Adhesive Capsulitis, commonly referred to as frozen shoulder, can be a difficult diagnosis to understand. There have been many classification systems put forward over the years to describe the condition characterized by chronic pain, limited range of movement (active and passive) and a misunderstanding around the management and prognosis.
Today I’d like to provide some clarity and comfort around the management of frozen shoulder and explain how our team at Melbourne CBD Physiotherapy and Sports Medicinetherapy and Sports Medicine can keep you on the right track throughout the journey.
The first thing you need to know is that frozen shoulder gets better. Now it might take 18-24 months, so be patient, but history tells us that taking a conservative approach is the right path to take. The second thing you need to know is that the cause of frozen shoulder still remains unclear, which makes the condition hard to define and equally hard to explain to someone siting in your clinic room. Our experienced physiotherapy team will provide you with the education you need to confidently manage each stage.
Statistics tells us that between 2-5% of the general population are affected by frozen shoulder between the ages of 40-65 years old, with the incidence commonly higher in females. Your chances increase to around 30% if you carry a history of diabetes or thyroid disease. Research also demonstrates strong links with anxiety, depression, surgery in the past 24 months and metabolic drivers; including hormones and increased levels of abdominal tissue. With that in mind, here are some other important reasons as to why someone might be at risk at developing a frozen shoulder.
Frozen shoulder can be broken down into two categories; primary and secondary. Primary is related to the unknown causes such as your family and medical history (eg. CVD, diabetes, Parkinson’s) while secondary can be linked to known shoulder causes such as a rotator cuff tear, ACJ arthritis or calcification all of which can drive the pain response. Now don’t panic; just because you have a history of some of these doesn’t mean you’ll develop frozen shoulder, but I will now take you through the stages of what a typical presentation may look like.
Usually our sports physiotherapists will initially see a >30% loss of movement in the shoulder range throughout multiple planes. This can make it hard to put your shirt on, brush your hair and even reach for your back pocket. Accompanying this is usually a combination of chronic pain and stiffness, quite typical of someone in the first 9 months (freezing stage). This is where non-operative physiotherapy modalities such as education, stretching programs and heat can be invaluable in the management of this difficult condition.
As we move forward between 9-18 months (frozen stage) the typical pattern of frozen shoulder demonstrates a notable reduction in pain and irritability but often still carries a limitation in movement. Developing a simple HEP or hydrotherapy plan with one of our experienced CBD physiotherapists can also be a great management tool.
And finally, from 18-24 months (thawing phase), you will see vast improvements in pain, movement and shoulder control. A key point to note, although de-conditioning of the rotator cuff muscles is seen, strength in the shoulder is usually unaffected throughout the process.
At Melbourne CBD physiotherapy, we acknowledge that every patient is different, so that’s why applying the correct intensity, frequency and duration when it comes to treatment stretching programs and self- management is critical to the outcome. Hence why we’ve taken the time to develop an exercise archive that can show you how to safely manage your condition using the guidance of our specialised and friendly physiotherapy team.