Exercises For Frozen Shoulder Treatment

Some of the best exercises for frozen shoulder treatment actually involve two people, you and a partner. These do not involve the other person "yanking" or "cranking" on your arm (which is a no no) so try to be in a relaxed state when following these suggestions. Moist heat also helps just prior to beginning these exercises. As always, it is recommended that any exercise is done under the guide of your physician or physical therapist, therefore you are on your own if attempting these without the above:

• Lie supine (on your back) and have your partner (standing) hold onto your wrist with your arm extended fully at the elbow and your shoulder at about 45-60 degrees. Your partner then will gently shake your arm, almost at a vibrating pace, for 30 seconds to a minute. This helps to relax tense and guarded muscles.
• Have your partner then gently pull your arm (while you relax) first straight down towards the direction of your toes. Hold this for about 20-30 seconds. Next, have them pull out to your side and hold the same amount of time. After that, have them pull in an upward direction and hold 30 seconds. Repeat this sequence 3-4 times before moving on to the next exercise.
• While lying on your back, have your partner stand facing towards the direction of your head. Your shoulder should be at about 45 degrees away from your body with your elbow bent at 90 degrees. Your hand should be pointing towards the ceiling if possible. They should then support your elbow underneath with the hand closest to your body and hold your wrist with the other hand. While relaxed, have them gently push your hand backwards toward your head until a mild stretch is felt. Hold this stretch at least 30 seconds then relax. Repeat several times.

The above frozen shoulder rehab exercises are great preliminary warm-ups for further stretching on your own. For maximum effectiveness, these should be done 3-4 times per day if possible, particularly if you are in the "freezing" stage of a frozen shoulder.

Frozen Shoulder Trigger Points

Trigger points are painful areas of hypersensitivity with muscle tissue. They often accompany a frozen shoulder and make the condition even more painful than it already is. These trigger points go through flare-up phases and can feel like your neck muscles or muscles of the upper back are tied in knots. There is relief for those trigger points - namely "trigger point massage". This involves using a hard, knobby instrument or one's knuckles to apply deep tissue pressure over the hypersensitive area. This will "release" the trigger point if done with enough force over time. Most people do not have the strength or endurance to perform this type of massage on another. The answer to this problem is the "knobber" which is a commercially available product designed to take the effort out of giving a trigger point massage. An excellent trigger point massage can be performed independently with a "Theracane". This ingenious device is shaped like a candy cane with knobby projections coming out from the side. This in conjunction with frozen shoulder exercise can make life much more bearable during a frozen shoulder.

A theracane is described and can be purchased at Frozen Shoulder Therapy on Squidoo.com

Physical Therapy Or Surgery - Which Is Best For A Frozen Shoulder?

You may have gotten the bad news from your doctor - "You have a frozen shoulder". Worse yet, he or she may have told you the terrible statistics regarding this condition: A frozen shoulder can take up to 2-3 years to heal on it's own. Now that's awful news or good news depending on which side of the coin you are viewing. On one hand 2-3 years suffering through a stiff and painful shoulder sounds like pure hell. On the other hand at least there's hope that your condition will improve and may not be permanent.

Personally, I don't like the sound of living with gut wrenching pain every time I try to reach to open a door or get a glass out of my kitchen cabinet. I want pain relief now, not 24-36 months from now. Your doctor may even suggest surgery or physical therapy. But which is best?

Surgery for a frozen shoulder involves arthroscopic methods which are supposed to release the tiny adhesions that have formed between the joint capsule and rotator cuff tendons. Anytime surgery is done anywhere on the body there is risk for infection. Therefore the risk may significantly outweigh to potential benefit, particularly if your immune system is down for any reason. Also if you are diabetic then you can look forward to slow healing times.

Another type of "surgery" that may be suggested is not really surgery at all. I'm speaking of manipulation under anesthesia. While the risk for infection is not present, you still have all of the risks associated with being put under anesthesia, including death. The risk of death, however small, is never an option to me, that is unless the pain is so bad that death would be a welcome option.

Physical therapy for frozen shoulder involves performing specific exercises at frequent intervals to increase shoulder range of motion (ROM). Increasing range of motion will lessen the pain and stiffness as adhesions are released. Physical therapy also involves joint mobilization by a trained therapist which loosens the joint capsule allowing for greater ROM. Your therapist may also introduce modalities such as ultrasound (typically used for focused deep heat), electrical stimulation (for short-term pain relief), and massage (relaxes spasms and tight muscles). Physical therapy, if performed in a structured program designed for this condition, can significantly reduce the chance of permanent dysfunction and can hasten recovery.

