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1.1 Intro: What is Frozen Shoulder?
1.2 Symptoms of Frozen Shoulder
1.3 Common Causes of Frozen Shoulder
1.4 Testing for Frozen Shoulder
1.5 Conservative Treatment for Frozen Shoulder
1.6 Physical Therapy Exercises for Frozen Shoulder
Intro: What is Frozen Shoulder?
Frozen shoulder is formally called adhesive capsulitis. To explain this diagnosis, you must first understand the anatomy of the shoulder.
The shoulder is composed of two bones coming together: the humerus and the shoulder blade. It’s a ball-and-socket joint! And where they meet, a capsule connects them and it is prone to “freeze” (hence the name frozen shoulder), thicken up, tighten up, and get inflamed when not used.
Frozen shoulders are very common, especially in older women, impacting about 2-5% of the population. As an outpatient Physical therapist, it was my top #1 favorite thing to treat! Why? Because with consistent dedication to mobility & stretching, results were often seen quickly.
So I’m super excited to finally write a blog for all of you about frozen shoulders because I’ve got some great tips and secrets up my sleeve. Keep reading!
PS- Suspect you have rotator cuff tendonitis? Then read this blog to learn more.
Symptoms of Frozen Shoulder
How do you know if you have frozen shoulder? Often times, it’s pretty clear because you’ll present with the symptoms below:
Pain in the outer shoulder (lateral brachial region) that may radiate down the upper arm
Muscle tightness / guarding
Inability to move, specifically to raise the arm overhead
The pain is often described as dull, achy, or tight.
All these “freezing stage” (0-2 months) or “frozen stage” (3+ months) symptoms typically worsen over time when left untreated.
Pain is often worse with movement or when lying on that side. Movements that are difficult typically include reaching overhead, reaching behind the back (like to fasten a bra or into the back pocket), or reaching behind the head to brush or do hair.
If you suspect you may have this, the first step would be to see your Physician or Physical therapist for an evaluation. Go now! The longer you wait, the worse the condition and quickly become making recovery slower.
Common Causes of Frozen Shoulder
What puts someone at higher risk for developing frozen shoulder?
Aging (over 40 years old)
Systemic diseases (i.e. Diabetes, Tuberculosis, Hypothyroidism, Hyperthyroidism, Cardiovascular disease, or Parkinson’s disease)
About 20% of people with Diabetes will develop frozen shoulder
Shoulder injury causing immobility (like a fracture, tear, degenerative joint disease (DJD), tendonitis (specifically calcific supraspinatus tendonitis, or stroke) Often occur after sling use
Poor posture / thoracic kyphosis
It’s often in the nondominant arm, but can occur in one or both shoulders.
The truth is, most cases of frozen shoulders are preventable. What happens is discomfort / pain get the best of us. Picture this: Let’s say you fell and hurt your shoulder. You were put in a sling and all movement hurt. So you just chill and are inactive with it for 8 weeks. The result? Likely frozen shoulder because you didn’t use it at all.
With any injury, MOTION IS LOTION. There is less synovial fluid around the capsule, so get it moving! You need to consult your Physician or Physical therapist on the best, safest exercises to do while you give the injury time to heal. No movement at all is not going to help anyone. You must keep the joint moving, even if that means doing passive exercises or just stretching. Anyone and everyone can do some form of safe exercise right after an injury. So take the time to learn which are best for you.
Testing for Frozen Shoulder
Testing for frozen shoulders typically begins in Physical therapy with some range of motion (ROM) tests, manual muscle selective tissue tensioning tests (testing tendon strength), muscle length tests (testing flexibility), manual muscle testing, palpation tests, and special tests.
The Physical therapist will specifically test your passive range of motion (PROM) and active range of motion (AROM) to see if you present with a positive capsular pattern. This means you’re most restricted with shoulder external rotation, then with shoulder flexion and abduction, and then with internal rotation. In the PT world we’d write it like this (ER>FLX / ABD>IR) so rotating the arm outward would likely be the most restricted and painful. Other tests would also be done to rule out other diagnoses.
