Frozen shoulder is a common condition that we see in physiotherapy clinics. It occurs in about 5% of the population, with females being more prone to suffering from it.
As is the case with nearly all conditions, the most common question I get from my frozen shoulder patients is: how quietly will physiotherapy work for me?
In this article, we’ll answer this question and elaborate on the factors that help you accelerate your recovery.
Quick Summary: What Is a Frozen Shoulder?
Frozen shoulder, also known as adhesive capsulitis, is a condition that makes your shoulder stiff and painful. Women, diabetics, and those who’ve suffered an injury to the shoulder are more prone to developing this condition.
The symptoms progress gradually, with pain being the predominant symptom in the first few months and then stiffness becoming the primary complaint in the later stages.
The cause of frozen shoulders isn’t always known.
You might develop it out of the blue or there could be an obvious cause for it. Often an injury or tightness of the muscles that are attached to the shoulder joint, such as the rotator cuff muscles, also causes this condition to develop.
In either case, a frozen shoulder involves an inflammation of the membrane and thickening of the connective tissues (fibrosis) of the capsule surrounding the shoulder joint.
This condition passes through three stages before resolving. For some people, the stages move from one to the next a lot quicker than others. But the estimated time for the entire process is 1-3 years.
How Quickly Does Physiotherapy Work for Frozen Shoulder?
Exercises and physical therapy are highly effective for frozen shoulder rehab.
You can start seeing results in 4 weeks (with 3 PT sessions a week) and notice a decrease in pain (especially night pain which disrupts sleeping) & disability and an improvement in function & range of motion.
You’ll need about 6 weeks of regular physiotherapy to get an increase in the range of motion (specifically abduction). Continued passive mobility drills can maintain your increased range in the short term (6 weeks) and the long term (24 weeks).
When talking about physical therapy for frozen shoulder, the effectiveness of the treatment doesn’t lie in how quickly you can get the results. Rather, it is about how many months of pain and limited mobility you can shave off.
Physical therapy exercises can help you speed up each stage of the frozen shoulder and get you to full recovery a lot sooner than what you’d get with no treatment or only medications and modalities-based treatments.
Tailored PT treatment programs can prevent you from a relapse after 6 or 12 months, which occurs in approximately 80% of people.
Stages of Frozen Shoulder
Frozen shoulder is a progressive condition. It gets worse for a few months and then begins to get better on its own. Here are the three stages of frozen shoulder: (Reference)
Freezing
The first stage of the frozen shoulder is called the freezing or acute stage. Here, pain will be your primary symptom. You might experience dull, moderate pain at rest and extreme pain at the end range of motion.
Your pain is also worse at night than during the day and can become aggravated in certain positions that apply force to the shoulder joint.
The first stage lasts for about 2-9 months and physical therapy can speed it along.
Physical therapy treatment during the acute stage of the frozen shoulder includes:
- Mobilizations of the joint to ease pain, break up adhesions, and realign collagen
- K taping to stabilize the joint and prevent it from going into the extremes of ranges
- Hot pack to relax the muscles and provide some pain relief
- Short duration (5 seconds) stretching to create space in the joint that’s beginning to tighten up and improve muscle extensibility
- Pendulum exercise
- Passive forward flexion, abduction, and external rotation with active extension, adduction, and internal rotation exercises
As you can see, pain relief is the focus during the freezing stage.
Frozen
This phase is characterized by stiffness and limited ranges of the shoulder in flexion, abduction, and external rotation. You’ll notice a decrease in pain during this stage which begins around 4-12 months after your first symptom.
Here’s how physical therapy treats the frozen stage of adhesive capsulitis:
- Stretches of the shoulder in all directions
- Scapular retractions (scapular squeeze exercise) to stretch the chest
- Mobilization with movement to recruit the muscles and decrease stiffness
- End range mobilization (grades 3 and 4) to reduce stiffness
- Heat pack for temporary pain relief
Thawing
At around 5-26 months after the onset of symptoms, the thawing stage begins in which your symptoms start to resolve.
You’ll be able to move your shoulder into the end ranges of flexion and abduction and experience less pain while doing it.
Here’s the physiotherapy protocol we generally follow during the thawing stage of frozen shoulder rehab:
- End range movements of the shoulder joint with overpressure
- Stretches with longer holds
- Pulley exercises to move the shoulder through its complete range
- Resistance band exercises to strengthen the muscles surrounding the shoulder
5 Factors That Influence Your Frozen Shoulder Recovery Timeline
Factors that influence your speed of recovery are divided into modifiable and unmodifiable ones.
Modifiable ones include your exercise compliance levels and weight while unmodifiable factors include age and the extent of the injury.
