Frozen shoulder (FS) is a common condition treated by physiotherapy. There are three classic stages to the FS: a freezing stage, a frozen stage and a thawing phase.
The freezing stage is characterized by a gradual stiffening with a increase in pain.
The pain usually starts locally around the shoulder and is progressive in nature. Early on pain tends to be felt mostly at night or when the shoulder is moved close to the end of its range of motion. Common painful movements include doing up a bra, reaching into the back pocket, shampooing hair and pulling on a shirt overhead. The pain usually progresses to a constant intense pain at rest, which is aggravated by any movement of the shoulder.
A stiff shoulder with less pain characterizes the frozen stage.
The thawing phase is characterized by a gradual return of mobility and a further decrease in pain.
In the thawing phase, forward motion of the shoulder typically returns first. The mobility of the arm out to the side and behind the back will return later. To raise the arm, an individual will hike their shoulder blade to compensate for the lack of mobility.
The FS can last from 1-2 years. Most people will regain full use of their arm, although some individuals continue to experience a lack of mobility.
FS affects women more than men and is more common in the non-dominant shoulder.
Common risk factors for FS include:
- Trauma to the shoulder
- Thyroid disease
- Increased cholesterol
Physiotherapy treatment should consist of manual physical therapy, exercises for mobility and modalities to decrease pain. The manual physical therapy is directed at the neck, upper back, shoulder blade and shoulder. The manual therapy can consist of joint manipulation, joint mobilization and soft tissue techniques. Exercises for range of motion help to improve mobility and are critical to maintain progress between visits.
It is worthwhile to try a course of physiotherapy to see if therapy can help speed up the recovery process. It is important that the therapy not increase the pain. It is okay to experience a temporary increase in pain during therapy but this should decrease to its usual level within 40 minutes. Improvements in mobility should start to be experienced in 3-4 visits, though more physiotherapy will probably be required. If no gains in mobility are noticed in the initial visits, physiotherapy may not be help, but a home exercise program should be continued. If the pain persists or if the therapy exacerbates the pain a cortisone injection may be a good choice.