The American Academy of Orthopedic Surgeons (AAOS) has defined frozen shoulder (periarthritis or adhesive capsulitis) as a condition characterized by a progressive limitation of active and passive shoulder motion.
According to the AAOS, the severity of the condition can vary, but however severe the condition, there may not be radiographic findings other than a mild form of osteoporosis (osteopenia). While frozen shoulder is the most common term used to describe the condition, it is also referred to as adhesive capsulitis, painful stiff shoulder, and periarthritis.
The condition is self-limiting. Once it runs its course, which usually lasts for two-three years, the shoulder ‘thaws,’ the pain subsides, and the shoulder returns to its full range of motion. However, statistics show that close to 40 percent of patients have mild yet persistent pain beyond three years, and about 15 percent of patients could suffer the symptoms for a long time.
While there is always the option of surgery, where the scalpel goes into the shoulder joint and hacks away at the adhesions, it’s better to let the condition run its full course, which consists of freezing stage, frozen stage, and thawing stage. Of course, one can hasten the onset of the thawing stage with the help of regular exercises.
Frozen Shoulder Treatment Options
Depending on the stage of the frozen shoulder and the severity of pain and stiffness, the treatment will vary. A wide variety of treatments can be used to treat a frozen shoulder, but there is no conclusive evidence of how effective each treatment is and, therefore, which treatment is best. The important thing here is for individual assessment to figure out which treatment is most effective in reducing shoulder pain and increasing the range of mobility.
As the first stage of the condition is most painful, the focus should be on relieving the pain. During this stage, it’s best to limit the range of movements that increase the pain. Also, ask your doctor or learn from online sources how to cure a frozen shoulder naturally, and even how to fix a frozen shoulder naturally.
If painkillers aren’t helping to control the pain, the next step is intra-arthroscopic injections. These injections can help relieve pain and improve the movement in your shoulder. However, they will not cure your condition and your symptoms may gradually return.
Taking too many injections may damage your shoulder and even reduce the effectiveness of the injections. Try and keep at least three-four weeks between injections.
The initial painful stage is followed by the more prolonged stage of stiffness. This is where exercises come handy. However, if your shoulder is very stiff, exercise may be painful. In which case, a physiotherapist can give your shoulder the correct mobility it needs to heal and become more mobile again.
There are many techniques a physiotherapist has at their disposal to keep the movement and flexibility in your shoulder.
- Specific stretching exercises that use techniques to move the joint omni-directionally
- Frozen shoulder massage therapy – massage techniques focused on certain muscles and tendons around your shoulder
- Thermotherapy, with warm or cold temperature packs
- More recently. there are newer and more sophisticated techniques gaining ground in the treatment and management of a frozen shoulder. Some of them are:
- Transcutaneous electrical nerve stimulation (TENS)
- Shiatsu massage
As with exercise, self-evaluation and evaluation with your physiotherapist will ultimately guide you to the best method suitable for you. So, it’s extremely critical that you assess the result of each treatment very carefully.
Surgery should be your absolute last resort. Because once the scalpel goes into your joint, there is no turning back. So, resort to surgery only if your shoulder has not responded to the other treatment options. But please give at least six months of trial for the other options. If it does come down to surgery, there are different types of surgery to choose from:
- Manipulation under anesthetic
- Arthroscopic capsular release
- Arthrographic distension (hydrodilatation)
Remember, like the injections, surgery is just a quick relief from the pain and not a cure for the problem.
Exercises for a Frozen Shoulder (Periarthritis)
Stretching exercises are usually the go-to strategy for managing a frozen shoulder. In fact, the Harvard Medical School has published six easy-to-do home exercises for frozen shoulder that can help you reach your ‘thawing goals’ faster. But before you start doing any of these exercises, please check with your doctor and make sure you warm up your shoulder before commencing any of these exercise routines.
The best way to warm up your shoulder is to take one 10-minute warm shower. And while doing the exercises, it’s important to remember not to stretch beyond the point of tension.
Do this once daily. Relax your shoulders. Bend forward as much as possible and let the arm of your affected shoulder hang down. Draw an imaginary circle with the hand about a foot in diameter. Draw 10 circles in each direction. As your symptoms improve, increase the diameter of your circle without straining too much. Once you’re ready for more, hold a light weight in your hand and repeat the exercise.
Hold one end of a three-foot-long towel behind your back with the hand of your affected shoulder and grab the opposite end with your other hand. Holding the towel in a vertical position, use your good arm to pull the affected arm upwards to stretch it. Do this simple stretch 10–20 times daily.
Stand three-quarters of an arm’s length away from the wall. Reach out and touch the wall at waist level with the fingertips of the affected arm. With your elbow slightly bent, slowly walk your fingers up the wall, spider-like, until your elbow is fully stretched, and you’ve raised your arm as far as you can, comfortably. Lower the arm slowly and repeat two-three times. Do this exercise 10–20 times a day.
