Frozen shoulder ¦ Rehabilitation

Rehabilitation
(Adhesive capsulitis / Frozen Shoulder)

A frozen shoulder usually passes through three phases. The first phase has reasonable movement but is very painful. Through the next phase the pain is reduced but movement becomes very limited (frozen). Finally the shoulder loosens up and returns hopefully to normal function. This whole process may take 2 to 3 years.

Freezing Phase:

• NSAID's (non steroidal anti inflammatory drugs) e.g. Ibuprofen may help reduce inflammation and pain - although will be of less value in later phases.
• Electrotherapy modalities such as ultrasound and laser treatment may help reduce pain and inflammation.
• Pain free mobility exercises such as the pendulum exercises (see below) can help maintain shoulder mobility.

Initial mobilizing exercises:

Lying on back and raising arm upwards. If the athlete can raise the arm 90 degrees then the weight of the arm will act as a mobilizing force. The athlete can either use short firm oscillating movements or sustained pressure at the end range of movement to increase joint range.

Same as the above but the athlete is in the side lying position. The arm is abducted to 90 degrees or as far as possible and then either sustained pressure or oscillating movements. The less painful the restriction, the more vigorously the stretch / mobilization can be applied. The therapist will usually judge this from the expression / reaction on the athletes face.

One exercise that the athlete can do themselves is free swinging of the arm in a slightly bent over position and supporting the body weight with the unaffected arm on a chair.

Frozen phase and beyond:

Mobility exercises should be continued as best as possible until range of motion increases. Cross friction massage to the surrounding tendons may help with stretching and mobility.

As range of motion increases then strengthening exercises can begin. If there is noticeable wasted muscle then tens or electrical stimulation can accelerate strengthening.

As the joint becomes less stiff and more flexible then prolonged stretches of 1 to 2 minutes in duration can be introduced. This stretching can be combined with distraction of the glenohumerol joint (pulling on the arm).

Once pain has gone then normal strengthening exercises with weights can be resumed.

During the early stages activities which involve stretching through painful range of motion should be avoided. Weight training can be done as long as the exercises do not involve moving through the painful range of movement or lifting up and away from the body.

Most athletes recover in 10 to 12 weeks with proper treatment. The athlete that fails to respond to treatment after 6 weeks is usually referred on to a specialist for further investigation.

Contact me for more info on 087 97 86 814 or

Email me on dave@allsportinjuries.ie

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