Looking For A Frozen Shoulder Cure? Start Here

I'm very familiar with the pain and dysfunction caused by adhesive capsulitis and the desparation to find a frozen shoulder cure. In fact in 1998 after rotator cuff surgery I developed this condition despite practicing as a physical therapist. I was about one year out from getting my license and this was the last thing I expected to develop. This actually turned out to be a good thing as it has allowed me to "connect" with my patients who have this diagnosis. It also has motivated me to discover what works and what doesn't by trying various treatments and techniques on myself.

Frozen shoulder syndrome or FSS is a condition marked by stages of progressive pain and stiffness in the shoulder which can take months or even years to recover. A cure implies a short course of treatment or single intervention which would eliminate the physiological process of frozen shoulder syndrome or "adhesive capsulitis". A "cure" would also imply an immediate halt to the progression of the stages of FSS. None of the current treatments available for frozen shoulder have met the above criteria, although in my experience a well planned and developed program can hasten the end results a person with this condition desires, that is, return of normal and pain free range of motion. Therefore the term "cure" for the purpose of this article refers to reduction of pain and return of function.

Studies have shown while there is no one single "frozen shoulder cure", there are treatments available to reduce pain and speed return of function when otherwise just resting the affected limb will do little to no good.

WHERE TO BEGIN?

* Start with an accurate diagnosis by a qualified physician, preferably one who specializes in treatments of frozen shoulder or conditions of the upper extremity

* Educate yourself about this condition and try to determine what stage you are in. Education is key in helping you maintain the motivation to continue and to choose the right program or treatment

* Choose programs that are multi-faceted in approach and treat both the painful symptoms and return of function

* Good programs are ones designed by a licensed professional and provide follow up support or answers to your questions

An accurate diagnosis prevents unnecessary treatments, wasted time and carries with it the benefit of finally knowing why your shoulder hurts. I have seen numerous clients who self-diagnosed a frozen shoulder, put themselves through unnecessary injections and exercise only to find that the problem was coming from the neck (yes, you can have pain in the shoulder which is coming from a compressed nerve in the neck).

Education begins by asking questions. Never take your doctor's word or anyone's word for that matter as the "gospel" without probing a little further and asking what that strange word the doctor said means, and/or why you are getting the treatment you are getting. If you are seeing a doctor you are unfamiliar with, it doesn't hurt to as what his/her medical specialty is (if it's not obvious). In these days of Medicare cuts and changes the specialists are starting to branch out and see more diagnoses outside their specialty. If you decide to educate yourself via the internet, make sure you are familiar with the medical terminology within your diagnosis or otherwise your frozen shoulder "cure" you find on the web can turn out to be harmful or ineffective.

Frozen-Shoulder-Help.Info is the closest thing to a "frozen shoulder cure" available. This is a comprehensive program specifically designed for this condition and focuses on returning function and reducing pain. "What Is A Frozen Shoulder Cure" originally posted on EzineArticles by this author.

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.

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.

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