the good arm, lift the affected arm onto the shelf about breast-high. Open the armpit by bending your knees. To stretch further, deepen the bending of your knee slightly and then return it to the original position. With each movement, the muscles near the armpit tend to stretch a little, increasing the flexibility.
FAQs:
Why is exercise important for a frozen shoulder?
As you keep your arm and shoulder immobile, the capsule that encases the joint thickens and tightens. On the other hand, if you perform gentle exercises as prescribed by your doctor or therapist, you can improve your shoulder’s strength and range of motion.
What exercise is good for a frozen shoulder?
In performing the following frozen shoulder exercises, stretch to the point of tension but not pain.
- Pendulum stretch. Do this exercise first.
- Towel stretch.
- Finger walk.
- Cross-body reach.
- Armpit stretch.
- Outward rotation.
- Inward rotation.
What happens if you don’t exercise a frozen shoulder?
Frozen shoulder (also called adhesive capsulitis) is a common disorder that causes pain, stiffness, and loss of normal range of motion in the shoulder. The resulting disability can be serious, and the condition tends to get worse with time if it’s not treated.
What is the best treatment for a frozen shoulder?
Most frozen shoulders get better on their own within 12 to 18 months. For severe or persistent symptoms, other treatments include Steroid injections. Injecting corticosteroids into the shoulder joint might help decrease pain and improve shoulder mobility, especially if given soon after a frozen shoulder begins.
Is it better to rest or exercise a frozen shoulder?
There is no clear recommendation on how to treat a frozen shoulder, but we believe it is best to rest the shoulder at first and do gentle shoulder mobility exercises. Later, when the symptoms start to improve, people can do increasingly ambitious range-of-motion exercises.
Conclusion:
These 5 frozen shoulder exercises for quick relief offer a practical and accessible way to alleviate discomfort and improve mobility. By incorporating gentle stretches like the pendulum and towel stretches, individuals can gradually loosen tight muscles and increase flexibility. Meanwhile, exercises such as the seated twist and horizontal abduction focus on strengthening the surrounding muscles, providing stability and support to the shoulder joint. Consistency and proper technique are key to experiencing the full benefits of these exercises. While relief may not be immediate, with dedication and persistence, individuals can gradually regain control over their shoulder health and enjoy a fuller range of motion. It’s important to consult with a healthcare professional before beginning any new exercise regimen, especially if you have pre-existing conditions or concerns. With commitment and regular practice, these exercises can be an effective tool in managing frozen shoulder symptoms and promoting overall well-being.
