Managing a Frozen Shoulder

Frozen shoulder is exactly what it sounds like – a gradual freezing of the joint where movement becomes stiff and painful. Also known as adhesive capsulitis, the connective tissue capsule around your shoulder thickens gradually, for reasons that are not entirely clear. In Chinese frozen shoulder is called “50 year old woman shoulder”, an accurate description of the typical frozen shoulder patient. Diabetics and people with thyroid imbalances are also at a higher risk, suggesting changing hormones as a contributing factor. It can also develop after surgery or injuries where the joint is immobile for prolonged periods of time. 

A body surfing mishap was the beginning of my frozen shoulder journey. I felt a sharp twinge in my shoulder after being dumped by a wave. The pain disappeared quickly and I thought no more of it. Gradually over the next few months things became increasingly restricted. Some yoga postures were difficult or impossible; reaching to the passenger seat of the car caused jolting pains; sleep was disrupted and uncomfortable.  Things progressively worsened despite treatment and my best efforts to keep my shoulder mobile. Yoga is a distant memory.  

In all honesty I hadn’t paid much attention to frozen shoulder as a practitioner. I mainly work in hormones and digestive health and don’t see a lot of musculoskeletal issues in clinic. That was, until I developed my own frozen shoulder! The chronic pain and discomfort have been at times unbearable, but have also given me a new insight and empathy into life with a painful health problem. In this article I share my own experiences for managing this frustrating condition. 

Frozen shoulder is self-limiting, meaning that even without any treatment, it will improve naturally on its own. That period of time can be anywhere from 6 months to 2 years – a long and frustrating time. There are a range of treatment options but research on their impacts on long term disease progression is mixed.  The main goal of treatment is to manage the pain and limit the impact on your daily life. 

Frozen shoulder develops broadly in 3 phases –

Freezing Stage

A frozen shoulder commonly starts from an innocuous injury, gradually increasing in stiffness and discomfort over a period of many months. It is also possible that the thickening process was already happening, and that the injury was the first time it made itself apparent. In the freezing stage mobility in the joint will become more restricted. There may be increasing pain, particularly at night. 

Frozen Stage 

In the frozen stage, the shoulder joint is very stiff. You won’t be able to move your arm much, and nor will someone else. It may be less painful than the previous stage. 

Thawing Stage

For reasons unknown the thickened tissue in the shoulder begins to soften and release, and movement gradually returns. 

My tips for dealing with a frozen shoulder –

Get a diagnosis

Shoulders are complex and your pain might be caused by a number of different problems. Your GP, physiotherapist or osteopath can organise imaging of your shoulder to rule out rotator cuff injury, bursitis and osteoarthritis. Having a definitive diagnosis can help with treatment options and a realistic prognosis.

Keep moving

It’s tempting to stop doing everything, but keeping the affected joint and the rest of your body moving is really important.  Walking, body weight exercises of the lower body and pilates are all possible. As well as the stiffening of the joint capsule, the surrounding muscles and structures become tense and tight to protect the joint. This guarding can also cause pain, and further limit your mobility. Small group or one on one guidance is best to prevent further damage and ensure you’re moving in the right ways. Massage, pilates, physio and soft tissue release with a tennis ball can help ease tight muscles. 

Try these pain relief techniques

When you’ve been in chronic pain, your brain can become rewired to become more sensitive to pain signals, and can even start registering pain that isn’t there. Techniques such as mindfulness, deep breathing and relaxation are helpful for dulling the pain signals your brain is sending. Acupuncture and heat are also helpful for pain management. By trying to focus on the times when I’m not in pain, I am strengthening and desensitising the “no pain” brain pathways. 

Structural vs Functional Freezing

Frozen shoulder happens when the structures of the joint are altered, causing pain and limiting your mobility. Over time, your body and brain develops patterns of movement to compensate for the damage. A very small surgical study showed significant increases in range of motion under general anaesthetic, suggesting that tension and guarding of the surrounding muscles was causing the freezing, not a thickening of the capsule.  Non surgical therapies can’t do much to change your shoulder capsule, but they can help by relieving some of the associated muscle tension, depending on your level of structural change.  

What treatments have been helpful?

I have been having regular physio, acupuncture and pilates, as well as seeing my gp and a medical specialist. The physio has given me exercises to help maintain what mobility I do have, and to gradually extend my range of motion as I get back to normal. Pilates too is essential for maintaining strength, and the targeted exercises help to minimise guarding and dysfunction by waking up supportive muscles and changing patterns of movement. Acupuncture has been helpful for the pain, but regular treatment is needed for ongoing benefits. 

After 6 months of managing my frozen shoulder I’ve just had a hydrodiltation. Hydrodilitation involves the injection of saline and steroids into the joint capsule, to both decrease inflammation and aid in breaking down the thickened capsule. The procedure itself was painless and the only real side-effect was a short period of strange squelching in my shoulder.  Six weeks post procedure I am in less pain, but have not regained any mobility. Many daily life tasks are beyond me and I’m working to accept that it may be a long time before I can put on my own bra again! 

Frozen shoulder is a frustrating diagnosis. There is an incomplete understanding of the processes underlying its development, and options for curative treatment are limited. My current management strategy is to utilise all the therapies that I find helpful to minimise the pain, whilst accepting that none on their own will be the fix. Knowing that in time it will slowly heal itself gives me reassurance that I will get back to yoga class, eventually.