I have received many phone calls or messages enquiring about physiotherapy treatments for frozen shoulder. My usual reply is: “I will need to assess first before I can advise”. My reply can seem unhelpful but that is the right way of doing things. I am unable to advise unless I have done a proper assessment and history taking. Otherwise, I may cause more harm than good.
Many patients that I have seen, have claimed to have frozen shoulder so this is what I do to determine if it’s true frozen shoulder but I won’t go into details:
1. Obtain a thorough pain history that includes aggravating and easing factors
2. Perform a physical examination that emphasises on shoulder range of movement
3. Perform other body movement screening
The phases of frozen shoulder
Generally, frozen shoulder has three phases and each phase last between 4-8 months.
Freezing
Predominantly painful
Pain around outside of shoulder
Worse at night & after lying on that side
Pain is better if movement is reduced
Frozen
Slowly progressive loss of shoulder movement with gradual reduction of pain
Affects ADLs usually (Wearing bra, combing hair or reaching to back pocket)
Usually loss of shoulder external rotation and abduction
Thawing
Gradually regain shoulder movement
Slow increase in movement with loss of discomfort
Quick facts on frozen shoulder
It is quite common for those 40 and above
It usually resolves in 1 - 2 years but some have reported to take longer
The most common risk factors to developing frozen shoulder are age, diabetes and cardiovascular disease
It is closely linked to metabolic syndrome
Metabolic syndrome is a cluster of abnormalities including lipid changes, elevated blood glucose levels and an immune response (increased pro-inflammatory cytokines) leading to a chronic low grade inflammatory state
So, what is the solution?
As of now, there is no cure or immediate solution for frozen shoulder but physiotherapy is highly recommended. I am not saying this because I am a physiotherapist but because people with frozen shoulder need help with shoulder mobility and strength.
A physiotherapist is well equipped with knowledge on shoulder anatomy and physiology and most importantly the risk of causing harm is low to negligible.
From my understanding of frozen shoulder and science, this is what I will do:
Strength training - A wide variety of strength training to suit the capability and interest of the patient. The patient will explore various strength movements with and without weights.
Mobility drills - Done mostly in weight bearing position to stimulate the shoulder joint. It is good for co-contraction and joint stability. It is another method to stretch the structures inside the shoulder joint.
Stretching - Not just any stretch. Muscles that are tight will be stretched with certain techniques and nerves will also be flossed to relax the shoulder.
Electrotherapy - This will be done if the client has pain.
Muscle release - A variety of techniques can be considered depending on patient sensitivity. Some techniques are direct release, functional cupping, “ trigger point” release, or skin traction.
Thank you for reading this far. Every physiotherapist has their own approach but I strongly suggest seeing one that listens to your concerns and tries to address it. Please avoid those that leaves you unattended or doesn’t show much interest in their work. New update:
Shoulder corticosteroid injection has been found to reduce shoulder pain after about 2 weeks. You can consider this if your pain is unbearable.
Do contact me on this website if you have any queries and all the best in your rehab journey!
Lian Yun-Perng
Chartered Physiotherapist
Ace Physiotherapy
