At ESP we commonly see shoulder injuries. Typically these are injuries to the rotator cuff or muscles stabilising the shoulder. However in the past 12-18 months we have seen a rapid increase in the number of patients coming into see us with Frozen Shoulder. For most people this condition is relatively unheard off and the aim of this blog is to explain what a frozen shoulder is and physiotherapy can help.
Frozen shoulder is exactly as it sounds – a shoulder that’s frozen in place. The normal amount of shoulder movement is significantly reduced due to pain and stiffness.
This is caused by a physiological process where the shoulder capsules stiffens up. The capsule surrounds the ball and socket of the joint, and its role is to provide stability to the shoulder.
In a frozen shoulder, the capsule tightens up excessively which prevents the shoulder from moving as it usually would.
There are two main groups of Frozen shoulder – primary and secondary. They have two different causes.
A primary frozen shoulder tends to come on with no clear mechanism of injury and it’s usually difficult to pinpoint a specific event. The shoulder starts hurting gradually and then progressively gets stiffer as time progresses.
This type of frozen shoulder is more common in people with existing medical history such as diabetes or thyroid disorders. The orthopaedic consultants that we work with tell us there is a link between hormonal-related disorders and primary frozen shoulder.
A secondary frozen shoulder tends to start following an injury, such as a fall. It is believed that either trauma to the capsule, or the pain in the shoulder limits movement of the arm, leading to tightening of the capsule.
The two key symptoms of frozen shoulder are pain and loss of movement.
The pain is typically difficult to pinpoint but felt generally around the shoulder and as the condition progresses it can travel down into the arms and even the fingers.
The pain is worsened when movement stretches the capsule and often quick movements such as catching a falling plate tends to set it off really easily.
At stages in the condition there is almost always significant night pain, and for many it is impossible to sleep on the affected side.
Loss of Movement
Patients always report losing movement in the arm. Typically turning the arm outwards, overhead or behind the back are significantly restricted. We usually hear people saying they struggle a lot with everyday activities such as showering, dressing or fastening a bra.
Frozen shoulder typically follows a 3 stage process, with wildly different time frames for each individual. The best way to determine the stage is based on the symptoms outlined above.
1. Freezing stage, pain-dominant (3-6 months)
2. Frozen stage, Stiffness – dominant (6-12 Months)
3. Thawing stage, reducing stiffness, no pain(>12 months)
This is why frozen shoulder is so frustrating to deal with- just when you think that the pain’s over, your still limited with what you can do!
With a primary frozen shoulder our job is to help minimise the pain and maintain as much movement and function as possible. With a secondary frozen shoulder, we can intervene in the early stages of the injury before the disease process sets in with hands on treatment to reduce pain and to allow you to move your shoulder better.
In the later stages when stiffness is the dominant feature, the aim is then to restore the normal range of motion and build the strength and function around the joint. This is achieved by hands on treatment for the joint and muscles combined with exercises to free up this area.
The mainstay of frozen shoulder treatment is an exercise program to maintain or improve the available shoulder range of motion. Here are some simple exercises that we commonly prescribe for this purpose – these are good to do in both the early and later stages.
Shoulder Flexion and Abduction with Stick
1️⃣ Start by holding onto a stick or similar item as seen in the videos
2️⃣ Move the affected shoulder (blue) overhead as far as you can
3️⃣ Once you feel limited, use your other hand to push the stick so that you go further into range
4️⃣ Repeat 10-15 repetitions, with 2-3 pause at the top. Do this as frequently as you can throughout the day
Shoulder Hand Behind Back Stretch
1️⃣ Start by holding on an exercise band or a stable object behind your lower back
2️⃣ Lean into the stretch by stepping forward
3️⃣ Hold this for 30-45 seconds, 3 sets or as tolerated
Shoulder Hand Behind Head Stretch
1️⃣ Start by lying against a wall on your back (you can do this on the floor/bed as well)
2️⃣ Put both hands behind your head with elbows pointing forward
3️⃣ Let both elbows drop as far towards the wall/floor as possible
4️⃣ Hold this for 5 seconds and repeat for 10-15 times, as frequently you can throughout the day
📌 Generally speaking if pain is limiting your movement, keep it pain-free.
📌 If stiffness is limiting your movement, push slightly into the pain.
📌 In our experience it is often the small adjustments made to the dosage and/or intensity that makes an exercise program effective.
📌 A physical assessment allows us to optimize the same exercise for your needs
If the shoulder pain is very bad and we are finding it difficult to progress the treatment then we may call on help from some of the expert Orthopaedic consultants we use. They will sometimes perform a corticosteroid injection or arrange for a distension of the joint. In severe cases they will perform a capsular release.
As with any injury, it can be challenging to find accurate and trustworthy information on the internet. Despite the information we have supplied being helpful it is also quite generic and in our experience it is always worth your while to speak to a qualified physiotherapist, to get an accurate diagnosis and treatment plan that’s tailored specfically to you.
If you would like to speak to one of our team then call us on 01324 227 370 or you can book yourself in for a physiotherapy appointment with us here
Written by Andrew Linn 🇸🇬