Frozen Shoulder
Summary
Frozen shoulder, also known as adhesive capsulitis, is a myofascial condition that affects the shoulder joint capsule. The bones, ligaments and tendons are all wrapped in dense connective tissue known as fascia. When the fascia gets too thick or dense, frozen shoulder symptoms can start to appear. Symptoms include joint stiffness and pain. These symptoms start small but will increase over time until the joint starts to feel “frozen” in place. The symptoms come in three stages.
Stage 1: Freezing Stage – any movement becomes painful, your body will start to reduce the range of motion to protect the joint capsule. Pain may increase at night and even disrupt sleep.
Stage 2: Frozen Stage – pain diminishes in this stage due to the joint stiffening up. Strength and mobility decrease or become stagnant.
Stage 3: Thawing stage – range of motion in shoulder begins to improve. Thawing can happen over time but is most effective when aided by physiotherapy to break up adhesive tissue and free the fascia that is binding up the joint. Range of motion may be limited even after thawing.

Cause
Though doctors can’t pinpoint the exact cause of frozen shoulder, they have noticed some common risk factors that can be potential contributors to frozen shoulder. Risk factors include but are not limited to age, sex, immobility and some systemic diseases.
- Age: people over the age of 40 are more at risk
- Sex: women are more likely to develop frozen shoulder than men
- Immobility: lack of use from injury or trauma can cause tissue build up and even muscle atrophy in the shoulder
- Systemic diseases: Patients with diabetes, hypothyroidism, hyperthyroidism, cardiovascular conditions, tuberculosis and parkinson’s have a higher chance of developing frozen shoulder.
Effects
Treatment
Common treatment approaches include pain management and preserving range of motion as much as possible. Prescription drugs or anti inflammatories are commonly taken to reduce pain and inflammation in the joint. Physical therapists will teach you exercises to increase strength and mobility. Most cases of frozen shoulder can resolve themselves within 12 to 18 months.
For those who have persistent problems or simple don’t want to wait for it to resolve itself often look into other options to promote recovery. These include injections, surgery and alternative therapies like massage, acupuncture or using a TENS unit.
Structura’s approach
At Structura we practice structural physiotherapy or structural integration as a means to not only mitigate pain but to increase range of motion in the joint capsule. We start by observing deviations in the structural integrity of the shoulder. Is it being pulled on by the back or maybe even the hips? How is the neck reacting to the shoulder being frozen? Through these evaluations we start to understand the full story of how the shoulder became frozen in the first place. We will evaluate your range of motion in the shoulder but will also look at the neck, thoracic spine and even down into the pelvis to check all possible contributors to the shoulder.
The second step is to create a treatment plan, anywhere from three to five sessions to get you started on the path to recovery. Depending on the severity of the frozen shoulder and clients active participation in the treatment plan it can take more than five sessions to fully treat the shoulder and other affected areas.
The physiotherapy treatments are designed to break down fascia restrictions by lengthening and strengthening tissue. We use a variety of tools to promote our work and increase our results. We use instrument assisted soft tissue mobilization (IASTM) tools to scan and prepare the superficial tissue to allow for more effective manual therapy with our hands, knuckles, fists and elbows. We also use cupping as a means of decompressing dense tissue. These can be applied to several key points on the shoulder and arm to break up tissue. Compression bands can also be used to reduce pain and increase range of motion.
We understand that the treatments by themselves can only go so far. At home self care is also important to ensure the complete treatment of the frozen shoulder. Receiving our postural alignment therapy that designs an exercise plan for each individual to treat them structurally as a whole, to ensure that not only is the physiotherapy maximizing its efficiency but that the client is receiving all the tools to keep frozen shoulder from returning.
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