In this blog article I describe my experiences in treating patients with frozen shoulders as a physiotherapist in Fitoont Platform website. The article contains everything you need to know about the causes, symptoms and 5 frozen shoulder exercises for quick relief.
Shoulder problems can affect the quality of life, especially if they result in decreased shoulder range of motion. In particular, patients with a so-called ” frozen shoulder ” tell me, as a physiotherapist in Fitoont telehealth platform, that they are afraid that their pain could become chronic or that they will have to be treated surgically.
The good news is: In many cases, a frozen shoulder can be successfully treated and shoulder mobility restored – in most cases without surgery.
What is a frozen shoulder?
Many people experience shoulder pain at some point in their lives. Most of the time these are not serious and go away on their own. But sometimes a so-called “frozen shoulder” can also occur, also known as peri-arthritis humeroscapularis or adhesive capsulitis.
A frozen shoulder often begins with increasing one-sided pain in the shoulder and progressive restriction of mobility. In the course of the frozen shoulder, the pain often tends to decrease, but the restriction of mobility tends to increase. At the end of the symptoms, mobility improves again. Many patients can regain their previous range of motion. Studies in recent years have shown that this is unfortunately not the case for all patients.
For many of those affected, the frozen shoulder is over after about a year and the shoulder can be used as normally as possible. However, there is also a smaller proportion of patients who have symptoms for longer. A small proportion of those affected may also experience permanent limitations in the function of the shoulder. The majority of those affected can use their shoulder normally again after the frozen shoulder has subsided.
How common is a frozen shoulder?
Frozen shoulder is relatively rare at 0.75% – 2%, occurs mostly in people over the age of 40 and affects women more often than men. It has not yet been possible to reliably explain why women are more frequently affected by frozen shoulder.
Causes of Frozen Shoulder
Frozen shoulder is a shoulder joint disorder likely caused by inflammation of the tendons and shoulder joint. In most cases, it is not known exactly why the inflammation occurs and why the shoulder remains stiff even when the pain subsides.
In research, several possibilities are discussed as possible causes for inflammation and stiffness (frozen) of the shoulder. There are other hypotheses in addition to the very popular theory of hardening or shrinkage of the capsule due to the inflammatory process.
Other possible explanations are stiffness as an increased protective reaction of the nervous system to the inflammatory processes and genetic factors that could increase the risk of a frozen shoulder.
Risk factors for frozen shoulder
There seem to be risk factors that could favor the occurrence of the disease:
- Age: Frozen shoulder is more common in people over the age of 40.
- Gender: Women are slightly more likely to be affected than men.
- Diabetes: often altered metabolic status, this seems to increase the risk of frozen shoulder.
- Accident, trauma, surgery on the shoulder joint: frozen shoulder occurs more frequently.
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Frozen shoulder symptoms
Frozen shoulder is a slowly progressive condition that usually causes only mild symptoms at first. However, these symptoms can increase over time and cause significant disability.
The possible symptoms of frozen shoulder are:
- Shoulder pain: can start with movement or rest and often gets progressively worse over time. Partly also a burning feeling radiating into the upper arm.
- Stiff shoulder: The mobility of the affected shoulder is limited.
- Insomnia: The pain in the shoulder can make sufferers sleep poorly. For some patients, the pain is worst at night.
The frozen shoulder can lead to significant impairments and significantly affect the quality of life of affected people.
Frozen shoulder diagnosis
The diagnosis of a frozen shoulder is most often based on the symptoms and signs that you and your doctor or physical therapist observe.
In most cases, a frozen shoulder can be diagnosed based on your symptoms and by asking about your medical history. In some cases, the doctor may recommend an X-ray or MRI to rule out other conditions that may be causing similar symptoms.
Although there are no specific blood tests to diagnose a frozen shoulder, certain blood tests can help rule out other conditions that can cause similar symptoms. This may include, for example, a complete blood count and a test for rheumatoid arthritis.
Treatment options for frozen shoulder
Because frozen shoulder is a slowly progressive condition, conservative treatment is attempted first in most cases. The main focus is on measures to alleviate the symptoms, since no treatment is known to date that can cure the disease directly.
The most important measures to alleviate the symptoms include:
Physiotherapy: Physiotherapy exercises can help restore mobility to the affected side and strengthen the muscles.
Medications: In some cases, anti-inflammatory or pain-relieving medications can help relieve symptoms. In severe cases, cortisone injections can also be given to the affected area.
But, in a small proportion of those affected, surgical intervention may be necessary in the advanced stage of the disease or if conservative measures are insufficient. In doing so, an attempt is made to restore the mobility of the shoulder joint.
Main treatment: physiotherapy for frozen shoulder
The most important therapy for a frozen shoulder is physiotherapy. Targeted exercises aim to improve shoulder mobility and reduce pain. In most cases of frozen shoulder, physical therapy and rehabilitation takes several months to a year.
