You May Be Recovering From Adhesive Capsulitis (Frozen Shoulder) and Not Know It

The physical therapists at Ability Rehabilitation provide treatments including exercise, functional training, manual therapy techniques and adaptive devices and equipment, and physical agents and electrotherapeutic modalities. The overall goal of a physical therapist is to restore movement in the patient.

David P. Whitaker, a physical therapist at Ability Rehabilitation, says, “During the first physical therapy appointment we will do a thorough evaluation. We review the patient’s medical history, do a subjective and objective evaluation and then assess the patient’s impairment and functional limitation. We ask the patient what their goals are and then establish a plan to help them get back to their prior level of function.”

In order to create an exercise program for frozen shoulder rehabilitation, the physical therapist must evaluate what stage of the condition the patient is in. Frozen shoulder usually develops slowly and in three stages:

The three stages of frozen shoulder are:

• Freezing: Any movement of the shoulder causes increasing pain. As the pain worsens, the shoulder will start to lose its range of motion. This stage typically lasts anywhere from six weeks to nine months.
• Frozen: The discomfort will start to lessen, but the shoulder will also become stiffer. Using the shoulder may become difficult. This stage typically lasts for four to six months.
• Thawing: The shoulder motion will slowly improve. It may take anywhere from six months to two years to get back to normal strength and motion.  

The goal of physical therapy in the first stage (freezing) is to help the patient maintain as much range of motion as possible and help reduce the pain. The physical therapist may use a combination of stretches and manual therapy techniques. Stretching will increase the range of motion. Manual therapy is hands-on physical therapy, which uses no devices or machines. Manual therapy techniques are used to decrease pain. During manual therapy, the physical therapist will use their hands to put pressure on muscle tissue and manipulate joints in an attempt to decrease pain. The patient may also be provided with an at-home exercise program designed to help reduce the loss of motion.

In the second stage (frozen), the goal will be the return of motion. The physical therapist will continue to use stretching and manual therapy techniques, but they may be more aggressive. Previous at-home exercises given from the physical therapist may change to include the newer exercises.

During the final stage (thawing), the goal of the physical therapist is to bring the patient back to full functional range of motion. The physical therapist will continue to use stretching and a variety of manual therapy techniques. Typically after full function range of motion is achieved, the physical therapist will create a strengthening program for the patient. Strengthening programs will strengthen muscles that are weak and stiff. The program will not only target the rotator cuff but will also target the specific muscles around the shoulder complex.

Causes of Adhesive Capsulitis (Frozen Shoulder)

There is no known direct cause of frozen shoulder. Certain diseases such as diabetes, hypothyroidism, hyperthyroidism, Parkinson’s disease and cardiac disease may increase the chances of frozen shoulder. The condition may also occur if the shoulder has been immobilized for an extended period of time, such as during a surgery, fracture, or other injury. Often patients will be directed to gently move their shoulders soon after an injury or surgery to prevent frozen shoulder.

Treatment for Adhesive Capsulitis (Frozen Shoulder)

The focus of treatment for frozen shoulder is to control pain and restore motion and strength. Initial treatments include nonsteroidal anti-inflammatory medicines, steroid injections, and/or physical therapy. Non-steroidal anti-inflammatory medicines, like aspirin and ibuprofen, can reduce pain and swelling. During steroid injections, cortisone (a powerful anti-inflammatory medicine) is injected directly into your shoulder joint.

Physical therapy involves specific exercises which will help restore range of motion. It can either be done under the supervision of a physical therapist or at home. The therapy will help stretch the shoulder to increase mobility. Even though it may take up to three years or more, frozen shoulder does generally get better over time. If your symptoms are not relieved with non-surgical treatments you may want to discuss a surgical treatment option with your doctor.