You can do this exercise while sitting down or standing. With the help of your good arm, hold the elbow of your affected arm and bring it up and across your body, exerting gentle pressure to stretch the shoulder. Hold the elbow in this position for 15–20 seconds. This simple exercise can be done up to 20 times a day.
Lift the frozen shoulder arm onto a shelf about breast-high with the help of your good arm. Bend your knees gently to open up the armpit. Increase the bend ever so slightly to the armpit, and then straighten. With each knee bend, stretch a little further, but don’t overdo it. Do this 10–20 times every day.
Hook one end of a rubber exercise band around the doorknob of a close door. Standing next to the door, hold the other end with the hand of the affected arm. Now, holding your elbow at a 90-degree angle, pull the band toward your body two-three inches and hold for five seconds. Repeat the routine for around 10-15 times at a stretch.
With the use of a bar, stand and hold the bar horizontally with both hands behind you. Your arms should be shoulder-width apart and your knuckles should be facing the ground. Lift your arms upwards until you feel a stretch and hold your arms upward for a few seconds before returning back down slowly. Repeat this at least 10 times.
Using a resistance band, hold it with both hands with your elbows bent and close to your sides. Keep the unaffected arm steady while you move your affected arm from the elbow outward pulling on the band (basically, one arm is facing forward while the other moves to face outward). Hold this position for a few seconds and return back to center. Repeat for 10 to 15 repetitions.
Should Blade Squeeze
Stand tall with arms by your side. Engage your shoulder blades to squeeze them together but not raising your shoulders. Gold for six seconds and return to normal. Repeat eight to 12 times.
Yoga for Periarthritis (Adhesive Capsulitis)
This yoga move is done by sitting in a cross-legged position. Now interlock your fingers and raise your arms above your head. Bring your chin down to your chest. Keep stretching your arms upward with your palms facing towards the ceiling, ensure you feel a stretch in your shoulders. Breathe deeply and slowly and hold this position for a few breaths. While in this position, uncross your legs and bring them in front of you and sit up taller while stretching.
Range of Motion Pose
Use either a bolster or stack of blankets to support your back and place them on your mat. Lay horizontal on the mat and rest your arms on the blankets/bolster and your shoulders on another blanket/bolster. Your legs can either be kept outstretched, knees bent, or crossed in the easy pose. Essentially, you’re laying with supported shoulders and arms and with each breath, you are lengthening your spine. As you increase your range of motion, you can use more supports to elevate your arms.
Healing in Supported Savasana
Savasana is when you lay on your back on your mat. To add support simply fold a towel and place it beneath your neck and head to keep it in line with your spine.
Home Remedies for Frozen Shoulder
Home remedies for frozen shoulder are also helpful in promoting healing and mobility of the shoulder. These can be used in conjunction to your doctor-prescribed treatment and exercises for frozen shoulder.
The question of whether to use a hot fomentation or a cold compress to relieve the pain of a frozen shoulder has been an ongoing debate for a long time. But so far, there is no clear winner. It all depends on what works best for you. So first try warming up the affected shoulder with a heating pad or a hot compress for 15 minutes. If that works for you, great. If not, don’t despair. Cool the affected shoulder with an ice pack for 15 minutes. One of these will definitely give you some relief. Either way, repeat the process several times daily.
Inflammation can trigger a frozen shoulder, or it might even be an integral part of the freezing stage. The simplest way to fight inflammation is to take a natural anti-inflammatory medicine or gently massage the shoulder with an anti-inflammatory balm.
While a frozen shoulder needs controlled exercise, it also needs adequate rest. Any sudden movements or jerks can slow down the healing process. The best thing to do is wear a sling while not doing your exercises.
Massage for Periarthritis
Regular massages for periarthritis are beneficial because they can help relax the muscles of the stiff shoulder. This is due to the fact that massages increase blood flow along with helping to reduce the formation of scar tissue. After a few massages, you can begin to experience less pain and improved range of motion.
You can undergo a variety of different massage techniques to improve frozen shoulder. Deep tissue, trigger point therapy, engagement massage technique, static compression technique, stretching massage technique, muscle release massage, Swedish massage, or heat therapy are some examples of different massages a registered massage therapist may use to improve a frozen shoulder.
Always seek out a professional when it comes to getting a massage to treat frozen shoulder or else you may find yourself in a worse position than you already are.
A frozen shoulder can be very frustrating. But the more frustrated you are, the worse it will get. The challenge is to work within the limitations the frozen shoulder allows you and learn to live with it.
For example, if the affected shoulder prevents you from playing tennis, golf, squash, or any other sport that requires you to use the affected hand, instead of feeling sorry for yourself, take up some other activity like cycling, walking, or even mentally stimulating games like a crossword.