Physiotherapy for Shoulder Pain

Do you present with mild to severe shoulder stiffness? Do you have difficulty with grooming, dressing, overhead activities and washing due to shoulder pain? If so, you may be suffering from Frozen Shoulder. Our qualified Physiotherapists in our Brisbane clinics can help educate you on shoulder exercises at home to help with the pain or can help with treating this condition in clinic with a myriad of hands-on treatment techniques. The following will demonstrate what Frozen shoulder is, the presenting symptoms, management of Frozen Shoulder and how Physiophi can help.

What is Frozen Shoulder?
Also known as adhesive capsulitis (AC), Frozen Shoulder is a condition that can cause marked pain and stiffness in the shoulder. Inflammation in the glenohumeral (shoulder) capsule is the driving force for pain and stiffness into external rotation of the shoulder. Most frozen shoulders can make a complete or almost-complete recovery over a varied period of time. The time frame for a full recovery varies between individuals and their background. There are multiple factors that contribute to the development of adhesive capsulitis.

Frozen Shoulder can present under two classifications, primary or secondary. A primary onset is idiopathic, which means there is no clear cause of onset. This can be frustrating due to no predisposition or injury event required to trigger the painful process. Secondary onset refers to Frozen Shoulder occurring from a known cause. Usuallypost-operatively butit can also happen after strokes and injuries to the shoulder. In the case of a secondary occurrence post-injury, shoulder movement might be limited due to pain, which changes how the shoulder moves through space, ultimately causing stiffness to accumulate in the joint. Arthroscopic studies and observations have found an inflammatory component in the axillary fold that might contribute to the development of frozen shoulder.

The Anatomy and The Process

Credit: https://www.sports-health.com/blog/5-things-you-need-know-if-you-have-frozen-shoulder

The condition affects the front and bottom aspects of the joint capsule, as pictured above. In a normal shoulder, the capsule can expand and contract, allowing for overhead movements. Once inflamed, cross-sectional adhesions occur in the capsule that restricts expansion and movement. Think of this as glueing together rings of a slinky spring, where the slinky is the capsule that is unable to expand fully on demand.

Individuals with structurally smaller joints and a loss of the axillary folds might be predisposed to developing Frozen Shoulder, but there is constant contention as to the validity of these factors.

Presenting Symptoms
Common symptoms on presentation include shoulder pain (ranging from mild to severe), stiffness (also ranging from mild to severe) of the shoulder and difficulty with grooming, dressing, overhead activities and washing.

Frozen Shoulder develops in three overlapping phases: freezing, frozen and thawing stages. That is, each phase is not distinct in its symptoms. Some phases may be quite short, while other phases can be drawn out. The time frames vary from case to case.

1. Freezing Phase: This is the most acute phase, which means pain is usually the most severe during this time. Pain can start quite abruptly or can onset gradually. Nocturnal disturbances are common and may last up to nine months.
2. Frozen Phase: As the name suggests, stiffness is the hallmark of this period. Pain starts to subside whilst stiffness increases. There is a progressive lack of shoulder mobility which limits function. Pain is still apparent at end-ranges but notably not as sharp before the limits of range. This phase may occur at approximately 4-6 months, and can last for up to a year.
3. Thawing Phase: Progressive improvement of range. This phase can last anywhere between 4-24 months. This last phase has been shown to linger for up to 3 years. Beyond 3 years, 40% of patients may continue to have restrictive symptoms.

Frozen Shoulder is more prevalent in the following demographics:

• 70% of frozen shoulder presentations are in females
• Ages between 35-65 years old
• There is a 20% occurrence rate in the diabetic population
• A previous episode of Frozen Shoulder. Bilateral involvement has a prevalence of approximately 14%

DO’s:

• Regular ranging of the shoulder is important
• Physiotherapy can aid in recovery of adhesive capsulitis. A program of stretching, strengthening and manual therapy can be conducted to prevent further decline of shoulder function
• Medical advice is vital to prevent misconception surrounding the condition. It can help to reduce frustration and encourage functional maintenance
• Pain management especially during the freezing stage to ensure pain does not impede daily function

DON’Ts:

• Excessive resting of the shoulder. This can cause adhesions in the capsule to worsen by thickening and becoming moreabundunt.
• Perform activities that cause pain
• Lift heavy objects with the affected shoulder

How Physiophi Can Help
There are a myriad of treatment options available for adhesive capsulitis, and even though they will not give instant relief, we aim to accelerate the pathway to recovery.

Patient education is vital. Understanding the prognosis of frozen shoulder acts as the first hurdle that can be overcome. Without adequate education, frustration and anger can plague the life of the patient and the lives of everyone around them. Manual therapy techniques and exercises aim to help with pain management and maintain or improve range.

Our clinic also has an extracorporeal shockwave therapy machine, which studies have shown aid in the recovery of adhesive capsulitis by accelerating the process of healing.

If your frozen shoulder is not getting better, you may need to consult your experienced Musculoskeletal Physiotherapists at Physiophiwho excel at fast-tracking your recovery to have you pain free and moving freely.

PLEASE CONTACT US ON: (07) 3172 4332 TO HAVE A CHAT WITH OUR FRIENDLY STAFF OR SIMPLY BOOK ONLINE AT: WWW.PHYSIOPHI.COM.AU

Reference List
Barbosa, F., Swamy, G., Salem, H., Creswell, T., Espag, M., Tambe, A., & Clark, D. (2019). Chronic adhesive capsulitis (Frozen shoulder): Comparative outcomes of treatment in patients with diabetes and obesity. J Clin Orthop Trauma, 10(2), 265-268. https://doi.org/10.1016/j.jcot.2018.02.015
Cao, D. Z., Wang, C. L., Qing, Z., & Liu, L. D. (2019). Effectiveness of extracorporeal shock-wave therapy for frozen shoulder: A protocol for a systematic review of randomized controlled trial. Medicine (Baltimore), 98(7), e14506. https://doi.org/10.1097/MD.0000000000014506
Jain, T. K., & Sharma, N. K. (2014). The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: a systematic review. J Back MusculoskeletRehabil, 27(3), 247-273. https://doi.org/10.3233/BMR-130443
Page, M. J., Green, S., Kramer, S., Johnston, R. V., McBain, B., Chau, M., & Buchbinder, R. (2014). Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev(8), CD011275. https://doi.org/10.1002/14651858.CD011275
Vahdatpour, B., Taheri, P., Zade, A. Z., &Moradian, S. (2014). Efficacy of extracorporeal shockwave therapy in frozen shoulder. Int J Prev Med, 5(7), 875-881.