Frozen shoulder, otherwise known as adhesive capsulitis, is one of those tricky conditions which I have found respond well to treatment, but patience is required. I am a physiotherapist who likes to see quick results, either objectively or subjectively, ideally both!
However as we all know, the pathophysiology of the frozen shoulder often does not lend itself to such expectations and at the outset and it is important to make the patient aware of this fact.
That said, if the correct treatment approach is applied in the correct manner at the correct stage, the speed at a which a frozen shoulder may resolve (compared to no treatment or ‘wait and see’) can be increased significantly.
Conventional wisdom and anecdotal evidence would suggest a frozen shoulder left alone may burn itself out and resolve spontaneously in 12-24 months. With an integrated physiotherapy approach, in most cases my clients have returned to full pain free function after 3-4 months of treatment, weekly at first and then staggered sessions after about 4-6 sessions.
One of the keys to my success in treating this condition is not pushing too hard too soon. In other words if treatment for a frozen shoulder begins during the more acute inflammatory phase with progressive stiffening, don’t push through pain to restore range! Not at this stage anyway as the inflammation and sensitivity will only be perpetuated and further aggravated. Better during this phase to manage pain while aiming to maintain range of movement until the inflammation and pain settles. Medication may have a role to play here, possibly injection therapy, as well as gentle manual therapy, Medical Acupuncture and graded exercises.
Once the inflammation has settled and pain is giving way to stiffness as the dominant symptom, the shoulder may be pushed a little harder in an effort to gradually restore range and function. At this stage I find treating the myofascial structures very helpful, usually targeting secondary trigger points which may have developed in the shoulder girdle musculature. These are likely to be further restricting range beyond the adhered joint capsule as well as contributing to restricted mobility as well as symptoms of pain and stiffness. I would often include segmental Electro-Acupuncture using points where the myotomal innervation corresponds with that of the shoulder joint (mainly C5-6). Electro-Acupuncture is very useful for central pain control and may also positively affect muscle tone more generally about the shoulder girdle. Following needling, I like to use graded manual therapy techniques, nudging into some discomfort, for further analgesia and to assist in the restoration of range of movement - I find Mulligan’s mobilisation with movement techniques very effective here but may also use some of Maitland’s techniques in the earlier stages. Of course exercise has an important role to play, but needs to be done carefully and specifically without overdoing it - this requires good instruction and regular review. Simple shoulder pulleys can be useful with a gradual shift away from active assisted to active and eventually resisted exercises to restore strength and stability. If you are struggling to restore range or find your patient reaching a plateau, I have found the arthrographic hydrodistension procedure useful to give another push forwards.
My shoulder course which ran in April 2014 included most of the points I would commonly use to treat frozen shoulder and will be repeated in the new year.
For those of you already needling, I would encourage you to use your techniques as part of an integrated approach to treatment which be of great benefit to frozen shoulder sufferers. Just remember to have patience and progress treatment at the correct pace, be prepared to deal with frustrated patients who want the ‘quick fix’ reassuring them that the outcome will be positive.