So when faced with the decision between physical therapy or surgery to treat a frozen shoulder, in my opinion, physical therapy wins hands down. It's simple - the benefits outweigh the risks. However even the best exercise can be risky without a proper diagnosis, therefore consult with your doctor before beginning any program or treatment for a frozen shoulder.

Top Frozen Shoulder Remedies

After suffering through the pain and debility of a frozen shoulder back in 1998, I finally realized what my physical therapy patients had been talking about. Not that I wasn't listening, but I mean I finally understood their desperate cries and the reasons they sought relief in the form of home frozen shoulder remedies. With this type of pain an individual will try most anything, including the absurd, to find a relief from this type of pain. Now I still stand firm on the fact that a good, organized physical therapy program is the best frozen shoulder treatment -- this based on the outcomes I see with most of my patients. However, not all patients subscribe to diligently following a program of exercise and stretching, but those that do will eventually break the cycle of pain and debility.

Frozen shoulder remedies have their place, though, despite their strangeness at times. Therefore I will list below the top frozen shoulder remedies as told to me over the years. Remember that some of these are anecdotal and anyone following them without advice from a doctor is doing so at their own risk -- the risk of increasing pain, dysfunction, or the risk of the remedy providing nothing in the way of relief.

1. Mustard Poultice -- This one is still used, mostly by the elderly. It consist of mustard powder mixed with water to form a paste. This paste is wrapped in cheesecloth or muslin cloth and applied to the affected area then covered with plastic wrap.
2. TENS unit -- These units are small portable electrical stimulation units which provide a current to the involved area. They have been widely used in physical therapy and by chiropractors as an adjunct to frozen shoulder treatment. They are really a "coping mechanism" meant to help the patient "tune out" the shoulder pain by irritating the skin. This works by bombarding the sensory nerves with electrical stimulations which override the nerves that signal pain to the brain (simply put). They are NOT the cure for a frozen shoulder.
3. Epsom salt bath -- The warm water does more for relief than the salts do. The idea is that the salts some how "draw" out the toxins that cause pain.
   
4. Auto part lubricant -- I'll avoid using the trademark name of this one, but it won't be hard to guess. Starts with a "W" and ends with a number. This remedy is more of a skin irritant and does nothing to heal a frozen shoulder.
   

These are the top remedies I hear of from some of my patients. I typically do not argue with anyone believing that they help (TENS actually does help with muscle spasm), but rather point out to the patient that there are other solutions that provide more lasting relief. Besides, who am I to argue that something does not work if it does work in the patient's mind (placebo effect).

Frozen Shoulder Therapy Massage

Will Massage Help My Frozen Shoulder?

The benefits of massage in frozen shoulder therapy are numerous. Besides just "feeling good" a massage calls in to play the release of pain inhibitors which can often sustain relief hours after receiving the massage. The type of massage most effective is "trigger point" massage and can be viewed in this video.

Trigger point massage involves applying pressure to particularly painful areas in the rotator cuff which contribute to stiffness and soreness when attempting to move the affected shoulder. Although a trained massage therapist is most effective in determining these trigger points, anyone can apply the massage and find these areas through feedback from the sufferer of the frozen shoulder.

Before beginning the massage it's best to apply moist heat for approximately 10 minutes to the affected shoulder. When applying the massage use a scent-free massage lotion or cream to reduce friction.

It's best to start with the person lying on their side with a pillow under their affected arm. The person applying the massage should start with "stroking" the affected arm. This induces relaxtion initially which is "key" to maximizing the effects of the massage. Next, gradual increasing pressure should be applied in a circular fashion to the back and side of the shoulder, taking note of painful trigger point areas as the patient responds.

Once a trigger point is found, the area should be worked on for 2-3 minutes before moving on to the next area. After completing massage to the shoulder for about 15-20 minutes, the patient should be left to lie in a relaxed position for another 5 minutes before getting up.

More information regarding frozen shoulder exercise and treatment can be found at http://www.squidoo.com/Melt_Frozen_Shoulder

Frozen Shoulder Manipulation

If you've gotten to the point where you feel a frozen shoulder manipulation is your only course of action, then there are some points to consider:

• If you have not yet reached the "frozen" stage of Adhesive Capsulitis within a full year your doctor may recommend a manipulation under anesthesia.
• There is a 70-75% success rate (success defined as any improvement in ROM, not necessarily function)
• This success rate is less likely with diabetics
• There is a small but still present risk of sustaining a fracture during the procedure (best research shows this as small as 2%)
• Most manipulations are done as outpatient and you will need someone to drive you home after the procedure
• There is to be an expected increase in pain for several days following a frozen shoulder manipulation. This is due to soft tissue trauma, increased swelling, and induced inflammation in the shoulder due to the procedure causing micro tears in the joint capsule
• Physical Therapy or frozen shoulder exercise is generally prescribed for 3-4 months following a manipulation
• There is risk of infection following injection into the shoulder joint

Obviously a manipulation should be a last resort and preferably should be considered only after a second opinion. Once the manipulation is performed, physical therapy should be initiated as early as day 1 following the procedure as the shoulder joint will stiffen up quickly and render the procedure useless if early movement is not performed.

