We treat many cases of adhesive capsulitis, a.k.a 'frozen shoulder' each year. It is an unpleasant, painful and tricky condition but usually responds very well to an integrated physiotherapy treatment approach.
The stiff and painful frozen shoulder is usually due to an inflammatory reaction of the sub-synovial tissue that results in capsular (the elastic tissue that holds the top of the arm bone in the shoulder socket) and synovial thickening and often accompanied by rotator cuff tendon inflammation (1). Women over the age of 50 years are more likely to develop this condition (2).
The condition's cause is not entirely clear; however, it is often associated with excess or repetitive physical stress to the shoulder and neck, infection, trauma, prolonged immobilisation and others (1).
The benefits of a course of physiotherapy treatment for frozen shoulder include a quicker recovery, improved pain management and a better chance of restoring full movement and function of the joint.
That said, patience is required; there is no quick fix! With physiotherapy, it can take up to six months to recover, but it could take up to 18-24 months without physiotherapy. Sometimes we request an anti-inflammatory injection to the joint to help facilitate and get the rehabilitation process going.
We have found that successful treatment is very dependant on determining at what stage of phase the client with frozen shoulder presents. The classification which works best for me from a clinically uses three phases (3,4):
I - The freezing (painful phase).
2 - The frozen (stiffness phase).
3 - The thawing phase indicates a gradual reduction in symptoms and hopefully a return to function.
What is my secret weapon in successfully treating frozen shoulder?
It is not so secret that there is a decent amount of research evidence to support its use in the treatment of the frozen shoulder. The problem is that the broader medical community does not know about it.
Studies are showing the effectiveness of acupuncture in frozen shoulder and chronic shoulder pain. Acupuncture is considered safe and effective in reducing pain and might directly improve shoulder motion in patients (1,5,6).
In addition to acupuncture, I find that specific manual therapy (3) and graded exercises (3) as used in a real clinical setting by an experienced therapist are an important part of an integrated treatment approach (7).
The greatest mistake I have seen less-experienced physiotherapists make is to treat a phase 1 frozen shoulder too aggressively and with inappropriate exercises. Not treating below the pain threshold in phase 1 may aggravate the shoulder resulting in further inflammation and delay recovery, often resulting in the client giving up on physiotherapy.
Less is more at the start; aim to settle pain and inflammation first, movement can be improved later once the client has moved into the latter stages of phase 2 and phase 3.
We have found that the sooner my clients start treatment, the shorter the overall course of treatment. If your GP has diagnosed frozen shoulder, or you suspect you may have the condition, an assessment with an experienced chartered physiotherapist is the next step.
By Simon Coghlan.
1. Tapper S, Stub T. Case report: Acupuncture treatment for frozen shoulder resulting from traumatic injury. Australian Journal of Acupuncture and Chinese Medicine. 2011;6(2):36.
2. Frontera WR, Silver JK, Rizzo TD. Essentials of Physical Medicine and Rehabilitation E-Book: Musculoskeletal Disorders, Pain, and Rehabilitation. Elsevier Health Sciences; 2014 Sep 5.
3. Wilson J, Russell S, Walton MJ. The management of frozen shoulder. Current Physical Medicine and Rehabilitation Reports. 2015 Jun 1;3(2):181-7.
4. Reeves B. The natural history of the frozen shoulder syndrome. Scandinavian journal of rheumatology. 1975 Jan 1;4(4):193-6.
5. Asheghan M, Aghda AK, Hashemi E, Hollisaz M. Investigation of the effectiveness of acupuncture in the treatment of the frozen shoulder. Materia socio-medica. 2016 Jul 24;28(4):253.
6.Molsberger AF, Schneider T, Gotthardt H, Drabik A. German Randomized Acupuncture Trial for chronic shoulder pain (GRASP)–a pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment. Pain. 2010 Oct 1;151(1):146-54.
7. Page MJ, Green S, Kramer S, Johnston RV, McBain B, Chau M, Buchbinder R. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database of Systematic Reviews. 2014(8).