Physiotherapy for a frozen shoulder

A frozen shoulder is a painful condition that limits movement in the shoulder joint. It happens when the tissues around the shoulder become tight and inflamed, making simple movements hard. Things like combing your hair, dressing, or lifting your arm can be painful. But don’t worry. Physiotherapy can help.

What is a frozen shoulder?

A frozen shoulder is also called adhesive capsulitis. It develops slowly. It has three stages:

1. Freezing stage - pain increases and movement reduces.
2. In the frozen stage, stiffness is severe, and pain might decrease.
3. Thawing stage - movement starts coming back.

This condition can last months or even years. The good news? It can be treated.

Why does it happen?

There is no single cause. Some common reasons:

• Injury or surgery that kept your shoulder still for a long time
• Diabetes (higher risk)
• Thyroid problems
• Long-term shoulder pain (arthritis, rotator cuff issues)
• A cerebrovascular accident, stroke or other nerve conditions
• Prolonged immobility due to fractures or illness
• Autoimmune diseases affecting joints
• Poor posture over time
• hormonal imbalances affecting joint health
• stress-related muscle tension
• Improper sleeping positions putting strain on the shoulder

Who gets a frozen shoulder?

It usually affects people between 40 and 60 years old. Women are more likely to get it than men. People with diabetes have a higher chance. Those with a history of shoulder injuries, surgeries, or other joint problems are also at risk. Frozen shoulders are standard in people who do desk jobs for long hours without movement.

How does physiotherapy help?

Physiotherapy is the best way to treat a frozen shoulder. It helps in:

• Reducing pain
• improving movement
• Increasing strength
• preventing further stiffness
• restoring daily activities
• Boosting blood circulation for faster healing
• Improving muscle coordination to prevent future injuries

Physiotherapists use different techniques. Let’s look at them.

1. Stretching exercises help loosen the tight tissues. Some common ones:

• Pendulum stretch - Bend forward, let your arm hang down, and make small circles.
• Towel stretch - Hold a towel behind your back and lift it slowly.
• Cross-body stretch - Use your good arm to pull the painful arm across your chest.
• Finger walk - Place your fingers on a wall and slowly walk them up.
• External rotation stretch - Use a doorframe to stretch your shoulder gently.
• Behind-the-back reach - try to touch your opposite shoulder blade.
• Chest expansion stretch - Hold a resistance band behind your back and stretch.
• Sleeper stretch - Lie on your side and gently push your affected arm downward.

2. Strengthening exercises improve muscle support. Some easy ones:

• External rotation - Use a resistance band and rotate your arm outward.
• Isometric exercises - push your arm against a wall without moving it.
• Shoulder blade squeeze - Pull your shoulder blades back together and hold.
• Wall push-ups - Do gentle push-ups against a wall.
• Light dumbbell exercises - Lift light weights to build strength.
• Scapular retraction - Pull your shoulders back and hold.
• Internal rotation exercises - Use a band to pull your arm inward.
• Overhead pulleys - Use a pulley system to increase movement gradually.

3. Manual therapy physiotherapists use hands-on techniques. They gently move your shoulder to improve flexibility. Massage can also help. Joint mobilisation techniques help loosen the tight capsule and improve movement. Deep tissue massage may also reduce inflammation and stiffness. Trigger point therapy may also help relieve muscle tension.

4. Heat and cold therapy: heat relaxes muscles and makes stretching easier.

• Cold packs reduce swelling and pain.
• Using both in alternation can be very effective.
• Warm showers before stretching can ease stiffness.
• Ice massage can reduce pain before exercise.
• A hot water bottle or heating pad is used to soothe muscle tension.

5. Ultrasound therapy uses sound waves to reduce pain and stiffness. It also improves blood circulation and promotes healing. Deep ultrasound therapy can reach deeper tissues and break down adhesions.

6. Dry needling or acupuncture helps relax tight muscles and improve blood flow. When combined with other physiotherapy treatments, it can significantly reduce pain. Some people report immediate relief after a few sessions.

7. Electrical stimulation (TENS therapy): Transcutaneous electrical nerve stimulation (TENS) sends mild electrical currents to the affected area. It reduces pain, improves mobility, and stimulates nerve function, reducing discomfort.

