It’s that time of year. The snow is falling, the sun sets early, and the shoulders are freezing. Just kidding. Adhesive Capsulitis, or Frozen Shoulder, can happen throughout the year and for a variety of reasons. Frozen shoulder is “characterized by initially painful and later progressively restricted active and passive glenohumeral (GH) joint range of motion with spontaneous complete or nearly-complete recovery over a varied period of time” (1).
You or someone you know may have experienced this in the past. They may describe their shoulder as stuck, or frozen, and are unable to perform simple activities such as putting on a sweater, reaching to open the door, or washing their hair while in the shower.
What exactly happens with Frozen Shoulder? Essentially, the complex bundle of ligaments and other connective tissues that surround the glenohumeral joint, or shoulder joint, become restricted due to a cascade of events caused by inflammation and subsequent fibrosis (1, 2).
Frozen Shoulder can be considered a Primary Frozen Shoulder, or Secondary Frozen Shoulder. Primary Frozen Shoulder means that the cause of it is unknown and happens randomly. Secondary Frozen Shoulder indicates a known cause. This can be post-operatively or post stroke when the arm is not being utilized and thus gets stiff. Or it can be caused by systemic factors such as diabetes or thyroid diseases (2). Frozen shoulder is more prevalent in females, those who have had frozen shoulder in the past, and those aged 40-65 years old (2).
There is a typical course of progression that a frozen shoulder follows (1):
- Acute/freezing/painful phase: There is a gradual progression of pain that is described as sharp at end ranges of motion. Pain can occur at rest and at night interrupting sleep. May last between 2 – 9 months.
- Adhesive/frozen/stiffening phase: Pain begins to decrease, but there is also a progressive loss of shoulder movement. Pain is still present, but only at the end of available mobility. May start around 4 months and last until 12 months.
- Resolution/thawing phase: A spontaneous, progressive improvement in mobility lasting 5 – 24 months.
Frozen shoulder is thought to be a self limiting disease and that by 12 to 18 months mild to moderate mobility deficits and pain may still be present, though many report minimal or no limitations at that time (2). However, reports of prolonged loss of some mobility have lasted for several years as well.
How does physical therapy help with frozen shoulders? Well one of the biggest things that we can do is provide education on this particular disease process. This can be a frustrating experience and it is our goal to reduce your anxiety around this.
The application of physical therapy depends on your particular phase. Earlier in the rehab process, while going through the freezing phase, we focus on decreased intensity of stretching, and apply generally pain free exercises and movements. Moist heat and soft tissue massage may also be beneficial for pain management. It is helpful to reduce painful activities while in this phase. Working with a therapist during this phase can help manage pain, understand what specifically is going on, and become educated on what you should and shouldn’t do to allow for improvements in function at home.
As pain decreases, and stiffness becomes more of an impairment, longer stretching durations and gradual strengthening is applied. Your therapist can get a sense of how to progress your exercise intensity and apply updated activities to ensure ongoing progress is being made. Incorporating more functional movements such as dressing, overhead reaching, and different strategies to improve participation in tasks you feel limited during at home is an important aspect of this phase. As your mobility and pain improves, increasing strength is also progressed to ensure you achieve the goals that you have set at the beginning of therapy.
Overtime your mobility and pain levels should improve allowing for a return to your normal activities at home and in community. There still may be some stiffness at the end ranges of motion upon the completion of formal therapy as this disease process can take sometimes years to fully resolve. However, your therapist will equip you with progressive exercises to both maintain the progress you made in therapy and to ensure ongoing improvements.
If you or someone you know is experiencing shoulder pain or stiffness contact our physical therapy office today at Chicago, North Center, Lincoln Square, Lincoln Park, Roscoe Village, IL. We will set up an evaluation for you so you can get started on your road to recovery. At The Fit Institute (TFI), our physical therapists are dedicated to helping you return to your sport as quickly as possible!