● Severity of Injury
If your frozen shoulder is accompanied by torn ligaments and injured muscles, then your recovery will obviously take longer than the average frozen shoulder recovery timeline.
● How Soon Did You Start PT
Timely care is directly proportional to quicker recovery. The sooner you visit a physiotherapist for your frozen shoulder, the sooner you’ll start to feel better.
If you start PT in the frozen stage, then you’ll experience the results (less pain and more mobility) much later than what you’d feel if you started the rehab in the acute phase.
● Presence of Any Comorbidity
Diabetes, female gender, previous injury, hypertension, etc. are conditions that make your frozen shoulder worse or predispose you to a severe form of adhesive capsulitis.
If you’re young and otherwise healthy, then your body will heal much quicker than someone who isn’t.
Taking certain medications might also slow your rehab. You should talk to your doctor or surgeon about your medication before starting rehab and see if you can switch any of them to facilitate your recovery.
● Activity Levels
Rehab for your frozen shoulder might require you to rest for some time. If your work or home chores involve overhead activities and above-average shoulder movements, then that might be counterproductive to your recovery.
In contrast, not moving your shoulder at all, even within the permitted ranges, is also a problem.
People who’ve lived active lives before suffering from a frozen shoulder have good muscle strength, which helps speed up their recovery.
● Compliance With Treatment
Following the instructions of your physiotherapist regarding permitted movements, exercises, and precautions is extremely important. Complaint patients tend to have better results.
If you’re having trouble sticking to the things your physiotherapist wants you to do, then you should consider requesting them to explain the rationale behind each exercise and precaution.
I’ve found that my patients tend to have a change in attitude towards my recommendations when they understand why I’m asking them to do all that.
4 Tips to Speed Up Your Frozen Shoulder Rehab
While there may be some factors that you can’t control, such as your age and extent of injury, there are many things you can do to facilitate your rehab and get yourself healthy again a lot sooner.
Here are some tips to speed up your frozen shoulder rehab:
● Stay Active
Stopping all your activities just because you can’t move your arm as much is the worst thing you can do.
You should continue doing low-intensity activities that you can tolerate. Some of my patients even continue to drive and play sports with a frozen shoulder, with appropriate modifications of course.
● Follow Your Home Exercise Program (HEP)
The HEP is a crucial component of any physical therapy rehab program. You’re with your physiotherapist for only an hour or less per session. That’s not enough time to exercise and bring the physiological changes that you need for a speedy recovery.
That’s why you need to follow the home exercise program to a tee. These are tailored programs so can be extremely efficient if you can stick to them.
Ideally, you should go over the HEP with your physiotherapist at the clinic. That way, you can modify any activity that seems too difficult to do because of your home environment or your schedule.
Remember: the more convenient your exercises are, the higher the chances that you’ll actually do them.
● Don’t Overdo It on Your Good Days
You’re not going to experience the same level of pain throughout the months of the freezing stage.
Similarly, you’ll have good and bad days in the frozen stage and feel your shoulder being less or more restrictive on different days.
Many people forget to do their exercises towards the end of rehab in the thawing stage because that’s when you start to feel better and regain your range. But that’s a good way to lose your progress.
To maintain your improvements from physical therapy, make sure that you don’t excitedly overwork your shoulder when you’re feeling good. Stick to the range of motion limits that your physiotherapist gives you and trust the process. Be cautious even when you don’t feel like it until you’re close to 100% recovered, or close to it.
This is more common than you might think. Frozen shoulder takes months, if not years, to resolve, which gets frustrating. So when patients have a good day, they tend to go all out and perform too much activity which can set them back and cause more harm.
● Progressively Increase Your Exercise Intensity
Physiotherapy programs are designed to slowly increase your activity levels to ensure that you don’t hurt yourself again.
While you shouldn’t overdo your activity, you should also avoid being too sedentary because that can lead to long-term muscle weakness and loss of shoulder strength.
Don’t wait until you’ve fully recovered to lift the weight again and move your shoulder through its complete ranges because that might cause permanent changes in your shoulder and you might never get your ranges or strength back.
Instead, make sure that you follow your physiotherapist’s program as prescribed and maintain the recommended exercise levels in each stage of the rehab.
The Takeaway
Frozen shoulder is a common problem globally. Yet its rehab protocols are quite varied between physiotherapy clinics because of the massive differences in the duration of the symptoms.
The bottom line is that the sooner you receive proper treatment for it, the quicker it will resolve.
Feel free to contact us if you have questions regarding the best exercises for frozen shoulder or want to get a tailored home exercise program.
Disclaimer: This article is for informative purposes only. We provide well-researched and authentic information. Do not consider this personalized health advice. Please contact a licensed healthcare professional for medical issues and health concerns.
