What is the recommended approach for managing frozen shoulder using the Spencer technique?

Spencer Technique for Frozen Shoulder Management

The Spencer technique is an effective treatment approach for frozen shoulder that improves pain, range of motion, and functional disability with sustained benefits over time. 1, 2

Understanding Frozen Shoulder

Frozen shoulder (adhesive capsulitis) is characterized by:

• Pain and stiffness in the shoulder joint, significantly limiting movement 3
• Progression through three stages: freezing (painful), frozen (adhesive), and thawing 3
• High incidence (up to 72%) of shoulder pain in certain populations, such as stroke patients 4
• Common causes include adhesive capsulitis, traction/compression neuropathy, complex regional pain syndrome, shoulder trauma, bursitis/tendonitis, rotator cuff tear, and heterotrophic ossification 4

Spencer Technique Protocol

The Spencer technique involves a seven-step approach specifically designed to address shoulder movement restrictions:

• Implemented alongside standard management approaches for optimal results 2
• Typically administered over a three-week period with follow-up assessments 1
• Shows significant improvement in range of motion, pain reduction, and functional disability scores 1, 2
• Demonstrates sustained therapeutic effects at 2,3, and 6-month follow-ups 1, 2

Comprehensive Management Approach

Physical Therapy Components

• Spencer technique: Seven sequential mobilization techniques targeting specific shoulder movement patterns 1, 2
• Stretching and mobilization: Focus especially on external rotation and abduction movements to prevent frozen shoulder progression 4
• Avoid overhead pulleys: These encourage uncontrolled abduction and can increase pain 4
• Early exercise intervention: Prevents frozen shoulder development and promotes recovery 4

Adjunctive Treatments

• Heat therapy: Moist heat pack application before mobilization techniques 1, 2
• Codman's pendulum exercises: Used in conjunction with the Spencer technique 1
• Functional electrical stimulation: May improve shoulder lateral rotation 4
• Intra-articular injections: Triamcinolone injections can significantly reduce pain 4

Evidence-Based Outcomes

• Recent pilot study (2024) demonstrated significant improvements in Visual Analog Scale (VAS) pain scores, range of motion measurements, and Shoulder Pain and Disability Index (SPADI) scores 1
• Case report (2023) confirmed sustained benefits of Spencer technique at 2,3, and 6-month follow-ups 2
• Lateral rotation range has been identified as the factor most significantly related to shoulder pain onset 4

Clinical Considerations and Pitfalls

• Avoid immobilization: Shoulder immobilization with arm slings and wraps should be avoided as they contribute to frozen shoulder development 4
• Early intervention: Physical therapy should begin as soon as possible to prevent progression 4
• Staff education: Healthcare providers should be educated on preventing trauma to the affected shoulder 4
• Surgical alternatives: For resistant cases not responding to conservative treatment for 6-9 months, surgical options like arthroscopic capsular release may be considered, though the Spencer technique should be tried first 5

Monitoring and Follow-up

• Regular assessment of pain using validated tools like the Visual Analog Scale 1
• Measurement of shoulder range of motion progress 1, 2
• Evaluation of functional improvement using the Shoulder Pain and Disability Index 1, 2
• Follow-up assessments at 2,3, and 6 months to ensure sustained improvement 1, 2