Have you ever heard of the term ‘Frozen Shoulder’? It’s also known as Adhesive Capsulitis in medical language. Imagine waking up one day and finding it hard to move your shoulder, feeling like it’s “stuck” or “frozen” in place. That’s essentially what happens with this condition. The shoulder gets stiff and painful over time, making even simple tasks like reaching out for something or dressing up quite challenging. The reason it’s called “adhesive” is that the tissues around the shoulder joint stick together, causing the tightness and reduced movement.

Epidemiology and Risk Factors

Let’s talk about how common this condition is and who’s more likely to get it:

Age and Gender: People between the ages of 40 and 60 are more likely to get frozen shoulder. Interestingly, women have a slightly higher chance of experiencing it than men.

Medical Conditions: If you have diabetes, there’s a higher chance you might get a frozen shoulder. In fact, diabetics are 2 to 4 times more at risk. Other conditions, like Parkinson’s disease, heart problems, or thyroid issues, also increase the likelihood.

Inactivity: If someone has had their arm in a sling for a long time, say after surgery or a fracture, the shoulder might “freeze” from not being used.

Injury or Surgery: Sometimes, a direct injury to the shoulder or a surgery might be the starting point.

Autoimmunity: Without getting too technical, this is when our body mistakenly targets its own tissues. There’s some thinking that this might play a role in frozen shoulder, but researchers are still looking into it.

The importance of Rehabilitation in Recovery

So, what do we do if someone gets a frozen shoulder? The answer is Rehabilitation. Think of it as a series of exercises and treatments that help the shoulder “thaw out” and move freely again. Here’s why it’s so crucial:

  1. Pain Relief: Rehabilitation helps in reducing the pain. Simple exercises and treatments can make the shoulder feel much better.
  2. Getting Movement Back: Through specific exercises, the shoulder can slowly stretch out and regain its movement.
  3. Building Strength: As the shoulder starts moving, it’s essential to strengthen the muscles around it to prevent further issues.
  4. Getting Back to Normal: Rehabilitation ensures that people can get back to doing everyday activities without pain or trouble.
  5. Stopping It from Coming Back: By learning and continuing with some exercises, there’s a good chance of preventing a frozen shoulder from returning.

In simple terms, if someone’s shoulder feels “stuck,” rehabilitation is the key to unlocking it and getting back to normal life.

Pathophysiology of Frozen Shoulder

Underlying Molecular and Cellular Changes

Now, if we zoom in and look closely at what’s happening inside the shoulder during this process, we find some interesting changes:

Inflammation: At the start, certain tiny molecules in the body that cause inflammation and pain become super active. Think of these like little fire alarms that go off, causing pain and setting the stage for everything that follows.

Too Much Collagen: There are cells in our body, named fibroblasts, that make a protein called collagen. Collagen is like the building block of our tissues. In frozen shoulder, these cells go into overdrive and produce too much collagen, making the shoulder’s capsule thick and tight.

Tissue Changes: Some enzymes in the shoulder, imagine them as nature’s little scissors, become more active and might be responsible for the scar-like bands that form and stick tissues together.

Stress on the Cells: Cells in the affected shoulder face a kind of stress, like how a machine might rust or wear out if not taken care of. This can play a part in making the condition worse.

New Blood Vessels: Sometimes, more tiny blood vessels than usual form in the shoulder. Think of these like adding extra roads in a city. This might be the body’s way of trying to fix things, but it can add to the overall problem.

So, while frozen shoulder might seem like just a pain or stiffness, there’s a lot happening under the surface. But the good news is, with time and the right care, it usually gets better!

Principles of Rehabilitation for Frozen Shoulder

Goals of Rehabilitation

Rehabilitation for frozen shoulder aims to get the shoulder back to working as it should. Here’s what the goals are:

Pain Management: At first, frozen shoulder can be quite painful. Ways to manage this pain include:

  • Medicines like painkillers or anti-inflammatory drugs.
  • Techniques like using electric currents for pain relief, cold packs, or warm packs.
  • Gentle movements and massages to ease the pain.

