Treatment and management of frozen shoulder

For information on what frozen shoulder is read my blog What is frozen shoulder

Early painful stage - Management / advice
In the earlier stage the limitations are more to do with pain. For instance pain on lying on its at night, or catching pain on reaching movements. This pain can cause a person to "over guard" it or hold the shoulder / arm close to the side and not move it at all. It needs to be remembered here that the shoulder is not injured  
and that although one has to be somewhat more careful than usual with movements at this stage and not deliberately provoke the pain, one will not injure or damage it by using it as normally as possible, as long as the pain is respected and movement not forced.

Treatment in early stage  

These can include pendular (home exercise) and rhythmic harmonic osteopathic techniques, all well within pain free range. These gentle movement approaches can significantly reduce the pain. The aim here however, is not to try and prevent it freezing by forcing moment, but rather support the process.

                                                            Pendular exercise video

  A common mistake at this early stage of frozen shoulder is to try and prevent it freezing by forcing it to move. It is sometimes assumed by both patients and sometimes by practitioners, that if only they can keep it moving, the freezing can be prevented, or worse "if they don,t keep it moving it will freeze up." This will just lead to the early stage be more painful and  lasting longer.

The frozen phase - Management / advice

These two phase or stage in reality blend in to one. People don,t just wake up one day with the pain gone and movement restricted. It is a gradual process where one blends into the other, and therefore treatment and management need to be tailored accordingly.

When to start exercises to restore range and function 

This can start once any night pain is gone, and sharp catching pain on movement is gone. Rehabilitation then can become more active. This can bring the movement range and function back much more quickly than if just left.

Neuromuscular rehabilitation or stretching to improve function

Stretching
 Passive stretching exercises are not very effective in getting the movement back with frozen shoulder, though still widely used. Even if some extra movement is is achieved through stretching, if there is poor neuromuscular control of this extra range, it is usually quickly lost again.

Neuromuscular rehabilitation
It is much more effective to exercise in terms of "goal orientated movements" that are "active" and task based functional movements, than passive stretching.

  For example, rather than thinking about "lifting the arm" as an exercise the person will aim to "reach to grab or touch an object" This gives an "external focus" as rather than "internal focus". The reason for this is muscle recruitment is organized around external focus.