Frozen shoulder is a shoulder joint disability characterized by the painful status of joints with a decreased range of motion. It is a self-limiting disease. But physiotherapy for frozen shoulder is very important for these types of patients. If anyone doesn’t get proper treatment, sometimes it will be late to get rid of this condition.
The phase of frozen shoulder
1. Acute / painful phase
2. Stiffening phase
3. Resolution phase
Special test for diagnosing frozen shoulder:
L= Lateral rotation
M= Medial rotation
If this three-step movement is very hard to perform, we can provisionally diagnose frozen shoulder.
1. Female is more affected than male.
2. Diabetic neuropathy
3. Shoulder joint injury
4. Shoulder joint immobilization
5. Severe muscle spasm
6. Muscle insufficiency
Physiotherapy Management for frozen shoulder
Rapidly getting rid of the frozen shoulders is possible by following physiotherapy management
Clearly tell the patient what are you doing to gain rapid recovery. Encourage by telling the previous success. Which you applied for previous patients.
Physiotherapy for frozen shoulder in acute painful phase:
1. Stretches the specific muscle surrounding the shoulder girdle.
2. Very gently mobilize the joint
3. Apply a muscle relaxation technique
4. Apply dry needling or acupuncture
5. Range of motion exercise
6. Strengthening exercise to regain joint function
7. Perform the movement with mobilization techniques, which is more effective for frozen shoulder treatment
8. Any kind of aggressive exercise or movement must be avoided.
Physiotherapy for resolution phase:
1. Strengthening exercise like isometric or isotonic exercise
2. Increase capability and duration of stretching
3. Range of motion exercise by using a pulley
Though it is a self-limiting disorder. Wait for two to three years to recover this condition without any treatment. So, there is not any chance of the wait and see approach. Nowadays medical management is recommended for this. There appear several elements for getting care. Such as physiotherapy, electrotherapy, medication, manipulation, mobilization is also applied for this condition.
To reduce pain and increase the range of motion you can apply, including treatment procedure for frozen shoulder:
1. Heat: Heat can produce important lubricating materials to the joint. Thus, the joint range will be improved and pain reduces.
2. Pendulum exercise: When movement is severe painful and joint range of motion is not possible. There I can use the pendulum exercise technique for an increased range of joint movement.
3. Manual therapy: Soft tissue mobilization in the surrounding region of the shoulder joint. This can improve muscle relaxation and improve joint movement.
4. Joint mobilization: Mobilization of the joint is more effective than soft tissue technique. It can improve the internal structure of the joint by stimulating blood and nerve supply.
5. Strengthening exercise: Strengthening exercise for rotator cuff and surrounding soft tissue structure is an easy way to get rid of this disorder.
6. Home exercise program: When a physiotherapist recommends some exercise, which should be performed regularly at home. Maintain the home plan of exercise to increase the sustainability of a healthy joint life.
Several types of stretching we can do for increasing the mobility of the joint in the frozen shoulder:
1. Pendulum stretch: Keep the unaffected hand on the table and bend forward as if the affected hand is in a hanging position directly on the floor. Take ½ or 1 kg weight in the affected hand. Thus, stretching will be happening on the capsule and surrounding structure of this joint.
2. Towel stretch: Hold a towel behind the back (width of towel 3 feet). The lower part of the towel grasps by affected hand and the upper end of the towel catches by a good hand. Now pull the affected arm by using the good arm.
3. Crossbody stretch: Touch the opposite shoulder by using the affected hand. Press on the elbow of the affected side by good hand and hold it for 10 seconds. Do it three to four times. It can make a stretch in the shoulder joint capsule. It will be more helpful for correcting your shoulder joint easily.
Several strengthening exercises:
1. Muscle energy technique (MET): Strengthening by using resistance in three-stage shoulder joint flexion. Lift hand upward in a small range and strengthen by use of resistance. After that lift upward in mid-range and give resistance. Next to lift arm upward and in end range give resistance. Thus, increase the strength of muscle.
2. Outward rotation: Grasp two ends of Thera band using two hands. Now move the affected arm towards the outside, when the good arm is kept in a fixed position. Thus, increase the strength of the surrounding shoulder joint muscles.
3. Inward rotation: One end of Thera band which bends with a door locker and another end grasped by the affected arm. Now pull the affected arm inward for strengthening.
Corticosteroid injection for frozen shoulder:
corticosteroid injection is applied for frozen shoulder treatment when manual therapy is not effective for a patient. It has several side effects and adverse effects. The application of corticosteroid in chronic pain of joints is much helpful to reduce pain. Typically, it applies to the joint in injection form. It is not a permanent treatment procedure. After a long period of time patients may face this problem again. So, if we found any good effect in manual therapeutic exercise. We do not apply any corticosteroid injection.
Clinical final words
There is not any exact treatment for frozen shoulder diseases. It is a progressive disorder and physiotherapy treatment is more effective than another treatment.
I hope that in the following ways it will be cured within one week to a month.
1. Erb’s palsy
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Last updated 20/4/2020
Imtiaz Uddin Ahmed, BSc, is a health professional. He has been working with pain-related diseases and conditions for the last ten years, and he loves to give treatment without painkillers. Based on his experience with different types of physiotherapy manual techniques. He completed his BSc from Saic College of Medical Science and Technology. He loves to collect information from PMC. Here, he is sharing his opinion about various health conditions and health-related equipment. Find him on Facebook page here. Happy reading!