Frozen shoulder, also known as Adhesive Capsulitis, is a condition where the shoulder joint gets stiffer and stiffer over time eventually causing a significant range of motion and strength deficits throughout the entire arm.
The fastest way to fix a frozen shoulder is through physical therapy and receiving a corticosteroid injection within the first couple of months.
In this article, we will discuss what types of treatment works best for frozen shoulder during physical therapy and how long you could expect to be dealing with this issue.
What’s the fastest way to fix frozen shoulder with physical therapy?
A combination of education, manual therapy, and specific exercise is the most effective way to improve frozen shoulder.
According to this article, authored by Dr. Christopher K Wong, et. al, the timeline can be greatly reduced by following the below guidelines.
“The person-centered plan of care was a pragmatic application of a regional interdependence approach to shoulder dysfunction recognizing that glenohumeral function depends on scapular function [21], which in turn can be influenced by other upper kinetic chain segments depending on individual patient presentation.
Retrospective analysis of the pre-existing data revealed a loosely sequential design of the plan of care with the following components addressed: (a) patient education to break preconceived assumptions of frozen shoulder and provide a home exercise program, (b) treatment of the upper kinetic chain using manual therapy and stretching exercise, followed by (c) strengthening, neuromuscular reeducation, and functional training by the end of the episode.
Thus, identified movement limitations in all inter-related upper quarter regions were treated.
Specific treatment techniques selected from a consistent set of options were applied as indicated by related impairments based on patient presentation and preference, and the treating physical therapist’s clinical judgment.
Treatment region and treatment type were categorized by consensus discussion among investigators and described below after patient education.
Patient education regarding the diagnosis, prognosis, and plan-of-care was the starting point for all patients.
Misinformation common in health websites, textbooks, and primary literature related to the unsupported natural history of frozen shoulder theory and its prognosis without care [3] was discussed.
Because rehabilitation for frozen shoulder can be painful, an emphasis was achieving patient understanding that without care the likely prognosis was years of lingering limitations [11,12,14].
In order to gain ROM as quickly as possible, a goal of 10 degrees per direction per session was set with the motivational concept that extra ROM could be banked and counted toward the expected progress for any future session in the event of a difficult day with slow progress.
A home exercise program consisting of stretching exercises was provided after the stretches were introduced.
Four regions within the upper quarter were defined: (1) shoulder girdle (sternoclavicular joint, acromioclavicular joint, first rib via its ligamentous and muscular connection to the clavicle), (2) shoulder joint (glenohumeral joint, rotator cuff muscles), (3) scapulothoracic and humerothoracic muscles (pectoralis major, pectoralis minor, latissimus dorsi, serratus anterior), and (4) spine (cervical, thoracic, and costoverterbal/costotransverse joints). Manual therapy to all four regions have improved shoulder ROM or function: At the shoulder joint, for instance, grade III–IV posterior mobilization increased shoulder external rotation ROM for people with frozen shoulder and significantly reduced self-reported pain [25]. Manual therapy for the shoulder girdle joints have improved shoulder function [21,26], and has been suggested for the first rib to improve shoulder function [27]. The scapulothoracic joint can be affected through joint mobilization [21] and pectoralis minor muscle soft tissue mobilization [28]. Finally, manual therapy for the cervical and thoracic spine have increased shoulder ROM, decreased pain [29,30], and increased strength [31]”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5901425/
The above study excerpt that was shared was a pragmatic case study design and cannot determine cause and effect. Randomized controlled trials are the best strategy we have to assess cause and effect and even then we cannot always control for all variables.
I’ll summarize this data in a table and will share it below once it’s completed.
Will frozen shoulder go away on its own without treatment?
A frozen shoulder will improve over time even if you do nothing, however, this is not a good strategy.
Think about it. If you stop using your arm for 18 months, how much weaker do you think it will have gotten? Probably a lot weaker…
Instead, as I’ve detailed above, you should plan to work on implementing range of motion and strength training exercises.
How long does frozen shoulder last?
A frozen shoulder can last up to 18 months. This timeline can potentially be sped up by getting an early injection and by starting physical therapy treatment sooner, rather than later. It’s not guaranteed that these will speed up outcomes, but, it’s been show that it is more effective than the old approach of doing nothing.
When should you receive an injection for frozen shoulder?
As I detailed in this article about injections for frozen shoulder, it is ideal to receive an injection with the first few months of symptom onset.
As the study that I reviewed, showed, pain was significantly decreased in the short term, however range of motion gains were about the same in the long term regardless of whether you received an injection or not.
Receiving proper physical therapy treatment can speed up the healing time and it can also ensure that you return to full function versus, partial.
Key Takeaways
- Frozen shoulder can take 18 months to fully improve
- It does not go away on its own
- A combination of manual therapy, injections, physical therapy, and patient education is the best approach we have, to date for adhesive capsulitis (frozen shoulder)
- According to the article shared from Dr. Christopher Wong et. al, it is possible to improve this condition in some people much faster than 18 months.