Also, in some courses, the treatment phase can be significantly longer than a year. In order to prevent a renewed decrease in mobility, it is important that the affected person regularly carries out exercises for strength and mobility in addition to the physiotherapy in the practice.
In physiotherapy, it is particularly important to constantly adapt the intensity of the treatment and the exercises to the current situation of the frozen shoulder. For this purpose, it is advantageous for those affected to consult a physiotherapist who is not only familiar with the clinical picture, but also has expertise in the field of medical training and exercise treatment.
5 Frozen Shoulder Exercises For Quick Relief
- Starting position: relaxation and decoatation exercise for the shoulder can be performed in 3 positions, sitting, standing or lying prone.
- Execution: with the arm completely relaxed, small and slow oscillation or circling movements must be performed, with a maximum weight of 2 kg in the hand or attached to the wrist.
- Repetitions: to be performed for 2-3 minutes.
2- Elevation from flexion
- Starting position: it can be performed in three positions, sitting, standing or supine, even if the supine position is to be preferred. With the fingers of the hands intertwined and the arms stretched out resting on the abdomen.
- Execution: perform a slight traction and slowly lift the limbs up above the head or at least up to the point where you feel a stretch, without pain, and then always bring them back to the abdomen. Hold the maximum position for 20 seconds.
- Repetitions: 20 seconds for 3 repetitions.
3- Pectoral stretch
- Starting position: standing, facing an open door, rest both hands and forearms on the side uprights with elbows bent at 90° and at the same height as the shoulders.
- Execution: advance in small steps slowly with the whole body up to the point where you feel a stretch in the front area of the shoulders. Once you have reached the maximum possible position, hold it for 20 seconds.
Repetitions: repeat the exercise 3 times for 20 seconds each.
4- Scapula stabilizers
- Starting position: standing with your back facing the wall and arms extended outwards at 45° and elbows bent. Lean your elbows against the walls, placing a pillow or towel on the wall.
- Execution: Push your elbows against the walls bringing your torso forward. Maintain the position for a minimum of 6 seconds, up to a maximum of 20 seconds.
- Repetitions: 6 to 20 seconds and repeat 10 times.
5- Deltoid and supraspinatus
- Starting position: Standing with a rubber band or a weight held in the hand. With the arm extended, abducted and the thumb pointing down.
- Execution: lift the limb remaining about 10 cm below shoulder height and then slowly return to the starting position.
- Repetitions: Perform 10 repetitions for 2 or more sets until the shoulder muscles feel a little tired.
Dosage of exercises
In the post surgery for reconstruction or shoulder prosthesis, in a conflict syndrome or in the presence of pain, it is necessary to consult a professional. For the prevention of probable future pathologies, the advice is to do the exercises every other day, at least 4 times a week.
In particular, in strengthening exercises it is necessary to feel that the muscles involved have worked, up to a feeling of tiredness, without however feeling any pain or discomfort. Naturally, your therapist will tell you when you are ready for the exercises and when it is better to keep the joint at rest, perhaps with a brace that protects it and keeps it motionless.
There is no best time of day in which to do these “5 frozen shoulder exercises” for quick relief and there is no time limit to stick to and then stop doing them. It takes up to three months to obtain results which then remain consolidated over time, but the advice is to do them as long as you feel the need.
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Typical course of frozen shoulder (Source)
The course of a frozen shoulder is often divided into several phases:
Freezing – freezing phase:
In the first phase, the so-called “freezing” phase, the pain is in the foreground and mobility decreases. In this phase, the pain in the shoulder is in the foreground.
Frozen – frozen phase:
In the second phase, the “Frozen” phase, the main focus is on the stiffness and restricted movement of the shoulder. In this phase, pain is often felt more at the end of the movement.
The third and final phase, the “thawing” phase, is the time when the pain continues to decrease and the shoulder joint becomes more flexible again. At the end of this phase, many of those affected have significantly less pain and improved shoulder mobility.
How long these phases last is very individual. In earlier theories, fixed periods of time were ascribed to the respective phases. Recent research shows a very individual course of the individual phases of the frozen shoulder.
There are also studies that show that not all frozen shoulder patients can return to full shoulder function. Why this is so has not been finally clarified.
Conclusion frozen shoulder: painful, sometimes tedious, usually good prognosis
The frozen shoulder is an often protracted, sometimes painful disease with a mostly good prognosis. Most affected individuals can overcome the pain and stiffness in the shoulder and often regain their quality of life within 6 to 12 months. Unfortunately, not all patients seem to be able to heal the frozen shoulder without consequences.
For the course of the disease, it is important to behave correctly at the right time in order to optimally support the healing process of the disease. For this purpose, these 5 frozen shoulder exercises for quick relief from competent physiotherapy is extremely useful.
People affected by a frozen shoulder need patience and confidence. In many cases, the disease heals largely without consequences.
I’m Kyrillos Mina, CEO and founder of Fitoont. I work as a physiotherapist, I created this platform to treat people with all the diseases and symptoms that physical therapy treats. In addition, I will provide tips to lose weight through diet and exercise plans.