Frozen shoulder. or adhesive capsulitis, is a condition that causes significant shoulder stiffness and pain. This condition can develop after trauma to the shoulder, affecting middle-aged patients most frequently. Menopause, underlying metabolic disease and periods of shoulder immobilization can all increase the risk of experiencing frozen shoulder. Exercise can help alleviate the symptoms of frozen shoulder and restore joint mobility. Stretching, in the early phases of this condition, will be more effective to reduce symptoms than strengthening exercises.
Most explanations of the cause of frozen shoulder are theoretical. Commonly, this condition is described as having three stages of varying duration. The three stages are the painful, frozen and thawing stages. Exposing the traumatized joint to painful stimuli aggravates the condition and increases its duration and intensity, leading to the second, frozen, stage. Shoulder stiffness can also cause impingement pain at the top of the shoulder joint when raising the arm. Continuing to force the arm overhead will result in repetitive, painful stimulus to the shoulder, perpetuating the condition. Restoring full rotational range of motion (inward and outward rotation) is essential in the thawing stage before full and pain-free shoulder elevation can be achieved.
A study in the "Journal of Athletic Training" by Kevin Laudner and colleagues found the sleeper stretch an effective way to increase shoulder joint range of motion.To complete this stretch, lie on your affected shoulder, bringing the joint forward from underneath you. Maintain a 60- to 90-degree angle at your armpit between your body and your arm. Bend your elbow and place the side of your face on top of your shoulder. Using your opposite arm, press your hand toward your belly, while preventing the shoulder from lifting. Longer, lower loaded stretches are most effective to improve joint mobility.
To increase outward rotation, two stretching positions are recommended. Each stretch targets different parts of the joint. With your elbow bent at your side, place your hand on a door jam. Keeping the elbow from moving away from your side or behind your body, turn away from this arm until a stretch is felt. For the next stretch, sit on a chair, sideways to a counter or table and place your arm on the table. Your arm should be slightly ahead of your midline with your elbow bent. Ideally the angle at your armpit, between your body and arm, should be less than 90 degrees. Lean your body forward to rotate the shoulder.
The Role of Strengthening Exercises
Strength and flexibility exercises should not be painful. Weight exercises performed above shoulder height will likely cause pain and discomfort. Strengthening exercises should therefore be performed only in your pain-free range of motion. Strengthening the external rotators of the shoulder will offer the greatest benefit to improving shoulder function. Lying on your unaffected side, place your affected arm at your side with the elbow bent and your hand resting on your belly. Beginning without weight, raise your affected hand upward toward the ceiling without moving your elbow away from your side. Work up to three sets of eight to 15, avoiding pain. Gradually add weight to your hand, up to five pounds.
Forcing your arm into elevation that is painful can aggravate the condition. Rehabilitation protocols that use this method to restore flexibility may contribute to the prolonged nature of this condition. Pain-free, rotation-biased programs are more effective to resolve this condition and hasten recovery. Full range of motion should be achieved before you complete global strengthening of the shoulder.