Frozen shoulder, also known as adhesive capsulitis, is one of the conditions of the body that is very poorly understood. For one, nobody knows what is the cause and there is no suitable to explanation to why does it take so long to heal!
Even though frozen shoulder patients tend to have severely limited range of motion, they tend to regain full range of motion when placed general anesthesia. When they’re unconscious, their shoulders can move freely in the affected directions. However, their shoulder returns to the frozen state once they are awake!
This suggests that muscular guarding (i.e., the body’s protective response to pain) may play a significant role in the condition.
This discovery points to frozen shoulder being more than just a purely physical problem. It appears to involve psychological factors, making it a truly complex mind-body condition rather than simply damaged tissue that needs time to heal.
What does a true frozen shoulder look like?
The term “frozen shoulder” gets thrown around frequently in medical settings. It often applied to any shoulder with reduced mobility. This inappropriate usage creates confusion about what the condition actually entails.
Researchers and clinicians who specialise in shoulder conditions make clear distinctions between true frozen shoulder (adhesive capsulitis) and general shoulder stiffness from other causes.
True frozen shoulder follows a very specific pattern that unfolds predictably over time, affecting movement in a particular sequence that helps distinguish it from other shoulder problems.
Early stage aka freezing phase (2-9 months)
The condition typically begins with a characteristic sequence:
- Pain develops first: often appearing before any noticeable stiffness, this pain is frequently severe and disruptive to sleep
- External rotation becomes restricted : turning the arm outward (like opening a door) is usually the first movement to become limited
- Abduction follows: lifting the arm out to the side becomes increasingly difficult
- Flexion becomes limited: forward lifting of the arm starts to become restricted as the condition progresses
The frozen phase (4-12 months)
During the frozen stage, shoulder pain may lessen. However, the shoulder becomes stiffer and shoulder movements become more challenging. This stage can last from 4 to 12 months.
The movements that became restricted during the freezing phase may continue to worsen. Previously affected ranges of motion tend to be severely limited by this point.
The thawing phase (12-42 months)
Perhaps the most frustrating aspect of frozen shoulder is how long recovery takes. During the thawing stage, patients experience a gradual return of range of motion. This is a slow process that takes up to two years.
Complete recovery is also not guaranteed for everyone. Research shows that up to 40% of patients may have persistent shoulder symptoms beyond two years.
This is a good reminder that prevention is better than cure. Very often, it’s better to take a proactive approach to make sure that your body and health is in good shape. Waiting for it to become problematic before taking action can sometimes lead to poor long term outcomes.
Most effective treatments for adhesive capsulitis
Exercise is the most effective treatment for adhesive capsulitis. The objectives should be to retain as much as range of motion and strength as possible. Once the frozen shoulder is in the thawing stage, exercises can be programmed to help previously lost range of motion.
Results with treatment tend to be slow for adhesive capsulitis. While exercise can slow the progress and also reduce the severity, some symptoms are still expected. Most patients will only see the most significant results after one or two years.
Exercises to help retain or increase range of motion can include isometric and eccentric exercises of the shoulder joint. It is important to work within the range of motion and not push too far into the shoulder stiffness. Too much too soon can lead to further stiffening due to aggravation of the condition.
Scapular wall push-ups
The scapular wall push-up is a good exercise to help introduce weight to the shoulder joint. It is an exercise can be easily done at home and can also be modified to each individual’s needs.
In the picture above, the man is doing a scapular push up by squeezing his shoulder blades and bringing his chest to the wall. If this is too difficult for you, you can focus on just retracting and protracting the shoulder blades without bringing the chest to the wall.
If that is still too challenging, it is possible to modify the exercise further by changing to a forearm contact. By resting your forearm against the wall, instead of your palms, there will be less load going through the shoulders.
The scapular wall push-up strengths the serratus anterior and rhomboids. While they are not muscles of the true shoulder joint, they play an important role in keeping the shoulder blade stable during exercise. The scapular wall push up also promotes good scapulohumeral rhythm, which is often disrupted in frozen shoulder.
