Washing your hair, fastening your bra, tucking your shirt into the back of your trousers - these are daily activities that a frozen shoulder can play havoc with because reaching up or back will result in sudden pain. Aargh!
Frozen shoulder is the layman’s term for adhesive capsulitis, but what exactly happens?
“As the medical term suggests adhesions form in the capsule surrounding the shoulder joint,” Rory O’Neill, a chartered physiotherapist based in Ratoath, Co Meath explains.
“The capsule becomes inflamed and adhesions occur. The capsule contracts a bit because of all this and as a result restricts the movement of the shoulder joint. This is coupled with pain.”
There tends to be three phases related to a frozen shoulder:
1. Freezing phase
Where it tightens up over time or in some cases, quickly, and is now quite painful.
2. Frozen stage
Where the pain (when you move your shoulder) has subsided but the shoulder remains extremely stiff.
3. Thawing out stage
Where the movement starts to restore.
Rory O’Neill is a chartered physiotherapist based in Ratoath, Co Meath
Causes of frozen shoulder
While many people will say that their frozen shoulder came “out of the blue”, Rory believes that the condition is often preceded by an incident, however minor.
“The person may have been hedge clipping, for example, or moving furniture and did more than they should at one time. This causes an initial slight strain but then ramps up with the shoulder getting tight, perhaps quickly, perhaps slowly,” he says.
“Sometimes it happens after a fall onto the shoulder too – a trauma - even a minor one. It’s also common after shoulder surgery.”
Who is most affected?
The condition is also much more prevalent in middle-aged females than males but the exact reason for this isn’t known.
“Women in the 40-50+ age group are more affected and while there may be a hormonal involvement at play there isn’t a definitive reason why.”
Those with diabetes are also more likely to get it.
“Any condition that is systemic – that affects your whole system – makes you a little more vulnerable,” he adds. “Also, with diabetes, the person’s circulation is affected. The blood supply to the peripheries may not be as good and the body’s ability to heal reduced.”
Frozen shoulder is also very common after shoulder surgery e.g. after rotator cuff surgery. The shoulder has to be immobilised in a sling for healing purposes, but this immobilisation can lead to a frozen shoulder.
“Often as a physiotherapist the rehabilitation of the surgery isn’t a major issue or ordeal but the rehab of the frozen shoulder may be,” says Rory.
Most people seek help
The interesting thing is that with a frozen shoulder, if you do absolutely nothing about it, in nearly every case, Rory states, it will spontaneously resolve, but that can take anything from one to two years.
Six months freezing, six months frozen and six months thawing is often mentioned in relation to this condition.
“(Leaving it to resolve by itself) is quite a long drawn out thing, however. I find that for the majority of people who come to me come because the pain or the restriction of movement drives them to seek intervention.
Most people can’t slog it out, particularly if it is a dominant hand as it is going to affect your ability to work.
If you have a desk job it won’t affect you too much but obviously any job that involves you reaching a little bit or carrying things, especially any kind of overhead work, is going to be a struggle.
The condition varies from person to person too, from mild to severe so time frames for recovery differ too.”
Hair washing difficult
He talks about the principal complaints patients have in relation to frozen shoulders.
“People come in saying they can’t wash their hair (without pain). A really common thing with females is that they can’t fasten their bra. Reaching up behind the back tends to be one of the most restricted and provocative (painful) movements.
Men will say that doing something like tucking their shirt into the back of their trousers can be an ordeal.”
One of the positives of the condition, however, is that the pain doesn’t stay all the time.
“If you reach for something and you get an almighty pain in your shoulder it’s usually just the pain at that point in time – you’re not in agony for the rest of the day.
That’s probably one of the positives about this condition.”
Treatment
Continuing to move the frozen shoulder as it develops is very important, he says, much as you might feel like not doing that.
“We always assume that if something is sore we have to protect it and mind it and not move it.
While that applies to a lot of injuries and conditions, frozen shoulder is probably the opposite in that if you start to see your shoulder getting sore you should move it.
“People are often afraid to do this and will literally tend to hold their arm across the chest or keep the hand in the pocket but unfortunately, with frozen shoulder, that’s the worst thing you can do.
You have to push it, stretch it, move it. The backbone of treatment and the exercises that go alongside physiotherapy is movement.”
One or two in every 10 people don’t respond to exercises, he says. What, then, are there other options or what can be done as well as physio?
1. Shoulder Flexion
Exercise 1: Active assisted shoulder flexion
Hold a brush handle or stick in both hands, hands a little wider than shoulder width. You are using your good arm to assist the affected one. Lift both arms up holding the stick as high as you can so you feel a stretch and minor discomfort in the affected shoulder. Hold for a couple of seconds and lower down. Repeat 15-20 times at regular intervals through the day.