Restoration of Range of Motion (ROM):

  • Start with easy stretching exercises, like letting the arm dangle and swing slowly.
  • Move the joint gently to keep it from getting too stiff.
  • Exercises in water, like swimming or water aerobics, can be helpful as the water supports the arm, making movements easier.

Strengthening of Shoulder Musculature:

  • Begin with exercises that activate muscles without moving the joint.
  • As pain decreases, use resistance bands or light weights to make the muscles stronger.
  • Focus on the key muscles around the shoulder to ensure the joint moves smoothly and without pain.

Improving Functional Capacity:

  • Training that focuses on daily tasks, like reaching for objects or lifting things.
  • Tips and tricks to make daily activities easier and pain-free.
  • Balance and coordination exercises to make sure the shoulder works well with the rest of the body.

Individualized Patient-Centered Care

Every person is different, and so is their experience with frozen shoulder:

Assessment: A detailed check-up at the start and regular check-ins to see how things are progressing.

Patient Education: Making sure patients understand their condition, what to expect, and how they can help themselves get better.

Feedback Loop: Regular chats to know how the patient feels, what they expect, and any problems they’re facing, ensuring they’re actively involved in their healing process.

Key Rehabilitation Exercises for Frozen Shoulder

Gentle Movements (Passive Range of Motion Exercises)

These are exercises where you use your good arm or an external tool to move your affected arm. Think of these as “letting the arm go along for the ride”.

Pendulum Exercises:

What it does: Helps your shoulder move more freely.

How to do it: Stand next to a table and lean forward slightly, letting your sore arm dangle. Now, gently sway your body side to side, front and back. Your arm should swing freely like a pendulum.

Wall Climb:

What it does: Assists in lifting your arm higher.

How to do it: Face a wall and place the fingers of your sore arm on it. Imagine your fingers are like spider legs and “climb” them up the wall. Go as high as you comfortably can, then bring them back down.

Cross-body Stretch:

What it does: Stretches the back part of your shoulder.

How to do it: Use your good arm to gently pull your sore arm across your body. Release after 15–30 seconds of holding. Repeat a few times [1]. You’ll experience a stretch on the outside of your shoulder. Hold it, but don’t push into pain.

External Rotation with Stick:

What it does: Helps your shoulder turn outward.

How to do it: Hold a stick with both hands in front of you. Use your good arm to push out the sore arm, like you’re opening a gate [1]. Once more, go to the area where you feel a stretch rather than pain.

Self-driven Movements (Active ROM Exercises)

These are exercises where you use the muscles of your sore shoulder to move. Once you’ve progressed with passive movements, you can start these.

Outward Rotation:

What it does: Strengthens the muscles that help turn your arm outward.

How to do it: With your elbow by your side, bent at 90 degrees, imagine you’re holding a tray on your hand. Now, turn your hand outward, like you’re handing the tray to someone on your side [2].

Inward Rotation:

What it does: Focuses on muscles that turn your arm inward.

How to do it: Similarly, imagine holding that tray. This time, turn your hand inwards, like you’re moving the tray across your belly [2].

Forward Flexion:

What it does: Lifts your arm in front.

How to do it: Start with your arm at your side. Now, raise it slowly in front of you. Lift as high as you can without pain, then lower it back down [2].

Remember, with all these exercises, never push into pain. Always work within your comfort zone, and it’s a good idea to get guidance from a health professional before starting a new exercise regimen.

Strengthening Exercises

Once you’re feeling a bit better and can move your shoulder with more ease, it’s time to start building strength. Strengthening helps ensure your shoulder gets back to its best form and helps you avoid similar problems in the future.

Isometric Exercises:

What it does: Helps muscles get stronger without moving the joint.

How to do it: Stand next to a wall. Push or pull your hand against it, but don’t let your arm actually move. Hold for several seconds [3]. It’s like playing a “tug of war” with the wall. Hold for a few seconds, then relax.

Resistance Band Exercises:

What it does: Challenges your shoulder muscles by adding some resistance.

How to do it: Use a stretchy band. For example,

  • For “External Rotation”: Hold one end of the band, with your elbow by your side, and pull the other end outward.
  • For “Internal Rotation”: it’s the opposite, pull the band inward.

Dumbbell Exercises:

What it does: Uses weights to make your muscles work harder.

