Frozen shoulder has several causes, including sports injuries (such as rotator cuff tears), and overuse injuries from occasional activities (such as gardening, painting, or pulling suitcases from the conveyor belt at the airport). Frozen shoulder is something of a catch-all term, rather than a specific diagnosis.
Tension is one of the worst offenders when it comes to frozen shoulder. If you have minor injuries and you are a tense person, a frozen shoulder can develop. I know of people who developed frozen shoulders before an important job interview. So one can't say that this problem is purely mechanical; there is often a psychological component involved.
Too much of an activity that you don't do every day, such as gardening or painting, can cause a frozen shoulder; it's the body's defense mechanism against overuse. Tendinitis or bursitis can be underlying causes as well. Frozen shoulder is often misdiagnosed as a pinched nerve, but imaging tests will be negative.
Frozen shoulder is one of the few injuries for which a heating pad can provide some relief. The best time to use a heating pad is immediately before doing exercises: 20 minutes of gentle heat can increase muscle movement by 15%–20%. That can make the difference between the patient being able to move the shoulder a little, or not at all.
Let's look at some exercises that can restore mobility to a frozen shoulder. (See illustrations and instructions below, which you can photocopy for your patients.)
Patients often don't seek help until they have lost substantial mobility in the shoulder. Emphasize that if they are diligent about doing their exercises 3–4 times daily for at least 4–6 weeks, they will probably see progress. For best results and motivation, patients should have a therapist assist with the exercises for the first few weeks.
Patients must loosen the adhesions that have formed in the sleevelike capsule that covers the shoulder joint (a condition called adhesive capsulitis), and exercises are the best way to do this. Encourage patients to go to the point of pain when stretching the shoulder, and remind them to breathe normally during the exercises and to relax completely between sets.
To prevent recurrence of frozen shoulder, patients should revisit the exercises periodically, even after returning to normal activities. Once the patient returns to daily activities, the movement associated with these activities should help keep the problem at bay. However, patients should be aware of what might trigger a relapse, such as carrying or pulling heavy objects.
Next month: Exercises to relieve the pain of sciatica.
Exercises for a Frozen Shoulder
Shoulder flexion, vertical. Either sit in a straight-backed chair or lie on a mat with knees bent and feet flat on the floor. Cradle the injured arm with the opposite hand. Slowly raise both arms above your head as far as possible. Allow your uninjured arm to do most of the lifting. Do not move past the point of pain. Hold your arms in the overhead position for 5 seconds. Relax. Repeat 6 times.
Shoulder flexion, horizontal. Sit in a straight-backed chair with feet flat on the floor. Cradle the injured arm with your opposite hand. Use the uninjured arm to slowly push the injured arm toward the injured side. Do not lift the arms upward; simply move them sideways in the direction of the injured arm. Hold for 5 seconds. Relax. Repeat 6 times.
Trapezius/rhomboid stretch. Sit in a straight-backed chair with feet on the floor. Place your fingertips on your shoulders, with right fingertips on the right shoulder and left fingertips on the left shoulder. Keep your hands in place, and try to touch your elbows together in front of your chin, at approximately shoulder height. Hold for 5 seconds. Relax. Repeat 6 times.
Trapezius stretch with towel. Sit in a straight-backed chair with feet flat on the floor. Hold a rolled-up towel behind your neck with your elbows bent, and hold one end of the towel in each hand. Slowly straighten your uninjured arm, which will pull the injured arm up. Try to point the elbow of the frozen arm toward the ceiling until you feel pain. Stop pulling and hold for 5 seconds. Relax. Repeat 6 times.