2. Wall Walks
Exercise 2: Wall walks
On your affected side, walk your fingers up the wall as high as you can until you feel a stretch and mild discomfort in your shoulder. Pause for a couple of seconds and walk back down. Repeat 15-20 times at regular intervals through the day.
Pain control
If the shoulder is very sore initially and you are not able to tolerate physio, your GP may prescribe anti-inflammatories.
“Pain control will dampen things down a bit and settle some of the inflammation,” says Rory.
Applying heat or cold to the shoulder can help also.
“Heat or cold can be beneficial any time you have any type of inflammation and there is no hard or fast rule about which one to use.
I generally find heat is a bit better but those affected should try both.”
Heat can make the exercises a bit easier.
“Even applying heat for five or 10 minutes before you start the exercises can help,” he says. “That’s because the warmer a tissue is and the more blood flow going through it, the more flexible it’s going to become and the easier it’s going to be for you to push those exercises.”
Physiotherapy treatment usually involves four-six appointments spaced out over weeks, depending on severity.
“If you are struggling to get the arm above the horizontal, 90 degrees at the shoulder, for example, you definitely would be looking at that sort of time frame.
It would usually be once a week for the first while, then more spaced out when the shoulder starts freeing up.
Patients have to be diligent doing the exercises at home, however, as going to the physio alone is not going to fix it. Again, it’s a ‘no pain no gain’ scenario.”
Severe cases
For severe cases injections may be tried. “Steroid injections may be prescribed and newer, hydrodilation where they inject a lot of saline solution into the joint.
This fills the joint and stretches it from the inside out. Imagine filling a balloon with water. The balloon gets bigger and stretches so that’s what they are doing with this. The saline solution stretches the capsule.”
In very severe cases manipulation under anaesthetic may be tried.
“Sometimes, in hospital, under anaesthetic, the arm is moved swiftly to break some of the adhesions.
It sounds crude but the vast majority of people don’t end up going down that road.
The worst case scenario is arthroscopy. That’s where keyhole surgery is done and the surgeon tries to cut away some of the adhesions around the joint.”
Rory tells patients that if the exercises he recommends aren’t hurting they aren’t doing any good.
“While it is not pleasant, it is literally only sore when you’re doing it (an exercise) so as soon as you stop the exercise the pain goes, but at least you’ve pushed the range of motion, you’ve stretched out that capsule again.
That’s what it’s all about – stretching out the capsule and restoring the mobility back into it. It’s not a pleasant thing but people who grit the teeth do recover much faster.”
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Washing your hair, fastening your bra, tucking your shirt into the back of your trousers - these are daily activities that a frozen shoulder can play havoc with because reaching up or back will result in sudden pain. Aargh!
Frozen shoulder is the layman’s term for adhesive capsulitis, but what exactly happens?
“As the medical term suggests adhesions form in the capsule surrounding the shoulder joint,” Rory O’Neill, a chartered physiotherapist based in Ratoath, Co Meath explains.
“The capsule becomes inflamed and adhesions occur. The capsule contracts a bit because of all this and as a result restricts the movement of the shoulder joint. This is coupled with pain.”
There tends to be three phases related to a frozen shoulder:
1. Freezing phase
Where it tightens up over time or in some cases, quickly, and is now quite painful.
2. Frozen stage
Where the pain (when you move your shoulder) has subsided but the shoulder remains extremely stiff.
3. Thawing out stage
Where the movement starts to restore.
Rory O’Neill is a chartered physiotherapist based in Ratoath, Co Meath
Causes of frozen shoulder
While many people will say that their frozen shoulder came “out of the blue”, Rory believes that the condition is often preceded by an incident, however minor.
“The person may have been hedge clipping, for example, or moving furniture and did more than they should at one time. This causes an initial slight strain but then ramps up with the shoulder getting tight, perhaps quickly, perhaps slowly,” he says.
“Sometimes it happens after a fall onto the shoulder too – a trauma - even a minor one. It’s also common after shoulder surgery.”
Who is most affected?
The condition is also much more prevalent in middle-aged females than males but the exact reason for this isn’t known.
“Women in the 40-50+ age group are more affected and while there may be a hormonal involvement at play there isn’t a definitive reason why.”
Those with diabetes are also more likely to get it.
“Any condition that is systemic – that affects your whole system – makes you a little more vulnerable,” he adds. “Also, with diabetes, the person’s circulation is affected. The blood supply to the peripheries may not be as good and the body’s ability to heal reduced.”
Frozen shoulder is also very common after shoulder surgery e.g. after rotator cuff surgery. The shoulder has to be immobilised in a sling for healing purposes, but this immobilisation can lead to a frozen shoulder.
“Often as a physiotherapist the rehabilitation of the surgery isn’t a major issue or ordeal but the rehab of the frozen shoulder may be,” says Rory.
Most people seek help
The interesting thing is that with a frozen shoulder, if you do absolutely nothing about it, in nearly every case, Rory states, it will spontaneously resolve, but that can take anything from one to two years.