The best course of action is always a conservative approach using frozen shoulder exercise versus a frozen shoulder manipulation. There are many treatment programs specific to treating a frozen shoulder which are effective in returning functional range of motion and reducing pain.

Topical Rubs Can Give Frozen Shoulder Pain Relief

While it's true that topical rubs such as Icy Hot, Biofreeze, etc... only provide short-term relief for frozen shoulder pain sufferers, they do have their place in the treatment of adhesive capsulitis, provided the patient has a targeted program and only uses it as an adjunct to treatment.

These or similar rubs work basically by irritating the skin, giving the recipient a warming sensation. This warming sensation is then translated by the brain into pain relief. This is known as the "pain gate" phenomenon and basically means that certain pain pathways in the peripheral nervous system can only process a certain amount of pain signals at any given time. After that, the "gate" is shut off to further pain signals in that pathway.

Think of it this way, if you have a headache and someone suddenly stomps on your toe, your headache is suddenly gone and the focus of pain is now on your freshly stomped toe. Same thing with topical rubs: Shoulder pain present? Rub in Biofreeze... ointment irritates the skin and therefore pushing a large amount of "irritant" pain signals to the brain, overriding the shoulder pain signals, and subsequently PAIN RELIEF!

Now there are certain rubs that are more effective at generating the amount of "heat" than others. A little research and experimentation will help you decide although I have found Biofreeze to be very effective for patients.

Even the best frozen shoulder exercise programs needs a boost, and often the answer can be found in the wide variety of ointments available on the market today. Don't fall for pitches that state a particular product "goes deeper" than another product, as this simply isn't true. NO topical ointment can penetrate past the dermal layers into the muscle, and thank GOD for this because then you're talking some SERIOUS pain. Therefore do not consider a higher cost product necessarily more effective.

Frozen Shoulder Pain Relief - How Long Does It Take?

I hate to sound wishy washy, but the length of time to get frozen shoulder pain relief depends upon a number of factors, even with a good frozen shoulder program. As much as I would like to give a general "catch all" answer but it honestly would be misleading. Therefore I will try to break it (pain relief time it takes) down:
(The following assumes the person is in stage II freezing stage -- These are my statistics based on clinical treatment, NOT nationwide or CDC statistics.

• If you are greater than age 45 (most frozen shoulder sufferers are) then you are in the "takes longer" category. Here, generally in my experience, relief comes in spurts with consistent exercise but I have typically seen significant progress with range of motion in about 3-4 weeks. If you are attending therapy 2-3 times per week with a trained manual therapist who is performing joint mobilization then this time frame is less. Remember, you must gain range of motion before you will have any lasting pain relief.
  
• If you are diabetic then you also fall into the above category. This is just a fact for just about anything healthwise diabetics go through. Here, the diabetic patient, in addition to consistent exercise, joint mobilization, and stretching, must pay strict attention to his/her diet. If you are able to do cardiovascular exercise, then this will help as well. A good cardio program, believe it or not, will help significantly. This has to do with oxygen exchange and bloodflow without getting too complicated. For diabetics - 6-10 weeks for significant range of motion gains. Pain relief will follow.
• If you are less than 35 years of age you also fall into the above category. This has nothing to do with physiological factors, but rather is an issue of compliance -- This age group typically has kids, a full time job on the upward career path, busier schedule, etc... and therefore will devote less time to consistent exercise.
• If this is your second or more frozen shoulder then you typically will get over it quicker. This has to do with previous knowledge and earlier recognition and initiation of treatment.
• The group that I see with the quickest recovery is female and 35-45. By contrast I see less patients in this category. I have actually treated individuals in this group and seen significant gains in ROM within 2 weeks!
• Sufferers of frozen shoulder pain in the age group 70+ take the longest and also have less favorable outcomes. There are various reasons for this, but one has to assume that some of it has to do with compliance, bone structure/posture, and possibly pain tolerance.

Is My Shoulder Frozen?

