What is the role of physiotherapy in the management of adhesive capsulitis (frozen shoulder)?

From the Guidelines

Physiotherapy is a crucial component in the management of adhesive capsulitis, also known as frozen shoulder, and should be initiated early in the treatment process. The goal of physiotherapy is to gradually stretch the shoulder capsule, break down adhesions, and restore normal gliding motion between joint surfaces. A typical rehabilitation program lasts 3-6 months, with gradual progression as mobility improves.

Key Components of Physiotherapy for Frozen Shoulder

• Gentle range-of-motion exercises like pendulum swings (letting your arm hang and moving it in small circles) for 5 minutes, 3-5 times daily
• Stretching exercises including cross-body reaches and doorway stretches, holding each for 20-30 seconds and repeating 3-5 times
• Strengthening exercises using light resistance bands or small weights (1-2 pounds) should be incorporated once pain decreases
• Heat application for 10-15 minutes before exercises and ice for 15-20 minutes after can help manage pain Consistency is crucial—daily exercises produce better outcomes than sporadic sessions. While over-the-counter pain relievers like ibuprofen (400-600mg three times daily) or acetaminophen (500-1000mg every 6 hours) can help manage pain during the recovery process, they should not replace the exercise program 1. If pain is severe or progress stalls after 4-6 weeks, consult a healthcare provider as corticosteroid injections might be beneficial alongside continued physiotherapy.

Importance of Physiotherapy in Frozen Shoulder Management

Physiotherapy has been shown to be effective in managing postsurgical musculoskeletal symptoms, including frozen shoulder, and can help improve range of motion, reduce pain, and enhance overall quality of life 1. Recent data from the Hormones and Physical Exercise trial demonstrated that participation in an intensive exercise regimen resulted in a 20% decrease in aromatase inhibitor-associated pain, highlighting the importance of physiotherapy in managing musculoskeletal symptoms 1.

From the Research

Role of Physiotherapy in Adhesive Capsulitis

The role of physiotherapy in the management of adhesive capsulitis (frozen shoulder) includes:

• Therapeutic exercises and mobilization to reduce pain, improve range of motion (ROM), and function in patients with stages 2 and 3 of frozen shoulder 2
• Low-level laser therapy for pain relief and moderately suggested for improving function, but not recommended for improving ROM 2
• Acupuncture with therapeutic exercises for pain relief, improving ROM, and function 2
• Electro-therapy for short-term pain relief 2
• Continuous passive motion for short-term pain relief, but not for improving ROM or function 2, 3
• Deep heat for pain relief and improving ROM 2
• Mobilization techniques and exercises, guided by tissue irritability, as a recommended physical therapy intervention 4
• Proprioceptive neuromuscular facilitation and mirror therapy as latest evidence-based practices 4

Treatment Options

Different treatment options have been studied, including:

• Corticosteroid injections for stage 1 frozen shoulder 2
• Intra-articular steroids, which may benefit pain and range of movement in the early stages of the condition 5
• Mobilisations, which may have little long-term advantage, but can be beneficial in the early stages 5
• Ice therapy, which has shown little long-term advantage 5
• Conventional physiotherapy treatment protocol, including active stretching and pendulum exercises, which can be effective in improving pain and function, but may not be as effective as continuous passive motion in the early phase of treatment 3

Comparison of Treatment Regimens

Studies have compared different treatment regimens, including:

• Continuous passive motion (CPM) vs. conventional physiotherapy treatment (CPT) protocol, which showed that CPM provides better response in pain reduction than CPT in the early phase of treatment 3
• Intraarticular steroids vs. mobilisations vs. ice therapy vs. no treatment, which showed that there is little long-term advantage in any of the treatment regimens, but steroid injections may benefit pain and range of movement in the early stages of the condition 5