The shoulder has a wider and more varied range of motion than any other joint in the body. Our shoulder allows us to do everything from paint to play basketball, but this flexibility also makes the shoulder joint more prone to injury.
Those most at risk for shoulder problems are athletes or workers with “overhead” movements—swimmers, throwers, painters and construction workers. The older we get, the more vulnerable to injury we all are.
The shoulder is not a single joint, but a complex arrangement of bones, ligaments, muscles, and tendons that is better called the shoulder girdle. The primary function of the shoulder girdle is to give strength and range of motion to the arm. The shoulder girdle includes three bones—the scapula, clavicle and humerus.
What is a frozen shoulder?
A frozen shoulder starts with shoulder pain, which gets worse all the time. This pain is caused by inflammation within the joint capsule (the connective tissue that surrounds a joint). In the course of a few weeks to months you can move your shoulder less and less well, because the joint capsule stiffens. The shoulder becomes “frozen”. This stiffening can occur in all directions, but we only speak of a frozen shoulder if you are less able to move in at least three directions.
Sometimes a frozen shoulder develops after a fall or operation, but often there is no clear cause. With diabetes mellitus, thyroid disorders, epilepsy, Dupuytren’s disease, heart and lung diseases or Parkinson’s disease, a frozen shoulder is a bit more common. Recent research shows that long-term stress can also play an important role.
The symptoms of a frozen shoulder
With a frozen shoulder you almost always see three phases.
The freezing and stiffening phase
This phase lasts from a few weeks to an average of nine months. The pain in the shoulder is slowly getting worse and can be experienced as very severe. The pain can radiate into the upper arm and even the forearm. Getting dressed and undressed, grabbing something from a tall cupboard and driving a car are painful and can cause severe pains. You also have pain at rest, so if you do nothing, and even at night. The upper back and neck can also hurt. Your shoulder is getting stiffer. In this phase it is not wise to force your shoulder. Exercising too aggressively can actually lead to more pain.
The frozen phase
This phase lasts on average four to nine months. The pain in the shoulder slowly decreases, but the stiffness remains. You can gradually practice more intensively.
The thawing phase
This phase lasts an average of four to twelve months. The pain disappears completely and the mobility slowly returns to (almost) normal.
The treatment of a frozen shoulder
A frozen shoulder usually passes on its own, but this can take a very long time: between ten months to more than three years. To ensure that this process runs as smoothly as possible, expert guidance from the physical therapist is important. Together with your physical therapist you can find out if there are factors that impede recovery and look for a solution. Under “What physiotherapy can do” you can read more about the treatment of a frozen shoulder. If you want to use painkillers, discuss this with your doctor first.
What you can do yourself
Certainly in the first phase of a frozen shoulder it is good to do relaxation exercises. Easy movement, such as walking, promotes recovery. As the pain diminishes and the mobility of the shoulder increases, you can gradually do more and more. The force in the arm will then return automatically.
What physiotherapy can do
Our physiotherapist will explain what is going on with your shoulder and advise you on how much you can put on the shoulder. Even if you have a lot of pain, it is important to keep moving within certain limits.
Our physiotherapeutic treatment consists of:
- Assistance in monitoring the balance between exercise and relaxation.
- Learn how to deal with the limitations during exercise, at work, when driving, cycling and walking and during (domestic) work.
- A homework exercise program to promote recovery.
- Mobilizations and other techniques to reduce the pain of the shoulder and upper back / neck and to increase mobility. Exercises and stretching are tailored to the phase of the frozen shoulder.
With measuring instruments, your physiotherapist can see to what extent you are making progress. That way you remain motivated to practice.