What is Frozen Shoulder and How to Treat It

Adhesive Capsulitis or frozen shoulder can be both very painful and movement restrictive for the shoulder joint. Whilst this may be a term familiar to some, it is often poorly understood and misdiagnosed in the field of sports medicine. Clients coming in with Frozen Shoulder can usually expect a slow and steady recovery lasting from months to over years, which can be frustrating to some. That being said, Adhesive Capsulitis under the right management is a resolving condition (non-permanent), and full recovery can be achieved.

Symptoms & Phases

Like most medical conditions, there are some signs and symptoms to look out for. Frozen shoulder undergoes a three stage/ phase progression towards recovery.

Freezing Phase (Phase 1)

The beginning of frozen shoulder usually begins with a one sided gradual shoulder pain or ache. Most people notice that pain occurs when lying on the affected side at night making it difficult to sleep comfortably. Pain can occur insidiously without prior trauma or as a result of direct trauma to the shoulder.

  • One sided shoulder pain
  • Can be painful for 2-9 months
  • Can be a Gradual onset

Stiffening Phase (Phase 2)

The next phase of frozen shoulder is where the shoulder gradually gets ‘frozen’ or ‘stiff’. With frozen shoulder it is important to consider that the stiffening follows a pattern known as the capsular pattern. In this case the first movement to be lost is external rotation, followed by abduction and then internal rotation. This would mean tasks such as opening doors may be the first to get difficult to perform.

  • Capsular pattern range of motion loss
  • Shoulder muscle pain and atrophy
  • Can go on for 4-12 Months

Thawing Phase (Phase 3)

This is where the Light at the end of the tunnel becomes apparent to clients after months of rehabilitation. Range of motion improves along with pain; this occurs gradually although pain may re-appear from time to time.

  • Improvement in pain and stiffness
  • May last 5-12 months

Treatment

Like most conditions that are slow and insidious with onset, it is important to obtain early advice and rehabilitation. Clients with best results often have the best management approaches and take on the condition with a positive mindset. There are certain manual therapy and hands-on techniques that can be used to help with pain and mobility around the neck and shoulder region. The value of receiving treatment at the neck and thoracic spine (chest level) cannot be understated as these are usually the first regions in the body to be affected as a result of a frozen shoulder.

With regard to rehabilitation, a well thought of exercise prescription which is tailored specific to individual needs is often times the most beneficial. Your physiotherapist or sports physician would often times recommend specific shoulder mobility exercises to prevent excessive loss of range of motion as well as improve muscular strength and motor control. This is the most important part of the treatment aspect as it often provides the best prognosis and outcomes. It will also prevent future complications around the shoulder joint.

Medical intervention and surgery is usually recommended when conservative management fails to produce improvement.

Recovery

Overall, recovery happens over the period of 1.5-2 years, for more severe cases it may take up to 5 years. Complete recovery and a good prognosis is achievable by most, for optimal results; clients are expected to self manage together with treatment from their healthcare professional