Six months freezing, six months frozen and six months thawing is often mentioned in relation to this condition.
“(Leaving it to resolve by itself) is quite a long drawn out thing, however. I find that for the majority of people who come to me come because the pain or the restriction of movement drives them to seek intervention.
Most people can’t slog it out, particularly if it is a dominant hand as it is going to affect your ability to work.
If you have a desk job it won’t affect you too much but obviously any job that involves you reaching a little bit or carrying things, especially any kind of overhead work, is going to be a struggle.
The condition varies from person to person too, from mild to severe so time frames for recovery differ too.”
Hair washing difficult
He talks about the principal complaints patients have in relation to frozen shoulders.
“People come in saying they can’t wash their hair (without pain). A really common thing with females is that they can’t fasten their bra. Reaching up behind the back tends to be one of the most restricted and provocative (painful) movements.
Men will say that doing something like tucking their shirt into the back of their trousers can be an ordeal.”
One of the positives of the condition, however, is that the pain doesn’t stay all the time.
“If you reach for something and you get an almighty pain in your shoulder it’s usually just the pain at that point in time – you’re not in agony for the rest of the day.
That’s probably one of the positives about this condition.”
Treatment
Continuing to move the frozen shoulder as it develops is very important, he says, much as you might feel like not doing that.
“We always assume that if something is sore we have to protect it and mind it and not move it.
While that applies to a lot of injuries and conditions, frozen shoulder is probably the opposite in that if you start to see your shoulder getting sore you should move it.
“People are often afraid to do this and will literally tend to hold their arm across the chest or keep the hand in the pocket but unfortunately, with frozen shoulder, that’s the worst thing you can do.
You have to push it, stretch it, move it. The backbone of treatment and the exercises that go alongside physiotherapy is movement.”
One or two in every 10 people don’t respond to exercises, he says. What, then, are there other options or what can be done as well as physio?
1. Shoulder Flexion
Exercise 1: Active assisted shoulder flexion
Hold a brush handle or stick in both hands, hands a little wider than shoulder width. You are using your good arm to assist the affected one. Lift both arms up holding the stick as high as you can so you feel a stretch and minor discomfort in the affected shoulder. Hold for a couple of seconds and lower down. Repeat 15-20 times at regular intervals through the day.
2. Wall Walks
Exercise 2: Wall walks
On your affected side, walk your fingers up the wall as high as you can until you feel a stretch and mild discomfort in your shoulder. Pause for a couple of seconds and walk back down. Repeat 15-20 times at regular intervals through the day.
Pain control
If the shoulder is very sore initially and you are not able to tolerate physio, your GP may prescribe anti-inflammatories.
“Pain control will dampen things down a bit and settle some of the inflammation,” says Rory.
Applying heat or cold to the shoulder can help also.
“Heat or cold can be beneficial any time you have any type of inflammation and there is no hard or fast rule about which one to use.
I generally find heat is a bit better but those affected should try both.”
Heat can make the exercises a bit easier.
“Even applying heat for five or 10 minutes before you start the exercises can help,” he says. “That’s because the warmer a tissue is and the more blood flow going through it, the more flexible it’s going to become and the easier it’s going to be for you to push those exercises.”
Physiotherapy treatment usually involves four-six appointments spaced out over weeks, depending on severity.
“If you are struggling to get the arm above the horizontal, 90 degrees at the shoulder, for example, you definitely would be looking at that sort of time frame.
It would usually be once a week for the first while, then more spaced out when the shoulder starts freeing up.
Patients have to be diligent doing the exercises at home, however, as going to the physio alone is not going to fix it. Again, it’s a ‘no pain no gain’ scenario.”
Severe cases
For severe cases injections may be tried. “Steroid injections may be prescribed and newer, hydrodilation where they inject a lot of saline solution into the joint.
This fills the joint and stretches it from the inside out. Imagine filling a balloon with water. The balloon gets bigger and stretches so that’s what they are doing with this. The saline solution stretches the capsule.”
In very severe cases manipulation under anaesthetic may be tried.
“Sometimes, in hospital, under anaesthetic, the arm is moved swiftly to break some of the adhesions.
It sounds crude but the vast majority of people don’t end up going down that road.
The worst case scenario is arthroscopy. That’s where keyhole surgery is done and the surgeon tries to cut away some of the adhesions around the joint.”
Rory tells patients that if the exercises he recommends aren’t hurting they aren’t doing any good.
“While it is not pleasant, it is literally only sore when you’re doing it (an exercise) so as soon as you stop the exercise the pain goes, but at least you’ve pushed the range of motion, you’ve stretched out that capsule again.
That’s what it’s all about – stretching out the capsule and restoring the mobility back into it. It’s not a pleasant thing but people who grit the teeth do recover much faster.”
Read more
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Protect your children: store medicines and pesticides safely
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