How to do it:

  • Shoulder Press: With a weight in your hand, push it straight up above your head.
  • Lateral Raises: Lift the weight out to the side.
  • Front Raises: Lift the weight up in front of you.

Exercises for Functional Training

These are exercises that help you get back to doing the things you love or need to do every day without pain.

Daily Life Activities:

What it does: Helps you with everyday tasks.

Examples:

  • Reaching Overhead: Practicing reaching up as if you’re trying to get a bowl from a top shelf.
  • Push & Pull: Pretend to open a heavy door or pull open a drawer.
  • Carrying Things: Safely practice carrying bags or objects to help you with grocery shopping or lifting things at home.

Sport-specific or Occupation-specific Drills:

What it does: Gets you ready to return to your sport, hobby, or job.

How to do it: Think about the movements you often do in your sport or job. If you’re a tennis player, this might mean practicing your swing. If you’re a painter, it might mean practicing lifting and using a brush.Start slowly and gradually build up the intensity, always being mindful of how your shoulder feels.

Remember, it’s always a good idea to chat with a physical therapist or another expert if you’re unsure about how to do these exercises or if they’re right for you. And always listen to your body – if something hurts, stop and seek advice.

Ways to Boost Your Shoulder Healing

Physical Therapy Tools

When you visit a physical therapist, they have some special tools to help speed up your healing and make you feel better. Here’s what they might use:

Heat/Cold Therapy:

What is it: Using warmth or coldness to help your shoulder.

Why use it:

  • Heat: Makes you feel relaxed, soothes pain, and helps blood flow.
  • Cold: Helps calm down any swelling or pain.

When might you see it: Maybe before or after exercises to help prepare or soothe your shoulder.

Ultrasound:

What is it: A device that uses sound waves (don’t worry, you can’t hear them!) to treat deep inside your shoulder.

Why use it: Helps relax tissues deep inside and can speed up healing.

When might you see it: If your therapist thinks it’ll help make your tissues softer and easier to move.

Electrical Stimulation:

What is it: Sticky pads (called electrodes) that give small, safe electric pulses.

Why use it: It can wake up your muscles and reduce pain.

When might you see it: If your muscles need a little “boost” or if you’re feeling a lot of pain.

Hands-on Healing Techniques

Sometimes, the best tools are the therapist’s hands! Here’s what they might do:

Joint Mobilizations:

What is it: Your therapist gently moves your joint in specific ways.

Why use it: Helps your joints move better and eases pain.

When might you feel it: Throughout the rehabilitation process, especially if joint restrictions are identified [4]

Soft Tissue Massage:

What is it: Kind of like a massage you’d get at a spa, but focused on your shoulder.

Why use it: Relaxes tight muscles and helps blood flow.

When might you feel it: If you have sore or tight muscles.

Tips and Tricks for at Home

Your therapist will want to make sure you know how to help yourself at home, too!

Home Exercise Program:

What is it: A set of exercises to do at home.

Why do it: Keeps your healing on track and makes sure you keep getting stronger.

Posture Education:

What is it: Tips on how to sit, stand, and move in ways that are good for your shoulder.

Why is it important: Proper posture can prevent undue stress on the shoulder, reducing the risk of injury and aiding recovery [5].

Activity Modification:

What is it: Changing the way you do certain things so they don’t hurt.

Why is it important: So, you can do your favorite activities without making your shoulder feel bad.

These are just some of the ways professionals can help your shoulder get better. If something doesn’t feel right, always ask. They’re there to help!

Conclusion

In wrapping up our exploration of frozen shoulder and its treatment, it’s essential to underscore just how vital rehabilitation is in the recovery process. Just like a musician practicing daily to perfect a piece or a gardener tending to a plant to ensure its growth, the journey to a fully functional shoulder requires dedication, specific exercises, and sometimes adjustments to our daily activities.

Beyond just the physical aspects, there’s a broader perspective we need to adopt when approaching treatment. This means considering not just the shoulder in isolation, but the whole person—how they feel, how they live, and how they use their shoulder in their everyday life. Furthermore, in today’s world, where information is abundant, it’s crucial that the treatments and methods we choose are evidence-based. In other words, they’re not just popular fads but have solid research and proven results backing them up.

