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Frozen Shoulder: The Culprit Causing Your Shoulder Pain

Frozen Shoulder is real, and doesn’t only occur in the winter! Generally the condition doesn’t have a definite start point, ie. patients often can’t think of an injury that started the pain. Some warning signs to look for include pain and a loss of motion in multiple directions.

Medically termed adhesive capsulitis, frozen shoulder is a condition that affects the capsule surrounding the shoulder joint. The capsule is a sheath of tissue that maintains fluid within the joint and maintains pressure, ensuring relative stability. Inflammation causes the capsule to become more fibrous and thicken. This causes limitations in range of motion and pain. If your shoulder is feeling stiff and painful, with loss of motion in multiple directions, you may be facing frozen shoulder. Identifying it early is the best way to help effective progress.

Who gets it?

Although anyone can get this condition for a variety of different reasons, there are a few predisposing factors:

  • Most prevalent in women ages 45 and older
  • Glandular conditions (diabetes, hypothyroidism, etc.)
  • Immobilization of the shoulder following certain surgeries
  • This condition can also develop after a minor shoulder injury

There are 3 overlapping stages of the condition called the freezing; frozen; and thawing phases. Each stage has certain treatments that may be beneficial to help speed recovery, which will be discussed below.

Recovery from the condition generally takes anywhere from 6 months to 2 years, and has the following stages and interventions that can help at each stage.

Freezing (months 1-6)

What to expect:

  1. Freezing is the most painful of the 3 stages
  2. This is when the inflammation and fibrosis of the capsule worsens, causing the tissue to become irritated and sensitized thus causing an increase in pain
  3. Range of motion usually becomes progressively worse and daily activities (reaching, dressing, bathing, workouts) can become more uncomfortable

In this stage seeing a physical therapist for a few visits to learn exercises to maintain range and slow the loss of motion is advisable.

A few tips:

  1. Use the shoulder as normally as possible without exacerbating symptoms.
  2. Intense stretching or manipulation techniques are not advisable in this stage, as they can lead to greater losses in mobility and increases in pain.
  3. Listen to your body, if your causing a significant increase in pain you’re doing too much 
  4. Keep contact with your PT during this stage; activity or exercise modifications are often needed

Frozen (months 4-12)

This is the stage where the range of motion limitations slow in progression and pain begins to improve. Gross range of motion limitations are notable with external rotation usually being the most affected followed by abduction and internal rotation.

During this stage you may begin stretching and manual therapy at a tolerable level. Strengthening exercises  to begin improving shoulder strength and muscle activation for function. Leaving the shoulder untreated can lead to other consequences later down the road.

Thawing (months 6-24)

Thawing is when the shoulder begins to return to normal function. Here motion limitations improve and function begins to return and become less painful. This stage can take up to 2 years to complete, and some people may be left with minor losses in range of motion following this condition.

More intensive stretching and manual therapy are recommended to improve range of motion to baseline levels. Strengthening exercises are progressed to improve shoulder mechanics and function. Exercises should be tuned towards your goals in order to restore normal shoulder movements and strength for specific goal-related tasks.

Treatment of frozen shoulder can be long and arduous, but arming yourself with information can be one of the most effective tools. Make an appointment with your physical therapist or chiropractor to learn more about the condition and how you can manage it effectively. Remember, early intervention and education is essential for recovery. If your shoulder has been nagging you form months don’t wait any longer to take care of it! If you have questions, email me at [email protected]

Bryan Esherick PT, DPT