Defrost the Pain: Why Physical Therapy is the Key to Treating Frozen Shoulder

As if aging didn’t present enough challenges, 2-5% of us will eventually experience a painful condition known as “frozen shoulder”. Also known as adhesive capsulitis, frozen shoulder is an inflammatory condition that causes stiffness and pain in the shoulder joint, and significantly reduces range of motion. Frozen shoulder typically affects people 40 and older and is more likely to occur in women. Symptoms can improve over time, but without treatment will often last as long as 1-3 years. That’s a long time to go without a strong, functional shoulder!

Thankfully, once the pain subsides, it is unlikely to occur again in the same shoulder. The bad news is some people will develop the condition in the other shoulder – usually within 5 years. In this article, we will investigate the signs and symptoms of frozen shoulder, and discuss the treatment options that are available.

What Causes Frozen Shoulder?

Adhesive capsulitis occurs when the capsule of connective tissue that encloses the shoulder joint thickens and tightens around the joint, restricting its movement¹. It’s not clear why this happens to some people, but the likelihood increases when the shoulder is kept still for a long time. The risk is higher for people recovering from surgery or a fracture. Certain injuries like rotator cuff injuries also seem to increase the risk.

Per the Mayo Clinic, certain systemic diseases may also increase the risk of developing frozen shoulder. These diseases include diabetes, hyperthyroidism, hypothyroidism, cardiovascular disease, and Parkinson’s disease.

Stages of Frozen Shoulder  

Adhesive capsulitis is said to develop in three stages² – each with its own symptoms and duration.

Stage 1: Freezing – In the “freezing” stage you gradually develop more pain. AS the pain worsens, range of motion is lost. This stage can last from 6 weeks to 9 months.

Stage 2: Frozen – Pain can actually decrease somewhat during the “frozen” stage, but the stiffness remains and regular activities can be very difficult. This stage can last 4 to 6 months.

Stage 3: Thawing –During the “thawing” stage, motion slowly improves. This gradual improvement is very slow, and you won’t return to anything like normal strength and motion for anywhere from 6 months to 2 years.

How is Frozen Shoulder Treated?

Though frozen shoulder generally gets better over time, most people aren’t comfortable waiting 3 years to use their shoulder again. Some people undergo surgery to alleviate symptoms, while many others will opt for temporary relief through steroid injections or non-steroidal anti-inflammatory drugs (NSAIDs). Surgery is obviously invasive, risky, and can come with a difficult recovery period. Pharmaceutical remedies are typically not long-term solutions, as symptoms often return after a short time.

For most people, the most effective long-term treatment option for frozen shoulder is physical therapy and home exercises. While clinicians are encouraged to start treatment of adhesive capsulitis by educating their patients, many primary care practitioners find themselves limited to prescribing medications. As soon as symptoms of frozen shoulder present themselves, making a physical therapist your first point of contact can help you avoid unnecessary surgery or drugs, and get you started on your recovery and pain treatment right away.

Why Physical Therapy?

Studies have shown that physical therapy can bring both pain relief and return of functional motion when used as a first-line treatment for adhesive capsulitis³. Rather than applying a one-size-fits-all approach to your treatment, a physical therapist will consider your symptoms and current stage of the condition, and create a personalized treatment plan tailored to your specific situation.

A physical therapy treatment program can allow you to experience both pain relief and improved motion and functionality. Your therapist can also create a home exercise program that will allow you to progress in your treatment on your own time in your own home.

If you are currently experiencing symptoms associated with frozen shoulder – or are concerned you may be, reach out to a physical therapist today and take the best first step toward recovery.

SOURCES:

1. Mayo clinic. “Frozen Shoulder - Symptoms and Causes.” Mayo Clinic, 19 Aug. 2022, mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684.
2. American Academy of Orthopaedic Surgeons. “Frozen Shoulder - Adhesive Capsulitis - OrthoInfo - AAOS.” org, 2010, orthoinfo.aaos.org/en/diseases--conditions/frozen-shoulder/.
3. Chan, HBY, et al. “Physical Therapy in the Management of Frozen Shoulder.” Singapore Medical Journal, vol. 58, no. 12, Dec. 2017, pp. 685–689, https://doi.org/10.11622/smedj.2017107.