If your shoulder is stiff and painful most of the time, you may have a condition called adhesive capsulitis. Adhesive capsulitis is the medical term for a “frozen shoulder”. This painful and sometimes debilitating condition affects up to 2-5% of Americans and causes a lot of discomfort and inconvenience. It’s more common in females and those over 40.
If you lift weights, adhesive capsulitis can make it difficult to do some of the upper body exercises you usually do but it’s still important to stay active. Not moving a frozen shoulder can make the condition worse. Adhesive capsulitis is a frustrating problem to treat, and even with treatment, the symptoms can persist for months to years. One treatment that physical therapists recommend for adhesive capsulitis is shoulder stretches. Will shoulder stretches help “loosen up” a frozen shoulder?
What Causes Adhesive Capsulitis?
The shoulder is a weight-bearing joint and is subject to repetitive micro-trauma when you do overhead movements, like overhead presses. This micro-trauma, combined with changes in the collagen of the shoulder capsule, contributes to the development of frozen shoulder.
Adhesions are bands of tissue that form between surfaces in the body. They can occur anywhere in the body but are most common in the joints and are sometimes described as internal scar tissue. With adhesive capsulitis, adhesions form in the glenohumeral joint and make it harder to move the shoulder.
Unfortunately, adhesions restrict movement and cause pain. In the shoulder, they can prevent the head of the humerus from moving freely in the socket. This can cause the shoulder to freeze, leading to pain and loss of range of motion.
Risk Factors for Frozen Shoulder
People with conditions such as diabetes, connective tissue disorders, and lung or heart problems are more likely to develop adhesive capsulitis. Immobilization of the shoulder is another cause. For example, wearing your arm in a sling or cast, where it can’t move can cause adhesions to form that restrict movement of the shoulder. It can also occur after surgery or in response to bursitis or tendonitis where you don’t move a joint as much.
The Pain of a Frozen Shoulder: Do Shoulder Stretches Help?
A frozen shoulder is not only painful, but the affected shoulder is difficult to move. This makes it challenging to do simple tasks – or even sleep at night. People who have frozen shoulder have a hard time reaching behind their backs, for example, to pull a wallet out of their back pocket or put on a belt. If you have a frozen shoulder, raising your arms above your head may also be painful or difficult. People with frozen should usually walk with their arms close to their sides without swinging them.
Unlike other shoulder conditions, people with adhesive capsulitis don’t experience pain with pressure on the shoulder, such as touching or lightly tapping the area. Discomfort only occurs with movement of the shoulder, particularly overhead lifting or backward reaching. However, a frozen shoulder can sometimes ache at night when lying in bed too.
Shoulder Stretches for Adhesive Capsulitis
With a frozen shoulder, the connective tissue that surrounds the shoulder socket is inflamed and thickened. This thickening and the scar tissue restricts the normal motion of the shoulder, leading to stiffness and pain.
That’s where stretches come in. Shoulder stretches help break up some of this scar tissue and reduce the stiffness and discomfort that goes along with this condition. According to an article published on Medscape.com, stretching the shoulder in multiple planes helps boost the mobility of a frozen shoulder and reduce pain. Shoulder stretches are easy to do at home, but it’s best to consult a physical therapist for a few sessions to learn the best way to stretch a frozen shoulder.
A physical therapist can also perform treatments to stretch the joint capsule, which helps reduce stiffness and discomfort. Before doing shoulder stretches, you can apply moist heat to the shoulder to relax the muscles.
People with severe pain may benefit from a series of steroid injections into the shoulder to relieve pain and reduce inflammation. But talk to your doctor about the potential risks of injecting steroid into a frozen shoulder. The relief that comes from injections is short term and there are other risks including infection, bleeding, weakening of tendons or even a tendon rupture.
Other Therapies for Adhesive Capsulitis
Non-steroidal anti-inflammatory medications also reduce pain and inflammation but taking these medications long-term can have serious side effects including bleeding from the digestive tract and an increased risk of heart attack and stroke, based on some research. Another option is to use natural inflammation reducers such as turmeric, ginger root, tart cherry extract, and omega-3s instead. But talk to your doctor as these supplements can interfere with blood thinning medications.
Adhesive capsulitis may go away on its own, but it can take months to a year or longer. In some cases, shoulder manipulation under general anesthesia may be necessary. The goal of manipulation is to break up the adhesions that limit the movement of the shoulder. In severe cases, a surgeon may recommend a capsular release to cut and release the adhesions.
Shoulder stretches to keep the joint mobile and as fluid as possible may reduce the need for surgical manipulation or breaking up the adhesions. Some small studies suggest acupuncture may be effective for adhesive capsulitis by boosting endorphin release. Endorphins are hormones that act as natural painkillers. This could be a potential treatment for this condition along with stretching although there’s not enough evidence to recommend it at this point.
Conclusion
Shoulder stretches can reduce the pain and stiffness of a frozen shoulder, but it’s best to see a physical therapist to learn proper techniques for stretching a frozen shoulder. The worst thing you can do for a frozen shoulder is not to move it, as lack of movement increases the stiffness and discomfort and worsens the adhesions.
References:
- com. “Adhesive Capsulitis and Dynamic Splinting”
- “Adhesive Capsulitis: Diagnosis and Management | AAFP.” https://www.aafp.org/pubs/afp/issues/2019/0301/p297.html.
- Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):180-9. doi: 10.1007/s12178-008-9031-6. PMID: 19468904; PMCID: PMC2682415.
- American Family Physician. 59(7): 1843-52.
- Redler LH, Dennis ER (June 2019). “Treatment of Adhesive Capsulitis of the Shoulder”. The Journal of the American Academy of Orthopaedic Surgeons. 27 (12): e544–e554. doi:10.5435/JAAOS-D-17-00606. PMID
- “Frozen Shoulder (Adhesive Capsulitis): Signs, Diagnosis & Treatment.” https://my.clevelandclinic.org/health/diseases/15359-frozen-shoulder.
- Sun KO, Chan KC, Lo SL, Fong DY. Acupuncture for frozen shoulder. Hong Kong Med J. 2001 Dec;7(4):381-91. PMID: 11773673.
- Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 2017 Apr;9(2):75-84. doi: 10.1177/1758573216676786. Epub 2016 Nov 7. PMID: 28405218; PMCID: PMC5384535.
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