Adhesive capsulitis of the shoulder or frozen shoulder, as it’s more commonly known is a painful condition causing significant restriction of movement of the shoulder – hence being described as ‘frozen’. There are a number of theories as to what causes this condition but it is thought that through musculoskeletal issues, postural dysfunction, injury to the shoulder and even systemic diseases such as diabetes and an over-active thyroid can contribute towards this problem. Ultimately the joint capsule of the shoulder is affected with a build up of scar tissue causing the pain and stiffness. Symptoms typically have 3 phases:
- ACUTE Phase one – the ‘freezing’/ painful phase. Can last 2-9 months. The first symptom is usually pain. Stiffness and limitation of movement then also gradually build up. The pain is typically worse at night and when you lie on the affected side. Can affect both shoulders but commonly the non-dominant only.
- SUBACUTE Phase two – the ‘frozen’ / stiff (or adhesive) phase. The pain usually eases but the stiffness and limited movement remains and can get worse. Rotation of the shoulder is most affected and there can be pain at the end ranges of movement. This typically lasts 4-12 months.
- CHRONIC Phase three – the ‘thawing’ / recovery phase. This typically lasts between 1-3 years. The pain and stiffness gradually go and the sufferer less likely to be affected at night but full range of movement is not always regained.
The frustration of this condition apart from the pain and stiffness is that normal everyday activities are disrupted like getting dressed, putting on a seat belt or even reaching behind you. According to Patient.co.uk, about 3% of adults can get this condition affecting people aged 40-65 and more common in women. If you’re suffering from similar symptoms, first thing is to get your GP to have a look at it. You may be referred for a shoulder x-ray or MRI scan. Once diagnosed, what are your treatment options?
- Discussing your options with you GP, they may prescribe painkillers such as paracetamol or anti-inflammatories.
- Physiotherapy – your GP may be able to refer you to an NHS physio who can give you exercises designed to keep the shoulder from stiffening up. If this is your option then it is important to do the exercises as prescribed to get the most from your treatment.
- Steroid injection – this would be put directly into the joint capsule which can help alleviate many of the symptoms but it’s not a cure and the symptoms may gradually come back.
- Surgery – this is an option if other treatments haven’t worked and has a good success rate but not in all cases.
How can massage help?
Seeing a GP and physiotherapist would be the first options to try to get correctly diagnosed and advised on exercises. The treatment of frozen shoulder goes through stages of good progress and then plateaus and the same would be said of trying massage therapy once diagnosis has been achieved. There are a number of muscles in the shoulder joint which may have got tight so the goal of the therapist would be to reduce hypertonicity (tightness) of certain muscles, improve blood circulation to the affected area, try to improve range of movement and treat trigger points, taking care with the positioning of the client on the couch so as not to aggravate the condition. During the acute phase of the condition, very little or gentle passive movement of the shoulder would be applied.
The therapist would also look at treating the unaffected shoulder, neck and chest area as this may be overcompensating for the under-use of the affected shoulder. In the subacute phase, heat can also be applied to the area. The therapist would help the client with their awareness of their posture when doing simple tasks like getting dressed and driving so as not to put the rest of the body under strain. Massage therapy once a week for 4-6 weeks could help alleviate the symptoms of frozen shoulder but the client would need a self-care plan of exercises from a physiotherapist to reduce the symptoms as much as possible.
Sources: Patient.co.uk, Clinical Massage Therapy, 2000 Rattray F. & Ludwig L