From the Guidelines
Physiotherapy plays a crucial role in the management of adhesive capsulitis (frozen shoulder) by improving range of motion, reducing pain, and enhancing quality of life. When managing frozen shoulder, a comprehensive physiotherapy program should be implemented, focusing on gentle stretching exercises, such as pendulum stretches, wall climbs, and cross-body reaches, to improve external rotation, internal rotation, and forward flexion of the shoulder. According to the study 1, improving range of motion (ROM) through stretching and mobilization techniques, especially external rotation and abduction, is recommended to prevent frozen shoulder. Key components of a physiotherapy program for frozen shoulder include:
- Gentle stretching exercises performed 2-3 times daily for 5-10 minutes each session
- Heat application before exercise to relax tissues
- Ice after sessions to reduce inflammation
- Manual therapy techniques like joint mobilizations and soft tissue massage to improve range of motion While the study 1 primarily focuses on stroke rehabilitation, its recommendations for preventing and treating shoulder pain can be applied to the management of frozen shoulder, emphasizing the importance of early intervention and a multidisciplinary approach to improve outcomes and reduce morbidity. In clinical practice, it is essential to prioritize physiotherapy as a first-line treatment for frozen shoulder, given its potential to significantly improve quality of life and reduce the risk of long-term disability.
From the Research
Role of Physiotherapy in Adhesive Capsulitis
- Physiotherapy is a common conservative treatment for adhesive capsulitis, also known as frozen shoulder, which can be used in combination with common analgesics 2.
- The effectiveness of physiotherapy for the treatment of frozen shoulder is still inconclusive, but previous clinical trials have reported that it can be used for treatment 3.
- Physiotherapy may be used alone or in combination with other treatments, such as corticosteroid injections, to improve symptoms and restore shoulder motion 4.
Treatment Options
- Nonsurgical treatments for adhesive capsulitis include nonsteroidal anti-inflammatory drugs, short-term oral corticosteroids, intra-articular corticosteroid injections, physiotherapy, acupuncture, and hydrodilatation 4.
- Physiotherapy and corticosteroid injections combined may provide greater improvement than physiotherapy alone 4.
- Surgical treatment options, such as arthroscopic capsular release, may be considered for patients who have minimal improvement after six to 12 weeks of nonsurgical treatment 4, 5.
Rehabilitation Regime
- The optimum rehabilitation regime for patients who have undergone release procedures for frozen shoulder has not been established, but physiotherapists consistently advocate early, frequent, prolonged, 1:1 treatment 6.
- Exercises that patients report as painful may be prescribed, but persistent pain and poor adherence to exercises are common reasons for poor outcome 6.
- Education and advice, range of movement exercises, stretching, and strengthening are commonly used in rehabilitation, while passive modalities such as manual therapy and electrotherapy are less likely to be used 6.