What is Frozen Shoulder?
Frozen shoulder is also known as Adhesive Capsulitis. This is a condition characterized by stiffness, pain, and limitations with range of motion in the shoulder. This is a condition that can come on suddenly, or in some cases develop over time. Frozen shoulder can be preceded by an injury or recent surgery, prolonged immobilization, but not in all cases. Despite much research and study regarding this condition, many questions have gone unanswered related to the exact cause of frozen shoulder. What is well documented are the risk factors to develop frozen shoulder and what portions of our population tend to develop this condition. Individuals age 40-70 are at increased risk. Women have a significantly higher risk of developing this condition than men. If you have been diagnosed with diabetes or have suffered a stroke you are at an increased risk of developing Frozen Shoulder.
In my experience, Frozen Shoulder, or Adhesive Capsulitis, can be one of the most painful and frustrating conditions to have to work through. It may start with a seemingly mundane or relatively mild overuse or strain of the shoulder. As pain in the shoulder progresses we tend to protect and limit the movement, in hopes of resolving the issue. The shoulder hurts and is painful while reaching behind the back, reaching overhead, reaching behind your back to put on a button up shirt or coat, or reaching the belt line to tuck in a shirt. Through protective mechanisms and a subconscious need to avoid pain the shoulder is protected from moving into these ranges. Stiffness builds and the joint capsule tightens. Joint irritation increases from the lack of movement. Scar tissue, or adhesions, develop in the shoulder glenohumoral joint due to the limited movement and joint irritation. Thus, you are sent into a terribly viscous cycle of pain, protected movement, lack of activity, and compounding joint adhesion and functional loss. How do you break this viscous cycle and get back to your normal daily life. I would like to give you my top three tips to Relieve Frozen Shoulder:
Start light stretches immediately!
The best thing you can do for yourself is to start a regimen of light movement and stretches. These stretches and exercises need to be very focused and performed properly to ensure you are not developing compensations, such as shoulder elevation and/or forward rolling protractions, to make up for the loss of motion and pain in the shoulder joint. Repeatedly using compensation movements to avoid pain will only serve to allow the shoulder joint capsule to tighten and further limit functional reaching and use of the arm. Here are 2 easy exercises to start;
- Wall slides: stand facing a wall with the shoulder facing forward and squared up to the wall. Place the hand of the injured shoulder on the wall palm-down. Slowly slide the hand up the wall, taking it as high as you feel comfortable. Once the hand is up above shoulder or even head height and you feel a stretch and pull in the shoulder, hold this position for 5 seconds. Slowly slide the hand back down the wall to relieve the stretch and tension on the shoulder. Repeat this sliding motion 10 times. This can be done 2-3 times per day.
- Use a terry cloth towel under the palm to allow the hand to slide with more ease up the wall. Again, pay close attention to avoid hiking the shoulder up or moving it forward to avoid pain or discomfort.
- Table slides: start by sitting next to a table or counter top with the injured arm and shoulder to the side of the arm. Raise the arm up and rest the hand and forearm on the countertop. Slowly slide the hand forward away from you along the top of the counter or table. As you reach forward, slowly bend forward at the hips to allow you to reach further and obtain an increased forward stretch on the shoulder. Once a good stretching point is reached, hold this for 5 seconds, then slowly sit back to an upright position to relive the stretch on the upper arm and shoulder. Repeat this sliding motion 10 times. Do this 2-3 times per day.
- To further challenge yourself, place the chair further away from the table or counter top you are working on. This will require you to reach out further away from your body, putting more stretch on the shoulder and upper arm. Once you have completed the forward reaching stretch, try reaching out away from your body at more of an angle. This will further challenge the shoulder and other additional muscles in the shoulder blade and upper back.
Use Ice and Heat
Ice treatment and the use of a heat pad on a low setting can be very effective tools to reduce pain and inflammation, while also reducing stiffness and improving the overall effectiveness of the light stretches and exercises. Ice, or cryotherapy, may be applied in various forms. Gel packs, plastic bags filled with crushed ice, and various ice wraps are commercially available. Ice is most effective when used within 1-2 days of an initial injury or re-aggravation. This is to reduce inflammation, control pain, and reduce any swelling or effusion which may be present in the upper arm and shoulder.
- Ice shoulder be applied for about 15 minutes, with one thin layer between your skin and the ice pack. Ice should be applied 1-2 times per day, and as needed for pain and soreness.
- Heat pad may be placed on the injured shoulder for 10-15 minutes, 1-2 times per day. The use of a most heat is preferred. The moist heat will serve to penetrate the skin and into the sore tissues more effectively. Heat will temporarily draw blood flow and promote fluid movement to the shoulder, allowing the tight tendons of the rotator cuff and stiff muscles in the shoulder to stretch and elongate with movement. This will serve to reduce the pain and tension felt in the shoulder during daily activities. I would recommend applying a heat pad to the injured shoulder for 10 minutes prior to working on stretching exercises. This will allow you to tolerate more stretching and will reduce the pain and tenderness felt with the light stretches. Avoid the use of the heat pad if you have recently aggravated or over-used the injured shoulder.
It is well established that medically guided treatment from a Physical or Occupational Therapist is crucial to prevent long term functional loss in the involved shoulder and arm. Guided and progressive stretching with controlled light strengthening exercises will allow the arm to re-gain the much-needed mobility in the glenohumural joint and slowly progress functional strengthening in the shoulder and other muscles of the shoulder girdle. A well-trained therapist will need to closely follow the progression of your exercises and stretches to ensure you are not only completing them properly and without compensations, but you are also being challenged and progressed in a way that will serve to improve the use of your arm, but also prevent you from doing too much and pushing weights and aggressive stretching to quickly, which can serve to further inflame the shoulder.
A guided home exercise program is crucial to the progressing of the shoulder recovery. With a well-managed home exercise program, you are able to continue the progress you make in the clinic with the therapist while you are at home. Progression through the rehabilitation process will always have its’ challenges. Our upper-extremity specialists here at Flex Physical therapy are here to continually challenge you and progress you in a way that will serve to meet your goals. Whether your goals are to dress yourself and reduce your pain, or to return to high level athletics and high intensity workouts, we are here to assist you and lift you up to your full potential! I hope that I have been able to provide you with tools to reduce your pain and reach your goals. If you are continuing to experience pain, weakness, or numbness in the shoulder or arm contact one of our upper extremity specialists at 1-800-930-8803 as we would love to help.