Frozen shoulder, known medically as adhesive capsulitis, is a common and often painful condition causing stiffness and restricted mobility in the shoulder joint. Understanding the symptoms, causes, and anatomy of frozen shoulder assists in determining optimal physiotherapy exercises and treatment approaches.
Frozen Shoulder Symptoms
The hallmark symptom of a frozen shoulder is progressively worsening shoulder pain and stiffness that limits the range of motion. Key signs and symptoms include:
- Gradual onset of shoulder pain, typically focused more in the upper arm
- Severely restricted active and passive shoulder movement in all directions
- Difficulty performing daily activities like brushing your hair or reaching behind the back
- Pain that is worse at night, disrupting sleep
- Eventual plateauing of symptoms over 6-24 months
Pain onset is usually gradual over weeks to months as inflammation builds. Diagnosis involves confirming a limited range of motion in all directions.
Anatomy of a Frozen Shoulder
To understand a frozen shoulder, it helps to first review the anatomy of the shoulder joint and associated structures. The shoulder joint capsule is a flexible sleeve of connective tissue enclosing the joint space between the upper arm bone (humerus) and the shoulder blade (scapula). This capsule allows extensive mobility.
In a frozen shoulder, inflammation causes the capsule to thicken and tighten. Scar tissue also builds up resulting in painful adhesions and constriction that limits shoulder movement. Muscles, ligaments, and the rotator cuff surrounding the joint capsule also become tighter as immobility sets in, resulting in more pain and stiffness.
Frozen Shoulder Causes
While the cause is not fully understood, factors believed to contribute to the frozen shoulder include:
- Injury or trauma such as a fracture or tendon tears
- Diabetes is correlated with increased incidence
- Hyperthyroidism has also been associated
- Prolonged immobilization of the shoulder joint
- Autoimmune conditions like rheumatoid arthritis
- Genetics may play a role for some individuals
There are also higher rates of adhesive capsulitis in people over the age of 40 and in women. The specific inflammatory triggers remain unclear.
Exercises for Frozen Shoulder
Pendulum Swings
Pendulum swings involve gently swinging your affected arm back and forth and in small circles to encourage mobility. This passive exercise uses gravity to provide momentum without active muscle exertion, making it a safe way to get the shoulder joint moving with minimal pain. Perform sets of about 10-15 swings or circles in each direction.
Shoulder Shrugs
Shrugging the shoulders gently up and down along with shoulder rolls mobilizes the upper back and shoulder muscles. Make sure to keep movements small and within a pain-free range of motion. This can help restore muscle coordination and strength around the shoulder as stiffness decreases.
Assisted Arm Raises
Using a stick, rope, or your unaffected arm, gently assist the affected arm through a partial range of motion raises to the front and side. Move just until a stretch is felt but not sharp joint pain. This improves elevation and abduction range of motion passively when active lifting remains difficult.
Isometric Wall Push
Stand facing a wall with the affected arm bent at the elbow. Push gently onto the wall without letting your arm bend further. Hold for 5-10 seconds, then relax. This strengthens the shoulder muscles in a safe, low-range manner avoiding joint impingement.
Doorway Stretch
Stand in a doorway and grip the frame with your affected arm. Gently rotate your body away, stretching the shoulder lightly across the chest until tension is felt. Hold for 15-30 seconds. This mobilizes the shoulder capsule and chest muscles safely when active stretches are challenging.
What Exercises Should I Avoid with a Frozen Shoulder?
When exercising a frozen shoulder, certain activities should be avoided:
- Exercises causing sharp joint pain or impingement
- Heavy lifting which can worsen the injury
- Aggressive overhead reaching and raising the arm too far
- Sudden movements or “pushing through” intense pain
- Any unsupervised exercise causing pain lasting over 20 minutes after stopping
Work within tolerable pain levels and focus on limited-range motions. Attempting too much too soon risks additional damage.
Is it Better to Rest or Exercise a Frozen Shoulder?
Finding the right balance is key. While complete rest halts mobility, light activity encourages blood flow and the range of motion needed to recover. Follow your therapist’s guidance:
- Take frequent breaks between exercise sessions to allow tissue recovery
- Apply heat before activity and ice after to manage inflammation
- Let pain levels and range gains guide the safe advancement of reps and resistance
- Perform prescribed at-home exercises consistently for incremental gains
Doing all the above with professional support, disciplined mobility sessions combined with sufficient rest aid recovery, and your therapists’ guidance.
Frozen shoulder is a complex condition requiring personalized clinical care. Skilled physiotherapists create tailored treatment regimens that gradually restore function. With patience and commitment to consistent rehab, full shoulder mobility typically returns within 1-3 years.