Wall slides
Wall slides is a great exercise for frozen shoulder patients to improve their range of motion. When done without any resistance, it is good for increasing range of motion. Remember to work with the shoulder, and to not push through any shoulder stiffness. Over time and with more practice, the range of motion will start to increase.
During the freezing or frozen stage, the wall slides can be used to preserve remaining range of motion and to reduce further stiffening.
To strengthen the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis), a light resistance band can be used. The wall slide combines range of motion with strengthening of the shoulder stabilisers. It promotes capsular stretching through active movements.
Understanding your frozen shoulder
Patient education is one aspect of frozen shoulder treatment that is often overlooked. Understanding the adhesive capsulitis is a chronic condition and involves complex mind-body interaction can help you to set expectations. Needless to say, patience is extremely important to have a successful recovery outcome.
Too much, too soon or trying to push your recovery can lead to further tissue irritation of the shoulder joint. This can lead to further stiffening and delayed recovery. Conversely, too little exercise can also lead to further stiffening of the shoulder joint. It is important to work through your shoulder range of motion regularly to preserve the most of your existing movement.
Home exercise is inevitable
However, chiropractic adjustments are not recommended as it can cause even more pain and injury to the tissue of the shoulder joint. Exercise, on the other hand, can be individualised to your current condition. It is also done by yourself so you can control how far to go or how hard to push. It’s a much more sensible and gentle approach.
Daily exercises are recommended to keep the shoulder joint active and moving. Your chiropractor can also help to identify other issues (e.g., shoulder stability) that may also need to be addressed. The daily exercises will involve trying to both increase strength and preserve movement of the shoulder joint.
Lifestyle and activity modification
Having frozen shoulder does predispose you to having more shoulder pain. Activity modification to work within your current range of motion can help to prevent shoulder injury or worsen your shoulder pain.
Complete rest is not recommended. Complete rest will like cause more stiffening due a lack of movement. It will also accelerate muscle atrophy that is associated with adhesive capsulitis.
Activity modification is about finding the sweet spot between maintaining movement and avoiding aggravation. The goal is to keep your shoulder active within pain-free ranges whilst avoiding positions or activities that trigger severe discomfort or further restriction.
Work and Computer Use
- Adjust your workstation height to reduce overhead reaching
- Use voice-to-text software to minimise typing strain
- Position frequently used items within easy reach
- Take regular breaks to perform gentle shoulder mobilisation or stretching
Household activities
- Use long-handled tools for cleaning to avoid overhead reaching
- Store commonly used items at chest level rather than high shelves
- Use lighter cooking pots and avoid heavy lifting
- Ask for assistance with tasks requiring significant shoulder mobility
Sleep positioning
- Sleep on your unaffected side with a pillow supporting the affected arm
- Use additional pillows to prevent rolling onto the painful shoulder
- Consider a wedge pillow to elevate your upper body slightly
- Try to maintain a consistent sleep routine despite pain interruptions
When to seek professional help
If you already have shoulder pain or weak shoulders, taking a proactive approach to address these issues can reduce risk of you developing a true frozen shoulder in the future.
Women between the age of 40 and 60 are most susceptible to getting frozen shoulder. If you are female, in this age bracket, and have some concerns about your shoulder, I highly recommend that you seek help early for your shoulder. It can save you years of pain and function limitations.
If you think you have frozen shoulder, you definitely want to see a chiropractor to get it diagnosed. A right diagnosis can help you understand which stage you’re in and develop an appropriate treatment plan tailored to your specific needs. Early intervention during the freezing phase can significantly improve outcomes and potentially prevent the condition from progressing to the more restrictive frozen stage.
Red flags of shoulder pain
Seek immediate professional assessment if you experience:
- Sudden onset of severe shoulder pain
- Complete loss of movement
- Signs of infection or systemic illness
- Neurological symptoms such as numbness or tingling
Frozen shoulder remains a challenging condition, but understanding its complex nature allows for more effective treatment approaches. At Square One Active Recovery, we specialise in providing evidence-based, non-adjustment chiropractic care for shoulder pain patients. Our approach recognises the complex nature of this condition and provides comprehensive treatment tailored to each patient’s specific needs and recovery stage.
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*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.