So, while the idea of a “frozen” shoulder may sound daunting, remember that with a comprehensive, well-researched approach and a sprinkle of patience, recovery is not just a possibility, but a promising outcome. Healing is a multi-faceted journey, and every step taken, be it an exercise, a therapy session, or even a lifestyle change, brings us closer to a healthier, pain-free tomorrow.

FAQ’s

1. What is frozen shoulder?

Answer: Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain and limited range of motion in the shoulder joint. It occurs when the soft tissues surrounding the shoulder joint become inflamed and stiff.

2. What are the primary symptoms of a frozen shoulder?

Answer: Symptoms typically include persistent pain, stiffness, and reduced range of motion in the shoulder. The symptoms can progress gradually, beginning with pain that worsens at night and eventually leading to limited mobility.

3. How long does frozen shoulder typically last?

Answer: Frozen shoulder generally has three stages: the freezing stage, the frozen stage, and the thawing stage. The entire process can last anywhere from 12 months to 3 years. However, with proper rehabilitation, the recovery period can be shortened.

4. What are the main rehabilitation techniques for frozen shoulder recovery?

Answer: Rehabilitation often includes a combination of physical therapy, range of motion exercises, strengthening exercises, and pain relief methods. Therapies such as heat/cold application, ultrasound, electrical stimulation, and joint mobilizations can also be beneficial.

5. How often should I perform exercises for frozen shoulder at home?

Answer: Typically, exercises should be performed daily, but it’s essential to consult with a physical therapist for a personalized regimen and to ensure exercises are done correctly to avoid further injury.

6. Is surgery necessary for frozen shoulder?

Answer: Most cases of frozen shoulder can be resolved with non-surgical treatments like physical therapy and exercises. However, if symptoms don’t improve with conservative treatments, surgery might be an option.

7. What role does posture play in frozen shoulder rehabilitation?

Answer: Maintaining good posture can help in reducing undue stress on the shoulder and facilitating the healing process. Proper posture training is often a part of rehabilitation techniques for frozen shoulder recovery.

8. Can frozen shoulder return after treatment?

Answer: While it’s rare, some people might experience a recurrence of symptoms in the same shoulder or the opposite shoulder. Regular exercises and monitoring can help prevent its return.

9. What are the risk factors for developing frozen shoulder?

Answer: Risk factors include age (being over 40), gender (more common in women), having a history of prolonged immobility or reduced mobility of the shoulder, and conditions like diabetes, thyroid disorders, and cardiovascular diseases.

10. How can I prevent frozen shoulder from developing in the first place?

Answer: Regular shoulder exercises to maintain mobility, addressing and treating injuries promptly, and managing health conditions that increase the risk are some ways to potentially prevent frozen shoulder.

References

1. American Academy of Orthopaedic Surgeons. (n.d.). Frozen Shoulder. AAOS. https://orthoinfo.aaos.org/en/diseases–conditions/frozen-shoulder/

2. Page, P., 2012. Current concepts in muscle stretching for exercise and rehabilitation. International journal of sports physical therapy, 7(1), p.109. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273886/

3. Ludewig, P.M. and Borstad, J.D., 2003. Effects of a home exercise programme on shoulder pain and functional status in construction workers. Occupational and environmental medicine, 60(11), pp.841-849. https://oem.bmj.com/content/60/11/841.short

4. Bialosky, J.E., Bishop, M.D. and Penza, C.W., 2017. Placebo mechanisms of manual therapy: a sheep in wolf’s clothing?. journal of orthopaedic & sports physical therapy, 47(5), pp.301-304. https://www.jospt.org/doi/abs/10.2519/jospt.2017.0604

5. Neumann, D.A., 2016. Kinesiology of the musculoskeletal system-e-book: foundations for rehabilitation. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=4GRgDwAAQBAJ&oi=fnd&pg=PP1&dq=6.%09Neumann,+D.+A.+(2016).+Kinesiology+of+the+musculoskeletal+system:+Foundations+for+rehabilitation.+Elsevier+Health+Sciences.+%E2%86%A9&ots=joD_fUEVk5&sig=4jSzxSVSIVgrG244dDIiw9kxEGE

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