• Physio Physique

Frozen shoulder: What is happening?!

What is 'Frozen Shoulder'?


Adhesive capsulitis, or more commonly known as “frozen shoulder” is a condition where a shoulder with no known previous history of shoulder issues, starts to tighten up and restrict itself in its natural range of motion. There is a lot of uncertainty regarding the triggers of this condition, with patients categorising their symptoms in 3 distinct stages:

Freezing: Experiencing severe shoulder pain that is typically worse at night, with no known locality.

(Diagram 1: Chan, Pua & How, 2017)

Frozen: Shoulder pain starts to subside, but is now characterised by progressive stiffness in the joint

Thawing: Gradual return to normal range of motion





Is this a common condition or is it just happening to me?

Frozen shoulder accounts for 2-5% of the general population, found more commonly in the ages of 40-60 years old. There are two classifications of Frozen Shoulder: Primary and Secondary.

Primary Frozen Shoulder occurs as a sudden onset with no previous history of shoulder injury, but is often linked with metabolic disorders such as Diabetes, Thyroid disorders, and Parkinson's.

Secondary Frozen Shoulder can occur as a result of previous injury to the area, and prolonged immobilisation ie. rotator cuff teas or impingements

...I think I know someone who might be starting to experience this – what can I do to help them?

Depending on the symptoms, severity and which stage they are currently experiencing, the first line of defence is physical therapy.

In the Freezing stage, where the pain is at its worst, it is highly important to manage the pain first. There are simple exercises such as:


Pendulum exercise: While bent over, relax and allow gravity to take the weight of your arm. Swing your body gently from the hips to facilitate gentle movement from the shoulder.


Active assisted shoulder movements Using the assistance of a stick or the "stronger" arm, assist the targeted arm to go through movements such as flexion, abduction and rotation.

Initially, these exercises are held for a duration of 1-5seconds, and only to your tolerable limit. You can also add heat or pain killers before attempting these exercises to further help with the pain.

In the Frozen stage, the pain is most commonly subsided and the range of motion is at its most restricted. As such, a combination of stretches around the joint, as well as gentle strengthening exercises will be highly beneficial to recovery.


Posterior Deltoid Stretch

Bring one arm across your body, and using the other arm to bring the first closer towards your chest. You shoulder feel a stretch at the back of the shoulder. Hold for 20-30 sec per arm.


Shoulder Retraction

Bring your shoulder blades together in a downwards and inwards motion, as if you were pinching a lemon in between them. Hold for 15-30sec at a time then release.

Isometric External/Internal Rotation

Hold one arm bent, against a door or wall, and push towards the wall. Hold for 15-30sec at a time, then relax. You shoulder feel the muscles working as your push through your arm.

Finally, in the thawing stage, once the pain and stiffness begins to settle down, it will be crucial to develop a regular exercise program to help the shoulder regain its initial range and strength. Depending on the remaining symptoms, your home exercises program will include a combination of:

  • Rotator cuff strengthening

  • Upper back strengthening

  • Scapular re-patterning

  • Targeted stretches

As always, the exercises above are simply guides and the best source of information will be your local health professional. If you, or someone you know is experiencing these symptoms, come down and see the physiotherapists at Physio Physique now!



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References:

Chan, H, Pua, P & How, C 2017, "Physical Therapy In The Management of Frozen Shoulder," Singapore Medical Journal, vol. 58(12), pg. 685-689

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