Suffering with shoulder pain at night and getting very poor sleep sucks right? Are you struggling to lift your arm and have limited movement all of a sudden? Are you between the ages of 35-60? Well, it very well could be a "Frozen Shoulder".
In this blog post, we’ll explore what Frozen Shoulder is, who it affects, the risk factors, how physiotherapy plays a crucial role in its treatment & give you 3 early stage exercises for treatment of Frozen Shoulder, to help you manage the shoulder pain at night.
What is Frozen Shoulder?
Frozen shoulder, medically known as adhesive capsulitis, is a condition effecting the shoulder joint, characterized by worsening stiffness and pain. The capsule surrounding the joint becomes inflamed which leads to thickening and fibrosis. This leads to a decrease in the space available for the shoulder to move, which results in stiffness and limited mobility. In turn, the condition can cause severe pain, especially at night.
Have you recently had surgery or a specific shoulder injury?
Well you would be more at risk if you had the above, but a large proportion of frozen shoulders have a random insidious onset! How strange... and annoying. Frozen Shoulder can severely limit range of motion making even simple daily activities like reaching for an item on a shelf or putting on a jacket difficult and painful.
Left: Normal shoulder joint capsule, Right: Pathological inflamed shoulder joint capsule
The Stages of Frozen Shoulder
The condition typically progresses through three main stages:
Freezing (Painful) Stage: This is the initial phase where pain onsets and leads to pain particularly with movement.
Frozen Stage: During this phase, the pain may reduce, but stiffness increases significantly. The shoulder becomes very rigid, limiting range of motion and ability to use the shoulder.
Thawing Stage: In the final stage, the shoulder gradually regains mobility, and the pain continues to decrease, though recovery can take months or even years.
The 3 stages of Frozen Shoulder
Risk Factors for Frozen Shoulder
While the exact cause of frozen shoulder is not always clear, several risk factors are associated with an increased likelihood of developing this condition:
Age: As mentioned, frozen shoulder is most common in people aged 40 to 60.
Gender: Women, particularly those who are middle-aged, are more likely to develop frozen shoulder than men.
Diabetes: People with diabetes are at a significantly higher risk of developing frozen shoulder, especially those with poorly controlled blood sugar levels.
Other Medical Conditions: Thyroid disorders (hypothyroidism or hyperthyroidism), heart disease, and Parkinson’s disease are also linked to a higher incidence of frozen shoulder.
Previous Shoulder Injuries or Surgery: Any trauma to the shoulder, including surgery or a fracture, can increase the risk of developing frozen shoulder due to prolonged immobility or altered movement patterns.
Physiotherapy Treatment for Frozen Shoulder
Physiotherapy is an excellent treatment option for Frozen Shoulder. The goal of physiotherapy is to manage pain, restore shoulder mobility, and improve function, with specific treatment modalities utilised in differing phases of the condition. Treatment typically involves:
Pain Management: Initially, managing pain and inflammation is key. Modalities like heat or cold packs, electrical stimulation and prescribed pain medications may help to alleviate discomfort.
Stretching and Mobilization: Once pain is controlled, physiotherapists will guide patients through gentle stretching exercises to improve or maintain the range of motion. These exercises target the shoulder joint capsule to reduce tightness and improve flexibility.
Strengthening Exercises: As movement improves, strengthening exercises are introduced to help rebuild muscle strength around the shoulder. This is essential for enhancing joint function and functional use of the shoulder.
Manual Therapy: Manual techniques, such as joint mobilizations, soft tissue massage, may be used as a package treatment to help improve shoulder movement and reduce stiffness. These hands-on treatments are often combined with exercises to maximize their effectiveness.
Education: Physiotherapists also play an important role in educating patients on posture, body mechanics, and activity modifications to prevent exacerbation of symptoms during daily activities.
An example of shoulder physiotherapy
Physiotherapy + Injection Therapy for Frozen Shoulder
Corticosteroid injections may be considered for very stiff and painful shoulders, on a case-by-case basis. Essentially, Corticosteroid injections aim to have a short-term analgesic effect, reducing pain and allowing a more intensive period of rehabilitation where the shoulder isn’t limited by severe levels of pain.
Corticosteroid Injections alone are likely to have little to no long-term effect on the shoulder. Additionally, if injection therapy is successful, evidence suggests the analgesic effect lasts no long than 8-12 weeks. Therefore, a holistic decision should be made by Physios & wider health professionals to ensure this is the right decision for someone with frozen shoulder.
Steroid Injections used to manage Frozen Shoulder in some cases
3 Mobility Exercises to use if you have a painful shoulder with limited movement
Now we've spoken about Frozen Shoulder, Here are some easy and gentle exercises to help you manage the shoulder pain and have a better nights sleep:
1. Pendulum Exercises
In standing over sitting, lean your upper body forward so the affected arm is hanging. In this position, you can make pendulum motions but gently swinging the arm is different directions like forward and backward, side to side and in circular motions.
2. Finger Wall Walks
Standing next to a wall, start the hand low and use your fingers to gently walk your hand up the wall, this will help to raise the arm higher up. Do this while facing the wall directly to work on shoulder flexion and while facing perpendicular to the wall as shown below and work on shoulder abduction.
3. Assisted External Rotation
In sitting or standing, grab a straight object like a walking stick, umbrella, golf club. With your elbows tucked into your side hold the object tightly in the unaffected hand, with the end of the object pushed into the palm of the affected side. Now, push the object with the unaffected side, aiming to guide the affected sides hand out and away from the body, as shown in the picture below.
Conclusion
Frozen shoulder is a painful and debilitating condition that can significantly impact a person’s quality of life. While it is more common in middle-aged adults, particularly those with underlying health conditions, it is treatable with proper intervention. Physiotherapy is a vital part of the recovery process, focusing on pain relief, restoring mobility, and strengthening the shoulder to ensure long-term function. If you experience symptoms of frozen shoulder, seeking early physiotherapy intervention can greatly improve your chances of a full recovery. Find some extra links below to more information from the NHS & Journal Articles:
NHS Information: https://www.nhs.uk/conditions/frozen-shoulder/
Frozen Shoulder Research Article: https://pubmed.ncbi.nlm.nih.gov/36075904/
Corticosteroid Injection + Physiotherapy in Frozen Shoulder: https://pmc.ncbi.nlm.nih.gov/articles/PMC6153137/
Jake Solomons (HCPC, mCSP)
ElevatePhysiotherapy
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