Frozen shoulder: Defrosting the myths and providing the best rehabilitation exercises for you

Frozen shoulder is a slowly developing, chronic disease that affects the shoulder joint. The reason it gets its name is at its peak, the shoulder feels frozen, and unable to move beyond 90° or overhead. The most painful and limited movement tends to be external rotation of the shoulder – the twisting of the upper arm away from the body. 

It can be highly painful and make significant impacts on an individual’s function and lifestyle. It is also known in the physiotherapy and medical profession as adhesive capsulitis. This refers to the stickiness or “freezing” of the shoulder joint capsule. The joint capsule is the balloon type structure that surrounds our humerus and glenoid fossa and encloses the ligaments and importantly the joint fluid that allows for lubrication of the joint. The accurate cause of frozen shoulder is unclear, and diagnosis can be confidently confirmed by one of our physiotherapists here at Instinct Health. On some occasions an MRI may be suggested, however with clinical testing true frozen shoulder is easily identifyable. 

There are three key phases of frozen shoulder: 

Stage one: freezing phase – this can be the longest phase of frozen shoulder, lasting anywhere from weeks to 6 months. There is a gradual onset of pain and a slow reduction in movement of the arm. 

Stage two: frozen phase – usually this phase sees a slight reduction in pain, but a lack of movement maintains. This can last up to 6-9 months. 

Stage three: thawing phase – in this phase there is a further reduction in pain and range of movement begins to return. This can again take several months.

The three phases combined are often seen to take beyond 9 months to resolve completely. At the conclusion of the thawing phase, a full and complete level of function can typically be seen. There are several myths out there about frozen shoulder, and we are going debunk some of those before outlining some of the best exercises to complete during the maintenance phase. 

Things that do work for frozen shoulder: 

  • Ongoing physiotherapy for muscle release 
  • Daily range of movement exercises 
  • Daily stretching exercises 
  • Maintenance of the neck, elbow, wrist and hand joints

Things that don’t work for frozen shoulder:

  • Slings or other immobilisation devices
  • Corticosteroid injections
  • Surgery 
  • Ultrasound therapy 
  • Anti-inflammatory drugs 

Given the level of understanding that we all have around frozen shoulder, let’s explore the top three exercises for maintaining shoulder strength and range of movement when experiencing frozen shoulder. 

  1. Four point kneel ball roll: 
    1. Starting on all fours, put the affected arm on a small, firm ball like a miniature basketball or Pilates chi ball
    2. Gently pressing down on the ball, roll the ball as far overhead as possible, or until pain restricts movement 
    3. Without pushing into pain, pause at the top of the movement for 2 seconds, then gradually roll the ball back under the shoulder 
    4. Complete 3 sets of 20 repetitions twice per day 
  2. Broomstick external rotation: 
    1. Standing against a wall with a broom or walking stick in both hands with the palms facing up towards the roof
    2. Keep the backs of both shoulders against the wall and elbows at 90°
    3. Using the unaffected arm for strength, gentle push the stick from side to side taking the hands towards the wall behind you 
    4. Ensure you don’t rotate the chest or shoulders and try to isolate the movement to the shoulders 
    5. Complete 30 repetitions each side and then rest. Complete 3 x per day 
  3. Overhead
    1. Lying on your back holding a moderate-weight dumbbell (5kg or above) 
    2. Hold the elbow and wrist straight
    3. Take the arm as high overhead as possible towards the floor until pain stops you from going any further
    4. Take the arm and the weight back to the starting position and repeat 
    5. Complete 15 repetitions and 4 sets once per day. 

These exercises can be great for those with frozen shoulder, however before completing any exercise program, you should consult one of our physiotherapists at Instinct Health. Frozen shoulder is a slow process that requires patience, however a full recovery can be expected after 6 months. Unlike other shoulder pathologies, frozen shoulder is rare, and the best preventative method is to keep the shoulder active and strong for as long as possible. 

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Frozen shoulder: Defrosting the myths and providing the best rehabilitation exercises for you