Frozen Shoulder, or adhesive capsulitis, is an affliction of the shoulder joint where the muscles tighten up and movement becomes difficult. Before we get to the important rules about your exercises, let’s take a quick look at the causes, symptoms, and treatments of this condition.
Causes Of Frozen Shoulder
The exact cause of Frozen Shoulder is unknown. However, cases are broadly divided into two forms:
- Primary cases have no apparent cause. It may be triggered by genetics, or by events too far back in someone’s medical history to be recognized as a cause.
- Secondary cases are often the result of illness, surgery, or trauma. For example, football players who take a tackle to the shoulder or baseball players struck in the shoulder by a fast pitch may be hurt enough to develop this condition.
Some research suggests that inflammation around the lining of the joint creates scar tissue that restricts the movement of the joint. Frozen Shoulder is most common in people age 40 or more, and the condition is more prevalent among people with diabetes than the general population. It’s estimated to occur in 10%-20% of all people with diabetes.
In these cases, some researchers believe that glucose may attach to collagen in the joint, causing stiffness. People with diabetes are also more likely to develop Frozen Shoulder in both joints, rather than the single joint more common in the rest of the population.
Other potential causes of Frozen Shoulder include lousy posture, extended periods without movement (especially from wearing a cast), and medical conditions like thyroid disease and heart disease.
In total, about three percent of the population will be affected by Frozen Shoulder at some point in their lives.
Symptoms Of Frozen Shoulder
Frozen Shoulder is characterized by three distinct stages, and alleviating the issues of each stage is the main goal of Frozen Shoulder exercises.
Stage 1: Freezing
In this stage, the shoulder is starting to tighten up. Common symptoms of this stage include limited mobility of the joint and pain whenever the shoulder is moved. The pain usually worsens over time and may be particularly bad at night or when pressure is put on the joint.
The “good” news is that the pain is at its worst during this stage. Doctors often prescribe non-steroidal anti-inflammatory drugs (NSAIDs) during this stage to combat inflammation and reduce the pain. Since you may be on the medication for several months, it’s important to avoid addictive drugs.
The Freezing stage usually lasts 6 to 9 months.
Stage 2: Frozen
Once Frozen Shoulder reaches this stage, the pain reduces while the stiffness increases. Most people still have some mobility, but without the full range of motion, everyday life becomes difficult at best.
Compounding the problem is the fact that lack of use typically results in atrophy of the muscles.
The Frozen stage usually lasts 4 to 12 months. Frozen Shoulder exercises can help minimize the loss of muscle strength while this stage lasts.
Stage 3: Thawing
The final stage features the shoulder slowly getting back to normal. Frozen shoulder exercises become more aggressive at this point, and focus on both regaining a full range of motion and strengthening the muscles weakened by the Frozen stage.
The Thawing stage generally lasts 6 to 24 months. As movement range is regained, everyday life becomes less of a problem.
Frozen Shoulder is not a permanent condition. Most cases are fully resolved within three years of developing the initial symptoms, and some people recover in as little as one year. Unfortunately, there is no “quick” fix for this condition.
Frozen Shoulder is diagnosed by a physical exam and, typically, one or more imaging tests. The exam is used to determine your full range of motion, how badly the area hurts, and how far you can move your arm on your own. Your doctor may also use anesthesia to check your full range of motion without pain getting in the way.
Imaging tests are used to rule out other problems. Conditions like arthritis and torn rotator cuffs can cause symptoms similar to Frozen Shoulder, and your doctor will rule out other causes before creating your treatment plan.
Each stage of Frozen Shoulder has different treatments, and a variety of treatment options are available. Most of the time, however, they come down to medication and physical therapy.
Treating The Freezing Stage
During this stage, most people go through physical therapy with a focus on mobility exercises. These are low-impact stretches, and may include things like gently swinging the arm back and forth or gripping a pole and slowly moving the arm around.
Pain medication is especially common during this stage. In particularly severe cases, doctors may inject a corticosteroid, which both reduces pain and improves the range of motion.
Finally, you’ll have ample time to learn how to live with a stiffer shoulder. Don’t try to force a normal range of motion – if your shoulder hurts, then stop doing whatever you were doing. Instead, look for other ways of getting things done. You may need to have someone else assist you with daily tasks. For this reason, it is not recommended that you live alone while you have this condition.
Treating The Frozen Stage
In this stage, exercises for frozen shoulder continue to focus on mobility but add a series of strengthening exercises as well. Movements like the shoulder flexion stretch and the shoulder external rotation stretch help to maximize movement range without harming the arm.
That said, no matter how many mobility exercises you do, your daily life will be affected. However, if you learned how to do things despite your stiffness back in the Freezing stage, you should still be able to manage.
Treating The Thawing Stage
Treatment in the final stage focuses on aggressive stretching and mobility exercises. As the body returns to normal, it becomes easier and easier to do each of the exercises. Most people move from simple contractions to devices with resistance, and eventually weights or other heavy-duty machines.
In rare cases, surgery may be necessary to restore the normal range of movement. This usually happens if normal treatment fails to resolve the condition in the normal timeframe. The most common surgery is arthroscopic capsular release, which physically divides the shoulder capsule.
Five Rules To Know Before You Start Your Exercises
Before you do any exercises, read these rules. They matter.
Rule #1: You Must Work Both Sides
Many people approach mobility exercises with the idea of strengthening the ‘bad’ side of their body. This is wrong. Chances are you’ll be doing these exercises for more than a year, and only exercising one of your shoulder joints can create a serious imbalance in their strengths.
Instead, make sure to exercise both of your shoulders. This won’t stop the muscle atrophy during the Frozen stage, but it will ensure that both sides are as close as possible when the condition finally clears up.
Rule #2: Do Not Do Exercises By Yourself Unless Told To
Some of the exercises you’ll do as part of your physical therapy require the attention of a trained therapist. Attempting to do these by yourself, or having someone in your family do them to you, runs the risk of causing serious injury. Therapists know how far to go, how many times to repeat an exercise, and how to adjust your exercise schedule for the best results.
Similarly, you should not do more exercises each day in the hope of resolving the problem faster. Frozen Shoulder ends when it ends, and trying to rush things may damage your joints and slow recovery.
Rule #3: If It Hurts, Stop
Pain exists for a reason – it’s your body’s way of saying that something is wrong and you should stop doing it. Listen to your pain. If an exercise hurts – even if it didn’t hurt before – stop doing it and immediately tell your doctor or physical therapist. They may need to reevaluate the status of your condition and come up with a new therapy plan for you to follow.
Never attempt to “fight through” the pain. Like excessive exercising, it’s more likely to hurt than help.
Rule #4: Manage Your Pain
Frozen Shoulder involves a lot of pain – usually a dull ache in the shoulder and the muscles around it. While the pain is the worst in the first stage, let’s be honest here: Living for as long as three years in effectively constant pain is not easy to endure.
As such, you need to manage your pain effectively. In most cases, this means keeping the pain dull enough that it doesn’t stop you from enjoying the rest of your life. Don’t try to eliminate the pain with medication – drugs strong enough to do that generally aren’t safe to use over a long period.
(However, you may want to consider asking your doctor for stronger painkillers that you can use on special occasions. As long as you can avoid addiction, this can make Frozen Shoulder more tolerable.)
Rule #5: Stay Positive
You will get through this. I know months of pills and exercises with little or no improvement can be disheartening, especially if you’re physically active and want to get back to your favorite sport as soon as you can. That said, I can’t stress enough that Frozen Shoulder is a temporary condition.
As long as you follow your treatment plan, you’ll get through it and be ready to jump right back to whatever activities you want to do.