As a physical therapist I'm often asked how to tell if someone's shoulder pain and stiffness means they are getting (or have) a frozen shoulder. A frozen shoulder (or Adhesive Capsulitis) is a specific condition typically involving adhesions which form around the joint capsule. The joint capsule is simply a fibrous structure encasing shoulder joint.

This capsule can shrink with disuse of the shoulder, such as after long term immobilization after a fracture (called adaptive shortening) causing increased stiffness and pain with range of motion. This is not a true presentation of primary frozen shoulder. Primary frozen shoulder seems to appear without cause or warning, often presenting as painful shoulder motion at first, then progressing to increased stiffness.

The treatment of these two presentations differ (at least they should), because the type of exercise used for treating a primary frozen shoulder is different than treating simple adaptive shortening. In primary frozen shoulder the first motion lost is external rotation (reach back and touch the palm of your hand to the back of your head), followed by loss of abduction (raising your arm out to the side), then flexion (forward elevation of the arm overhead), and finally internal rotation (reach behind your back as if fastening a bra (or threading your belt if you're a male).

In addition, a primary frozen shoulder will be painful at night without movement of the arm/shoulder. In contrast, adaptive shortening does not follow this pattern of loss of motion as any direction can be stiff/painful. Also with adaptive shortening the shoulder does not typically hurt at rest.

So if or a love on is asking "Is my shoulder frozen" the you can follow the above descriptions to better decide which condition you may have. In any case you should get a formal diagnosis from a physician and seek treatment from qualified professionals. It's important to get specific treatment for frozen shoulder syndrome as the wrong exercise can actually delay healing and prolong symptoms.

An excellent program for treating frozen shoulder is designed by a physical therapist and covers specific exercises and the best frozen shoulder exercise strategies for this painful condition.

frozen shoulder cure?

As a physical therapist I'm often asked if injections "cure" a frozen shoulder. I almost always begin by saying "no" and then proceed to tell the patient that an injection (typically and anti-inflammatory agent) MAY give some temporary relief, but is not the answer to their stiffness and pain.

In fact, an injection with a corticosteriod, if given multiple times, can cause way more problems than it solves. Repeat steroid injections can weaken tissues and bone and may actually put the recipient at further risk.

Now if the pain is unbearable I'm not totally against this type of injection, but would rather educate the patient on the benefits of specific frozen shoulder exercise and treatment to reduce the amount of pain and stiffness.

You see, when a frozen shoulder develops the first thing a patient does is stop moving the shoulder as much. This causes "adaptive shortening" of the joint capsule surrounding the crucial rotator cuff. When this happens the cuff muscles do not have enough "room" to perform their function and end up getting iritated due to friction againt the capsule wall.

Guess what happens then? MORE pain and stiffness. The best solution to relieving frozen shoulder pain is with a specifically targeted exercise program designed by a healthcare professional that has experience in this area. The gradual stretching of capsular tissue and release of adhesions is the true "cure" for a frozen shoulder.

Supercharge Your Frozen Shoulder Exercise

Most frozen shoulder exercise programs are performed in routines 3 times a day. However if the patient is not getting sufficient ROM gains then I would recommend a different attack. Try 8-10 times a day, however with significantly shorter exercise sessions. This allows the shoulder not to tighten up between exercises and often makes the exercise less painful and with less soreness afterwards. Always remember to warm the shoulder with moist heat prior to each session and ice after each session, particularly if you are prone to inflammation. The heat should be applied for approximately 20 minutes for maximum heat depth with a temperature that is very warm but of course not enough to burn the skin. Ice on the other hand should be applied for 15 minutes at a time. Gel packs are ideal as they conform to the shoulder nicely. Completely rest the shoulder in between these frequent but short sessions. The best frozen shoulder exercise will not do any good if not performed correctly.
For more information on excellent programs visit my web page on reviews of frozen shoulder exercise programs

Frozen Shoulder Treament After Cuff Surgery

This particular patient has developed a frozen shoulder (secondary) 4 weeks after undergoing cuff surgery. She came to physical therapy 1 week after her surgery and did well to begin with. I've discovered her main problem to be her exercise frequency as she is inconsistent. I was able to perform P/A glides with her and gained 20 or so degrees today. I reviewed her posture (very important) and her exercise frequency - focused on performing stretches in 10 (yes 10) brief sessions over the next few days. Believe it or not I find this type of frequency with my patients to be very helpful. She understands there is no frozen shoulder "cure" and that consistency is key in getting return of function. Here's hoping this session was successful! Also reviewed the most efficient frozen shoulder exercise.