Frozen shoulder, another name for adhesive capsulitis, is pain and stiffening of the shoulder that leads to restriction in shoulder movement. This condition can be managed through medication, physical therapy, or surgery. For physical therapy, the services of a physical therapist are required to improve the adhesive capsulitis.
Physical Therapy Exercises For Frozen Therapy
There are many exercises to be performed by anyone affected with a frozen shoulder. These exercises are demonstrated by the physical therapist to the patient. These exercise programs can also be continued at home. Examples of these physical therapy exercises are:
- Range Of Motion Exercises
Shoulder Passive Range Of Motion Exercise
The Passive Shoulder ROM Exercise involves the therapist moving the body parts and stretching the muscles of the patient. The exercise removes the joint stiffness and maintains flexibility. The therapist moves the shoulder to ease the stiff joint. The patient’s tissues are stretched to reduce tension and relax the muscles. During this exercise, the shoulder is relaxed and moved in motion, such as flexion and external and internal rotation.
Shoulder Active Assistive Range Of Motion Exercise
These exercises are carried out by the patient with assistance from the physical therapist. After the passive ROM exercise, the active ROM aids the normal movement of the hand, shoulder, and rotator cuff muscles. These exercises may be practiced alone at home. Examples are flexion, abduction, and external rotation.
Active Range Of Motion
This exercise builds up flexibility in the affected shoulder. The help of an external factor is not required while undergoing this type of exercise.
- Stretching Exercises
This series of exercises help to stretch the muscle and increase mobility. The shoulder is stretched to the range motion limit. Examples are:
Pendulum stretch
● The unaffected arm is placed across a surface (for example, a table) while the affected arm is allowed to dangle.
● The arm is then swung in a diameter. This is continued steadily, and the diameter is later increased as the pain improves.
● The swinging arm should be continued about ten times.
Towel stretch
● A short towel of about three inches is needed to perform this exercise.
● The opposite ends of the towel are grabbed across the back horizontally. The arm of the affected shoulder holds the bottom of the towel.
● The towel is pulled towards the lower back with the other arm. This should be repeated up to 20 times.
Cross-Body Stretch
● This stretch includes the lifting of the affected arm by the other arm.
● The arm is lifted at the elbow and brought closer to the body.
● The stretch will be repeated up to 20 times.
Other examples are the finger walk and the armor stretch.
- Isometric Shoulder Exercises
The Isometric shoulder exercise is used to strengthen the shoulder. No movement should be made apart from the muscle contraction.
The exercise is administered so that the shoulder can return to its normal mobile state and motion range. It improves shoulder strength and can be applied after surgery processes.
Isometric shoulder exercise can be used for flexion, abduction, internal rotation, external rotation, and shoulder extension. The internal and external rotation is for strengthening the rotator cuffs.
For The Flexion;
● Face the wall, proceed to bend the elbow of the affected arm, and make a fist.
● Use a towel to separate the fist from the wall by wrapping it around the fist. Do this for 5 seconds.
● Repeat about 15 times, then move to the next one.
For The Abduction;
● Position your body perpendicular to the wall.
● Place the affected shoulder close to the wall, make a fist, and press against the wall.
● Press the affected arm gently into the wall for around five seconds, then release slowly. Repeat this about 15 times.
For External Rotation;
● Stand perpendicular to the wall with the affected arm close to it.
● First, bend the elbow at 90 degrees and make a fist.
● Proceed to press the back of the hand into the wall as if rotating outwards.
● Make sure to press into the wall for a few seconds, then release slowly. If an increase in pain is there, then you should stop.
● Do this 10 to 15 times.
For Internal Rotation;
● Stand facing the outer corner of a wall or doorframe
● The affected shoulder should be near the corner of the wall
● Position your arm inwards towards your body, press for about five seconds, and release slowly.
● During this, there must be no motion in the affected shoulder.
For shoulder extension;
● Back the wall at about six inches.
● Maintain a straight elbow and place your arms near your hips.
● Make a fist and hold it against the wall for about five seconds and release slowly.
● Little motion should be felt in the shoulder. Repeat up to 15 times.
- Shoulder Stabilization Exercises
The Scapula shoulder stabilization exercise is practiced so the patient can gain control of the scapula. A frozen shoulder might result in a need to stabilize the scapula. This is because injury to the shoulder leads to the patient placing more support on the scapula. This exercise is divided into four.
Prone Row;
● A bed is required for this first step in scapular stabilization. Lay on your stomach.
● Move towards the edge of the bed so the affected arm can hang down.
● Bend your elbow, and lift your hand towards your armpit. Stay in the position for a few seconds, then release your hand slowly to the initial position.
● Repeat between 8 to 15 times. A small weight could also be included.
Prone T;
● Lie on your stomach towards the edge of the bed with your affected arm hanging.
● Keep your hand straight while lifting it slowly to your side.
● Stay in a ‘T’ position by placing the scapula above your spine.
● Stay in the same position for a few seconds, then release your hand slowly to the initial position. Repeat between 8 to 15 times.
Prone Y;
● Similar to the ‘T’ position, lay on your stomach towards the edge of the bed. Hand the affected arm low.
● Lift the arm diagonally, so the scapula pushes against the back. The thumb should face towards the ceiling.
● Stay position for a few seconds, then release your hand slowly to the initial position. Repeat between 8 to 15 times.
Prone I;
● Lie on your stomach towards the edge of the bed with your affected arm hanging. Keep your elbow straight while raising your arm over your head.
● The scapula pinches back as the arm is being raised.
● Keep in position for a few seconds, then release your hand slowly to the initial position. Repeat between 8 to 15 times.
While doing this, the weight could be added based on the physical therapist’s guide.
- Resistance Band Shoulder Strengthening Exercise
This involves strengthening the shoulder with the aid of resistance bands. It works on parts of the body such as the shoulders, upper back, triceps for stability and good posture.
To use the bands;
For Reverse Fly;
● Stand in the middle of the band, then cross the bands in front of your lower legs.
● Slightly bend forwards and hinge your hip. Pull the bands up until the hands reach chest height.
● Draw the scapula together and remain in the position for a few seconds.
● Release slowly to the initial position.
For Front Raise;
● Stand in the middle of the band, and then cross the bands in front of your lower legs.
● Rest your palms on your thighs and raise your arms to shoulder height.
● Keep your arms steady as you raise them. Stay in position for a while before returning to the initial position slowly.
For Lateral Raise;
● Stand in the middle of the band, then cross the bands in front of your lower legs.
● Bend your elbows slowly while raising your arm to the sides.
● Raise your arms slightly above the shoulder-length for a few seconds before returning to the normal position.
For Standing Row;
● Place the resistance band around an object firmly.
● Hold each handle with your forearms parallel to the floor.
● Bend your elbows without bending your back.
● Make sure your arms are kept straight to the sides of your ribs without moving the ribs forward.
● Return to the normal position slowly.
Other forms of these exercises are the Band pull-apart and the Overhead band pull-apart.
Conclusion
Physical therapy is a slow but steady method of treating adhesive capsulitis. All these exercises must be done under the supervision of a physical therapist. Constant repetition of the exercises leads to speedy improvement in the frozen shoulder. Not only can these physical exercises be carried out as a treatment procedure for frozen shoulder, but they can also be combined after surgery.
