Blogs from September, 2022

As discussed in Frozen Shoulder Part 3, there are 4 stages of frozen shoulder. The goals of treatment during each stage are different due to the presentation in each stage. Studies have been done that show that when treatment is matched to the stage of frozen shoulder (level of pain and irritability in the joint), the results are better.

1. Painful stage and Pain and Freezing stage – during these first 2 stages, the joint is highly “irritable”. The tissues do not want to take much physical stress. The goal of treatment is to reduce pain and inflammation while trying to minimize loss of range of movement.

• Important education is on the natural course of the condition. It also focuses on teaching the patient how to modify their activities to reduce the stress on the painful shoulder and on positions of comfort.
• Exercises for the shoulder are done gently but regularly to limit range of movement loss. These exercises should not cause significant pain.
• Manual therapy is done gently with the goal of reducing pain and inflammation.
• In a study of patients in these initial stages of frozen shoulder, an independent program of gentle pain-free exercises was found to be superior to aggressive stretching and manual therapy. So, not only are aggressive exercises painful, they actually result in a worse outcome.

2. Frozen stage – during this stage, the “irritability” of the joint is decreasing and the tissue can begin to take a little more stress. The goal of treatment is to start to improve range of motion and regular activities without aggravating pain.

• Education continues to be important as the patient progresses through the stages. The patient will gradually be able to do some regular activities that were painful before. The patient’s exercises will also be progressed, but it is important that the patient be educated to not push into pain.
• Exercises will start to progress to gentle stretching. Light strengthening exercises will also be added.
• Manual therapy will also be done with gradually progressive intensity and length of time.

3. Thawing stage – during this stage, the joint will be able to tolerate much more. The goal is to return the patient to normal range of movement, strength and return the patient to their normal activities.

• Education - the patient will now be able to do higher demand physical activities.
• Exercises will include stretching with progressively higher intensity and longer hold times, if tolerated without increasing pain. Also progressively more resistance will be added to strengthening exercises.
• Manual therapy will continue to progress in intensity with the goal of restoring normal range of movement.

Reference:

Kelley MJ et al Shoulder pain and mobility deficits: Adhesive capsulitis. J Orthop Sports Phys Ther 2013; 43(5):A1-A31.