The 8 BEST Frozen Shoulder Exercises for Pain Relief

What is Frozen Shoulder?

Frozen shoulder, medically known as adhesive capsulitis, is characterized by a progressive loss in range of motion of the shoulder. There is fibrous connective tissue that surrounds the shoulder joint in the form of a joint capsule.

During frozen shoulder, this connective tissue becomes inflamed. Visually, it looks red and angry when looking at it through an arthroscopic camera. The tissue inflammation continues to worsen over time resulting in progressive stiffness and tightness of the shoulder.

The natural range of motion that you can move your arm through gradually decreases and it becomes very painful to move the arm in most directions.

Causes of Frozen Shoulder

It has not yet been determined what the initial cause of frozen shoulder is, however, we do know that the progressive inflammatory process is what causes the shoulder pain and loss in the range of motion. It seems that there is some kind of autoimmune overreaction within the joint capsule tissue.

We also know that older adults (over the age of 40), women (sorry ladies), and those who also have other medical issues such as diabetes and other autoimmune disorders have a higher likelihood of developing a frozen shoulder at some time in their lives.

Lastly, those who have had their shoulder immobilized for extended amounts of time also tend to have a higher likelihood of developing this condition. These types of immobilization would typically occur after:

1. Rotator cuff repair surgery
2. Humerus fracture (upper arm bone)
3. Stroke

How to Diagnose Frozen Shoulder?

Frozen shoulder is traditionally diagnosed by a medical doctor or physical therapist. As mentioned before, the hallmark characterization is a progressive loss of shoulder range of motion. The individual would display limited ability to raise the arm to the front, to the side, and rotating the arm outward. This isn’t always the case, but definitely something to keep an eye out for.

Arthroscopic visualization (during surgery) of the joint capsule will appear red all over it. It actually looks very similar to red crab meat.

Magnetic resonance imaging (MRI) would also be able to clearly show the inflammation within the joint capsule.

Other types of shoulder injuries that cause similar shoulder pain to that of a frozen shoulder usually involve rotator cuff tendonitis or tears. These similar conditions can sometimes be difficult to distinguish without medical imaging, though all are treated very similarly initially with physical therapy exercises.

Three Phases of Frozen Shoulder

Unfortunately, frozen shoulder fits into the category of a marathon-length of recovery rather than a sprint. The natural process of this disease (without medical interventions) is approximately one year in duration. There are three phases to frozen shoulder:

1. Freezing Phase (2-4 months)

   • This phase is marked by a progressive increase in pain, loss of range of motion, and increased joint stiffness

2. Frozen Phase (2-4 months)

   • This phase is identified once the progressive loss of range of motion stops and the person is left with a severely limited range in most directions. The pain usually plateaus at a certain level in this phase.

3. Thawing Phase (2-4 months)

   • Eventually, a gradual improvement in range of motion and a slow decrease in pain will occur.

Treatment Interventions

First Line of Defense –> Get a Corticosteroid Injection into the Shoulder Joint

Because frozen shoulder is a progressive inflammatory condition, slowing down and reducing the inflammatory response within the shoulder joint capsule is of utmost importance. Research studies have recommended that individuals diagnosed with frozen shoulders would benefit from intra-articular corticosteroid injections to that shoulder AS SOON AS POSSIBLE after the diagnosis has been confirmed!

The corticosteroid acts as an anti-inflammatory inside the shoulder and it helps to slow and/or stop the progression of inflammation. By reducing the inflammation, the injection can provide immediate pain relief and improve the individual’s tolerance to physical therapy exercises.

Most primary care physicians are qualified to give their patients corticosteroid injections in the shoulder joint. If they do not feel comfortable doing so, it is easy for them to refer you to someone who is qualified to do so. Orthopedic surgeons also frequently give these types of injections.

If you happen to be afraid of needles, I’m sorry but the pain relief that they can provide for this type of severely painful and long-duration condition is usually worth the short time discomfort from an injection.

Physical Therapy:

Physical therapy is an important aspect in the interdisciplinary care of an individual who is suffering with a frozen shoulder. The physical therapist will perform manual therapy on the patient’s shoulder and teach the patient frozen shoulder exercises for home to help slow the progression of the loss of range of motion during the freezing phase.

The initial goal for physical therapy is to SLOW the progression of the loss of range of motion. If the dominant shoulder is affected with frozen shoulder, that person is going to struggle significantly with his/her daily activities (eating, dressing, bathing). The physical therapist will help the person maintain their daily function as best as possible during the freezing and frozen phases.

Typically, you would want to go to physical therapy most frequently during the freezing phase (2-3x/week), then decrease frequency during the frozen phase (1x/week), and then finally just check in with the PT every 2-4 weeks during the thawing phase to ensure that you are regaining full function with your home exercise program.

I definitely recommend that anyone who has a moderate to severe case of frozen shoulder should get in with a physical therapist as they will help provide manual therapy and specialize your home exercise program to you for maximal benefit.

Surgery:

In some severe cases, a capsulotomy procedure may be recommended. This procedure surgically releases some of the tightened and scarred tissue to allow for improved shoulder range of motion. This procedure is usually reserved for individuals who are significantly limited with range of motion and have limited capacity to perform daily activities.

Intensity of Frozen Shoulder Exercises and Stretches

It is very important that the intensity of these frozen shoulder exercises and stretches be kept to MILD LEVELS ONLY! 

This means that when performing the activity, do not push beyond a mild level. Because the joint capsule is inflamed and irritated, if you push more than a mild intensity, not only will it cause severe pain, but it can cause a rebound effect and actually cause a further decrease in range of motion.

So Be Gentle!