Physiotherapy Management for Frozen Shoulder

Frozen shoulder also known as Adhesive capsulitis is a painful persistent stiffness of the shoulder joint that makes it difficult to carry out the full range of motion of normal shoulder movements. Frozen shoulder occurs when the flexible tissue that surrounds the shoulder joint, known as the capsule, becomes inflamed and thickened. The exact cause is not fully understood and it cannot always be identified. However, most people with frozen shoulder have experienced immobility as a result of recent injury or fracture. It is also common in people with Diabetes.
Frozen shoulder can resolve on its own without treatment, however the pain and stiffness can remain for months or years. Physiotherapy, along with medication, plays a vital role in managing pain and stiffness and helping you return to your normal daily activities.

Physiotherapy management for this condition would include Electrotherapy ( Ultrasound, IFT, electrical stimulation), Hot fomentation, Cryotherapy, Manual Therapy (Mobilisation, Myofascial Release techniques), Exercises and Stretching.

The use of modalities such as Ultrasound, IFTor TENS can help to reduce the pain. Ultrasound is a good rehab method for frozen shoulder that uses sound waves to treat pain, inflammations and muscle spasms. IFT or Interferential Therapy has been known to deliver a continuous stimulation deep into the affected tissue. The stimulation both blocks pain and reduces swelling and inflammation at the shoulder.

Hot fomentation/Cryotherapy:
Hot or cold therapy helps to reduce pain, stiffness, swelling etc. Discuss your symptoms with your physiotherapist and based on their assessment, your physio will advise you on the use of hot/cold packs.

Manual therapy:
Within Manual therapy, Mulligan’s Mobilisation and Maitland’s technique for joint mobilisation are widely used and have shown good results for the rehabilitation of frozen shoulder. Your Physio will use highly skilled hand techniques to mobilise the shoulder joint and the surrounding tissues. Myofascial Release techniques will help to stretch and release tight muscles thus reducing pain and stiffness.

As mentioned earlier, the capsule around the shoulder joint tends to get thickened in frozen shoulder and hence it is important to stretch the capsule in order to allow the shoulder to move through its range of motion. Your physio will passively stretch the capsule for you during your therapy sessions and also teach you self stretching techniques for you to do at home.

Most stiff shoulders can be managed successfully by a simple exercise programme. It is basically a question of gently and progressively getting the shoulder moving again. The basic aim of the exercises are:
1. To reduce pain
2. To increase extensibility of the thickened and contracted capsule
3. To improve mobility of the shoulder
4. To improve the strength of the muscles.
Your physiotherapist will guide and supervise you through your exercise programme as well as give you a home exercise programme.

If you are suffering from a painful stiff shoulder, kindly contact us at HealthQuest for an assessment and consultation. We would be very happy for the opportunity to help you manage your frozen shoulder.

Chronic Pain Management

By Dr.VenuKulkarni(PT)

Pain touches us all. Generally, we experience pain as a result of an injury or illness, post surgery or due to poor posture. In most cases, this pain subsides or goes away completely after recovering from that particular episode. Sometimes, however, this pain persists for months or years post recovery. This type of longstanding or Chronic Pain often leads to secondary complications such as limitations with movement which cause muscle and joint stiffness and reduced flexibility, strength and stamina. Chronic Pain is also often accompanied by fatigue, sleep disturbances, moodand behavioural changes- it has an impact on the physical, mental and social aspects of day to day functions.

Management of Chronic Pain

The complex presentation of Chronic Pain requires healthcare professionals to have a holistic outlook towards its management. Psychological interventions along with medical management, Physiotherapy and Occupational Therapy increase the effectiveness of the treatment. Involvement of the patient and their family/friends in this process has proved to be beneficial in understanding and coping with Chronic Pain.

There are a number of effective strategies for managing chronic pain. However, you must ensure you consult specialised clinicians such as psychologists, physiotherapists and occupational therapists to help you with this process. These techniques usually include:

  1. Relaxation:

Relaxation calms the mind and recharges the body. It is particularly important for people who live with pain. Pain increases muscle tension which in turn creates more pain. When muscles are tense, they tighten and increase pressure on our nerves and other tissues and our pain sites. Relaxation can help break this pain-tension cycle.

Some forms of relaxation include-

  • Deep breathing
  • Progressive Deep Muscle Relaxation
  • Visualisation
  1. Physiotherapy:

This involves a range of therapies designed to reduce pain and promote and improve movement.

  • Exercise: An active exercise programme is needed for people living with chronic pain. It should be specifically designed for you by specialised physiotherapists. A stretching and strengthening programme can help build fitness and flexibility which helps people better cope with persistent pain. Emphasis is given on beginning to move with gentle and ‘safe’ movements in order to reduce anxiety and fear associated with movement and pain.
  • TENS: TENS or Transcutaneous Electrical Nerve Conduction has been used to control acute and chronic pain in a wide variety of cases. These include all kinds of musculoskeletal problems such as back and neck injuries as well as conditions such as osteoarthritis. Studies show TENS to be effective in reducing pain among 20-40% of patients treated for chronic pain conditions.
  1. Mindfulness

Mindfulness meditation is thought to work by refocusing the mind on the present and increasing awareness of one’s external surroundings and inner sensations allowing the individual to step back and reframe experiences. Mindfulness meditation has been shown in clinical trials to reduce chronic pain by 57%. Accomplished meditators can reduce it by over 90%. A typical meditation involves focusing on different parts of the body’s and simply observing with the mind’s eye what you find. It can also involve focusing on your breathing as the breath goes in and out of your body.

These strategies along with some other methods and guidance have been effective in helping manage their pain better. At HealthQuest, we offer advice and management strategies for coping with all aspects of Chronic Pain. If you think you suffer from longstanding or chronic pain and require help to get started with learning to cope with it, please contact us at HealthQuest for an assessment on 8554990486.