Prevention and Curative exercises for Frozen Shoulder

Shoulder pain is a common condition which can arise due to many anomalies, like Rotator cuff injury, Bursitis (sub-deltoid.sub-acromial), Tendinitis, Osteoarthritis, Rheumatoid  arthritis etc. Apart from those reasons referred pain can also be felt at the shoulder area due to the conditions like cervical 4,5,6 nerve root compression, right shoulder pain due to gall bladder problems, left shoulder pain due to heart conditions and problems in thyroid gland, acromio-clavicular, sterno-clavicular joint. Diabetic people are very prone to suffer from shoulder pain. But the most common cause of shoulder pain that can disable you is Frozen Shoulder aka Adhesive Capsulitis. This is a condition in which persisting all day pain with restriction of shoulder joint movement are present together.

What can cause Frozen shoulder ?

If the normal shoulder joint movement reduces due to pain or injury or any chronic disease, then frozen shoulder can arise. The main causes can be categorized as Injury (fall, blow on shoulder, fracture, dislocation), Pain (cervical spondylosis, cervical nerve root compression, hemiplegia, gall bladder and heart problems, O.A, R.A, tendinitis, bursitis) and Chronic disease (hypo/hyperthyroidism, Parkinson’s disease, diabetis).

What is the cure of Frozen shoulder ?

NSAID (paracitamol, diclofinac sodium, ibubrufen) are given and topical application of analgesics are advised to control the pain. If it dose not work then corticosteroid injections can be given. But in extreme case surgery (generally arthoscopy) is the last resort. At in any case Physiotherapy treatment is needed. An experienced physiotherapist can plan a pain relief regiment using electrotherapy (UST, IFT, SWD, LASER), ice and exercise therapy (stretching, mobilization, manipulation). Early physiotherapy intervention can prevent as well as cure completely. The common and specific exercises for frozen shoulder are shown and described with diagrams below.

Exercises for FrozenShoulder

Start shoulder exercise with Codman’s Pendular Exercises. In this the patient bends forward 90^o at waist using table for support and move the arm of the affected shoulder forward and backward (anterior-posterior) for flexion & extension pattern of movement as shown in Fig 1 and outside and inside (medially & laterally) for horizontal abduction-adduction pattern of movement as shown in Fig 2. Now in the same position rotate the affected arm clockwise and anticlockwise as shown in Fig 3 starting with small circle, progressively increasing the radius in each cycle for the circumduction (combine movement of flexion, extension, abduction, adduction) pattern of movement. While moving the affected arm one should consider that the movement should be smooth, continuous and rhythmical; progressively increasing the range. Repeat each movement 10 times.

Fig 1 codman's pendular exercise

Fig 2 codman's pendular exercise

Fig 3 codman's pendular exercise

The above exercises are followed by the wall climbing exercises. The wall climbingexercises should be done by facing the wall, as shown in Fig 4 for flexion pattern of movement and by standing beside the wall, as shown in Fig 5 for abduction pattern of movement. Stand around 2 feet away and touch the wall with keeping your elbow fully extended. Use your fingers to crawl up the wall and move near or away from the wall in order to keep your elbow straight. Try to reach the maximum height on the wall and mark it so you can try and go further next day. Slowly slide your hand back to the starting position and do 10 repetitions for each.

Fig 4 wall climbong exercise Fig 5 

Fig 6 pully exercise

Same exercises (flexion and abduction) are done in a sitting position with a pulley hanging above your head as shown in Fig 6.

Moving to the next level, start shoulder flexion exercise by lying on your back (Fig 7) or standing straight with your back touching the wall (Fig 8). Keeping your elbows straight, clasp your hands together and lift them up and try to touch the bed or the wall as shown in . You can do it for one hand also while the other hand can assist the movement (Fig 9); making the performance better. Do this exercise 10times for 3 sets every day.

Fig 7 shoulder flexion exercise

Fig 8 shoulder flexion exercise

Fig 9 shoulder flexion exercise

Next comes the shoulder extension exercise. You can either do it by standing or sitting, with your hands clasped together behind you. Now slowly take them more backward (Fig 10) as high as possible, hold there for 5 seconds and come back to the starting position. Do this exercise 10 times for 3 sets every day.

Fig 10 shoulder extension exercise

Fig 11 shoulder extension exercise

In the alternative method (Fig 11), you have to lie supine on a bed while your affected hand and shoulder is placed at the edge of the outer side of bed. Now slowly hang your hand down from the shoulder joint at the bed end and try to touch the floor. When you reach the maximum limit,  hold for 5 seconds and take the hand back on the bed. Do this exercise 10 times for 3 sets every day.

External rotation and internal rotation exercises are very important in case of frozen shoulder. In maximum cases external rotation movement of shoulder became restricted and is very painful. Eventually the internal rotation movement also becomes painful and restricted. You can do this exercise while lying flat on your back; keep your affected arm (in this case right) adjacent to your body with elbow flexed at 90^o so that your fingers are facing towards the ceiling. Now gently rotate your arm from the shoulder and take your forearm away from your body so that your fingers pointing the right wall. Maintain this position for 5 seconds and rotate your forearm back to the starting position. Now rotate your arm again to the opposite side in the manner to touch your other shoulder (left) and maintain that position for 5 seconds and come back to the normal (Fig 12). Do this exercise 10 times for 3 sets every day.

Fig 12 External rotation and internal rotation exercises

Fig 13 External rotation and internal rotation exercises

Alternatively, you can do this exercise by standing straight and keeping your hand at the side of your body with the elbow in 90^o flexion. Now gently rotate your arm from the shoulder and take your forearm away from your body and maintain this position for 5 seconds. Now rotate your arm again to the opposite side in the manner to touch your other shoulder, maintain this position for 5 seconds and come back to the starting position (Fig 13 A, B, C).Do this exercise 10 times for 3 sets every day.

You can do the modified elevation/external rotation exercise by lying on your back. Clasp your hands and place them at the back of your head. Bring both the elbows together; maintain this position for 5 seconds and take them to the starting position (Fig 14). Do this exercise 10 times for 3 sets every day.

Fig 14 modified elevation/external rotation exercise

Fig 15 modified elevation/external rotation exercise

Alternatively you can do this exercise in sitting. Interlock your fingers behind the neck. Move your elbows away from each other slowly until the lower arms are parallel to the shoulders (Fig 15). Do this exercise 10times for 3 sets every day.

Bring Modified Internal rotation with your affected hand behind back and cross your spine to the opposite side. Pull the hand upward across the back by using a towel or the contralateral (other) hand. Hold for 10 seconds and bring the hand back to starting position (Fig 16). Repeat 10 times. Do 3 sessions a day. You can do this exercise without using a towel instead, grasp your affected arm with your sound hand at your back (Fig 17). Slowly raise your hands upward touching your spine. You have to stay straight during this total maneuver and rest is same which you do with the towel.

Fig 16 modified internal rotation

fig 17 modified internal rotation

Lastly, the shoulder shrugging exercise which you can perform in sitting on a chair or in standing (Fig 18). Hang both your hands beside your body with shoulder in neutral position. Bring your shoulders up toward your ears gradually and back to starting position. Repeat 10 times. Do 3 sessions a day.

Fig 18 shoulder shrugging exercise