If they’re certain you only have a frozen shoulder, then you’d proceed with Physical therapy outpatient likely for 4-16 weeks. If they suspect more could be going on, they may refer you back to your Doctor for imaging (Xray, MRI) to rule out more serious conditions. If it’s just adhesive capsulitis, the Xray would be normal.
Conservative Treatment for Frozen Shoulder
When something is frozen and you don’t want it to be, what do you do? You thaw it. The “thawing stage” of frozen shoulder treatment involves warming and loosening it back up.
Your Doctor may request you take some medicine like anti-inflammatories to help with the capsular inflammation.
Then, the best treatment is going to be MOVEMENT - as prescribed by your Physical therapist. Physical therapy will likely include a combination of stretching, mobility, strengthening, functional exercise, heat, e-stim, and possible dry needling.
Physical therapy should 100% include manual mobilization of the shoulder joint and scapula for most people. This means, your PT should be getting their hands on your arm and pulling it in various directions to improve joint mobility and stretch out that capsule. This is not something that can be done on your own or by an inexperienced individual. Skilled PT is really needed for this treatment especially.
If after months of Physical therapy things don’t improve, then less conservative measures may need to be taken like injections, a manipulation while unconscious, or surgery (to remove adhesions and scar tissue).
If the case is severe and has been going on for awhile, the recovery may take months to years (5 months to 24 months according to this article).
Physical Therapy Exercises for Frozen Shoulder
In the video below, learn the best mobility and stretching exercises for frozen shoulder:
In the video below, learn the best strengthening exercises for the shoulder:
Mission: Mobilize, Modify, Move
It is my mission with every blog post to educate you on the best ways to mobilize your body, modify exercise, and move better. In the video above, you learned some of the best mobility exercises for the shoulder and those will be key to your recovery.
Next up, let’s discuss how to modify exercise and daily activity while you are symptomatic from frozen shoulder:
If you want to remain active, focus on more lower body and core work for the time being. Then do only PT-based upper body exercises on the injured arm temporarily.
You could continue to strengthen your uninjured arm like usual with unilateral (1-arm) exercises. Or perhaps use more load (weight) on the uninjured arm and do bodyweight only for the injured arm.
Assisted exercises are often a nice start when easing back into workouts. For example, can you use a lat pulldown machine of some sort and use your uninjured arm to assist the injured arm overhead to grab the bar? Then you’d get a nice, assisted stretch at the top and can strengthen those lats.
Modify exercises by regressing them (making them easier) if needed:
Use a smaller range of motion
Use less load or no load at all
Slow things down
Vary your grip to find what’s most comfortable (overhand vs underhand vs mixed vs narrow vs wide)
Finally, I want to share some tips for moving better (or more functionally) when you have frozen shoulder:
During the day, be extra aware of having good posture with the shoulders back. Having a rounded upper back will limit the humerus bones ability to fully rotate and bring the arm overhead - it will get blocked. So shoulders down and back allows more movement from the arm.
Avoid sleeping on the injured side. Instead sleep on your back or the uninjured side.
If you’re in a sling, take it off every so often and give your arms a break. Do some shoulder circles, shrugs, and swing that arm around every hour or so to avoid it freezing up more and more throughout the day.
Start your day off with some movement! Your shoulder will likely feel better after exercise than with none at all.
I hope you found this blog post helpful. If you did, leave a comment below to support me & the team. I read and appreciate every single one. Thank you for being here.
PS - Once your shoulder is more mobile, why don’t you try out Applied Mobility? It’s an online course teaching you all about the importance of mobility exercise and its role in preventing future injuries. You don’t want to develop a frozen shoulder again, right? Well keep your shoulder mobile and you’ll reduce that risk. It includes 12+ weeks of 5min/day mobility warm ups to do anytime of day or before your workouts. Learn more about Applied Mobility today!
Thanks for reading!
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