From the Guidelines
For treating frozen shoulder, a combination of flexibility exercises, including static, dynamic, and PNF stretching, should be performed at a frequency of ≥2–3 days/week, with each stretch held for 10–30 seconds, and a total stretching time of 60 seconds per exercise, as recommended by the 2018 EULAR guidelines 1. When designing an exercise program for frozen shoulder, it's essential to consider the principles of flexibility exercise outlined in the guidelines.
- Frequency: Exercises should be performed at a frequency of ≥2–3 days/week, with daily exercise resulting in the greatest gains in joint range of motion 1.
- Intensity: Stretches should be taken to the point of feeling tightness or slight discomfort, without causing pain 1.
- Time: Holding a static stretch for 10–30 seconds is recommended for most adults, while older persons may benefit from holding stretches for 30–60 seconds 1.
- Type: A series of flexibility exercises for each of the major muscle–tendon units is recommended, including static flexibility, dynamic flexibility, ballistic flexibility, and PNF stretching 1.
- Volume and Pattern: A reasonable target is to perform 60 seconds of total stretching time for each flexibility exercise, with repetition of each exercise two to four times 1. These exercises can be modified to suit individual needs and progressed as mobility improves, with the goal of restoring range of motion and function in the affected shoulder. It's crucial to note that consistency is key, as improvement typically takes several months, and exercises should become progressively more challenging as mobility increases. Heat application before exercising and ice afterward can also be beneficial in improving tissue elasticity and reducing inflammation, respectively. By following these guidelines and incorporating flexibility exercises into their treatment plan, individuals with frozen shoulder can work towards restoring mobility and reducing symptoms.
From the Research
Exercises for Frozen Shoulder
Exercises are a crucial component of treating frozen shoulder, also known as adhesive capsulitis. The following exercises are recommended:
- Pendular exercises 2
- Range-of-motion exercises 3
- Stretching exercises 3
- Strengthening exercises with a Theraband in all directions 3
- Post-exercise proprioceptive neuromuscular facilitation techniques 3
- Simple exercises and stretches as part of a home exercise program 4
Treatment Regimens
Various treatment regimens have been studied, including:
- Intraarticular steroids 2, 4
- Mobilisations 2
- Ice therapy 2
- Physical therapy 5, 3, 6, 4
- Electrotherapy 4
- Home exercise program 4
Effectiveness of Exercises
Studies have shown that exercises can be effective in treating frozen shoulder, with significant improvements in pain and functional capacity 3. The combination of physical therapy, exercise, and manual techniques is also effective in treating frozen shoulder, regardless of the location of the lesion in the right or left shoulder 3. Additionally, the early use of intra-articular corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes, and this treatment should be accompanied by a home exercise program to maximize the chance of recovery 4.