Physical Therapy for Frozen Shoulder

Frozen shoulder (aka adhesive capsulitis) is a condition of the shoulder in which the shoulder capsule – the connective tissue that surrounds the joint – becomes inflamed and fibrotic, leading to pain, joint stiffness, and loss of functional movement of the shoulder.

Little is known about the underlying cause of frozen shoulder, however some factors are known to contribute to the pathology:

Injury: Following a traumatic injury including a motor vehicle injury, a fall, or similar

Surgery: Following a shoulder surgery, especially if pain limits the ability to perform range of motion after the procedure

Insidious onset: Without cause, or lacking a direct relationship to an injury, accident or surgery. You are more likely to develop frozen shoulder if you are:

  • Aged between 40-60
  • Female
  • Diabetic

Frozen shoulder often causes pain locally in the shoulder, but can sometimes refer down the arm to the wrist, or up into the neck.

Frozen shoulder is a self-limiting condition. There are three overlapping stages of frozen shoulder, which may be progressed through over the course of 6-36 months.

  • Stage I (freezing stage): During this stage, pain and stiffness gradually increase, limiting range of motion most notably with reaching overhead, reaching behind your back, and reaching in a motion such as putting on your jacket. Pain at night, especially when laying on that shoulder, is a common symptom.
  • Stage II (frozen stage): Pain has primarily resolved during this stage, however significant stiffness persists, making everyday activities difficult.
  • Stage III (thawing stage): Stiffness gradually resolves and normal range of motion is restored.

Frozen shoulder is best treated by respecting the painful limits. Unfortunately, significant gains in range of motion are not seen by pushing through the pain. Some ways you can treat your shoulder on your own include:

  • Heat: Use of heat may help produce some of the lubrication that is missing due to the adhesive joint; try using heat (shower, heating pad, or heated rice or beans) prior to performing gentle range of motion exercises
  • Range of motion: Gentle range of motion exercises performed within a pain free limit may help to maintain the range that you have, and limit further loss of range. Some of these exercises may be helpful to stretch the different limited ranges:
    • Pendulum: Start leaning over at the waist, with your uninvolved arm supporting you on a table. Let your involved shoulder hang down, try not engage any of the muscles in that shoulder. Gently swing your upper body in small circles, allowing your shoulder to move freely through its natural range of motion.
    • Table slides: Start sitting at a table with your involved arm resting on the table. Lean your body forward to gently stretch the shoulder. Stop before the motion becomes painful.
    • Doorway rotation: Start standing with your elbow bent to 90 degrees, hand on a doorway. Keeping your elbow tucked in at your side, gently turn your shoulders away from your involved shoulder to create a stretch. Stop before the motion becomes painful.
    • Behind your back stretch: Start with your hand at your side. Keeping the palm turned out, gently slide your hand up your back, trying to keep the extended thumb sliding up the spine. This stretch may be too aggressive during stage I symptoms.

Physical therapy may be more or less effective during different stages of frozen shoulder. Therapy will be targeted to your specific stage and tolerance for movement. Emphasis is on pain free treatment strategies.

Manual therapy:

  • Soft tissue treatment: Hands on treatment of muscles surrounding the region of your shoulder will assist with reducing pain, improving muscle relaxation, and improving the ability of joints to move normally.
  • Joint mobilization: Hands on treatment focused at the level of the joint surfaces to reduce pain, improve joint specific mobility, and re-educate proper joint movement.
  • Range of motion: Gentle manual range of motion following manual therapy can help to maintain any gains achieved through hands on work.
  • Strengthening: Gentle strengthening exercises for the rotator cuff and shoulder blade may be instructed within pain free limits.
  • Home exercise program: You will be provided with strategies to assist with management of your stiffness and pain.