From the Guidelines
Heat therapy is conditionally recommended for adhesive capsulitis as part of a comprehensive treatment approach, based on very low certainty evidence of improvement for pain and physical function 1. Applying heat to the affected shoulder for 15-20 minutes several times daily can help reduce pain, increase blood flow to the area, and improve tissue elasticity before stretching exercises. Heat therapy options include warm showers, heating pads, or warm towels applied to the shoulder. For best results, use heat before performing prescribed stretching exercises, not after, as this helps prepare the tissues for movement. Heat works by dilating blood vessels, which increases circulation and helps deliver nutrients to the injured tissues while removing inflammatory mediators. However, heat should be used cautiously and avoided during acute inflammation phases when the shoulder is very painful and swollen, as it could potentially worsen inflammation. Some key points to consider when using heat therapy for adhesive capsulitis include:
- Using heat before stretching exercises to improve tissue elasticity
- Avoiding heat during acute inflammation phases
- Combining heat therapy with other treatments like gentle stretching exercises, physical therapy, and possibly anti-inflammatory medications for optimal management of adhesive capsulitis
- Considering patient preferences and individual responses to heat therapy, as people with similar conditions may receive varying levels of benefit from thermal modalities 1. In the context of adhesive capsulitis, heat therapy can be used in conjunction with other interventions, such as intra-articular injections, shoulder strapping, and improving range of motion through stretching and mobilization techniques, as recommended for treating shoulder pain 1.
From the Research
Treatment Options for Adhesive Capsulitis
- Adhesive capsulitis, also known as "frozen shoulder," is a common shoulder condition characterized by pain and decreased range of motion, especially in external rotation 2.
- The most effective treatment for adhesive capsulitis is uncertain, but nonsurgical treatments include nonsteroidal anti-inflammatory drugs, short-term oral corticosteroids, intra-articular corticosteroid injections, physiotherapy, acupuncture, and hydrodilatation 2.
- Physiotherapy and corticosteroid injections combined may provide greater improvement than physiotherapy alone 2.
Role of Physiotherapy in Adhesive Capsulitis
- Conservative treatment (physical therapy and NSAIDs) is a good long-term treatment regimen for idiopathic adhesive capsulitis, with statistically significant improvement in all measured movement directions 3.
- Physiotherapy interventions, such as exercise, manual therapy, and mobilization, are strongly recommended for pain relief, improvement of range of motion, and functional status in patients with adhesive capsulitis 4.
- However, the efficacy of one treatment modality over another is uncertain, and further research is needed to determine the superior combination of treatment 4.
Use of Heat in Adhesive Capsulitis
- There is no direct evidence in the provided studies to suggest that heat is beneficial for adhesive capsulitis.
- However, physiotherapy interventions, which may include the use of heat or other modalities, are recommended for pain relief and improvement of range of motion in patients with adhesive capsulitis 4.
Other Treatment Considerations
- Surgical treatment options, such as manipulation under anesthesia and arthroscopic capsule release, may be considered for patients who have minimal improvement after six to 12 weeks of nonsurgical treatment 2.
- Nonsurgical management is the mainstay of treatment for adhesive capsulitis, as the disease is self-limiting 5.