8. Hydrotherapy: Exercising warm water can reduce pain and improve movement. Water supports the body, making exercises easier. Floating exercises help reduce pressure on the joint.

9. Postural correction and bad posture can worsen a frozen shoulder. Physiotherapists guide patients on proper sitting, standing, and sleeping postures to reduce strain.

How long does recovery take?

It depends. Some recover in a few months, others take longer. Early treatment helps. Consistency is key. Do exercises daily. Full recovery can take anywhere from 6 months to 3 years. Those who stick to their physiotherapy plan recover faster. Recovery time varies depending on how severe the condition is and how well the treatment is followed.

What can you do at home?

• keep moving as much as possible,
• do your exercises regularly
• Avoid sudden movements that cause pain
• maintain good posture,
• Eat healthy and manage diabetes if you have it
• apply heat or ice packs based on pain levels,
• Practice relaxation techniques to reduce tension, 
• Sleep on your back or unaffected side for comfort
• Avoid carrying heavy loads on the affected side
• take small breaks if using a computer for long hours
• massage the affected area gently with warm oil
• Try mild yoga poses to keep the joints active
• Drink plenty of water to keep joints hydrated

When should you see a doctor?

If the pain is severe or doesn’t improve, see a doctor. They might suggest painkillers, steroid injections, or other treatments. In rare cases, surgery is needed to release the joint. If extreme stiffness has been present for over a year without improvement, surgery might be an option.

What are some alternative treatments?

Some people try alternative therapies along with physiotherapy:

• Yoga - gentle poses help improve flexibility.
• Ayurvedic treatments - herbal oils and massages may reduce stiffness.
• Homoeopathy - some people find relief with homoeopathic remedies.
• Chiropractic care - spinal adjustments may help with nerve-related pain.
• Cupping therapy - Improves blood flow to the affected area.
• Meditation reduces stress, which can help with muscle relaxation.
• Essential oils - Some oils, like peppermint and eucalyptus, may provide relief.
• Tai chi - slow movements help with joint flexibility.

How to prevent a frozen shoulder?

Prevention is always better than cure. If you have had a frozen shoulder before or are at risk, follow these steps:

• Keep moving your shoulder regularly
• Do gentle stretches daily
• Avoid prolonged immobility after an injury or surgery
• Maintain a healthy diet to prevent inflammation
• manage conditions like diabetes and thyroid problems
• strengthen shoulder muscles with light exercises
• Avoid repetitive overuse of the shoulder joint
• Stay hydrated to keep joints lubricated
• Sleep with proper support to prevent shoulder strain
• Practice stress management techniques to avoid muscle tension

Physiotherapy is safe and effective. If you stay committed, your shoulder will get better. A frozen shoulder takes time, but you are not alone. Keep moving, stay positive, and trust the process. With the proper care, you will regain your entire range of motion and live pain-free again. Small, consistent efforts bring the best results.TruePal offers at-home physiotherapy sessions to help you manage your frozen shoulder.

FAQs

1. Can physiotherapy be used to treat frozen shoulders?

A frozen shoulder restricts the arm's range of motion, making it challenging to perform daily duties. It also results in shoulder stiffness, which limits shoulder mobility. Physiotherapy is a simple way to treat a frozen shoulder and is also used to treat adhesive capsulitis. 

2. What is the best exercise for a frozen shoulder?

• Make sure your shoulders are relaxed.
• Standing, lean over slightly, allowing your affected arm to hang down.
• Swing the arm in a small circle, roughly a foot in diameter.
• Every day, perform 10 revolutions in each direction.
• As your symptoms improve, please increase the size of your swing, but never force it.

3. What is the quickest treatment for a frozen shoulder?

Unfortunately, there is no quick fix for a frozen shoulder. However, hot/cold compression packs may help relieve specific frozen shoulder symptoms. Applying heat or cold to your shoulder can help reduce discomfort and swelling. For a longer-term effect, physiotherapy is suggested. 

4. Is it safe to massage a frozen shoulder?

Massage your frozen shoulder. A frozen shoulder is a deep joint problem that might present as superficial pain. Don't be scared to massage the muscles around your shoulder to get relief. The capsule is the most impacted, but the muscles surrounding the shoulder joint might tighten due to inactivity.