If you have been diagnosed with a frozen shoulder, you may have been told that it will eventually ‘burn itself out’ and get better on its own.
There is some truth in this but unfortunately, it isn’t quite the whole story.
Frozen shoulder, or adhesive capsulitis, is a condition where the shoulder becomes painful and progressively stiff. It can be extremely frustrating, particularly when everyday movements such as getting dressed, reaching into a cupboard or putting your hand behind your back become difficult.
And although a frozen shoulder can improve without treatment, that doesn’t necessarily mean that waiting for it to go away is always the best approach.
How long does a frozen shoulder last?
Traditionally, frozen shoulder has been described as going through three stages: freezing, frozen and thawing.
You may also hear that the condition simply runs its course over around two years and eventually disappears.
In reality, frozen shoulders don’t always behave quite so neatly.
Symptoms can last for many months and sometimes several years. Some people regain very good movement without treatment, while others are left with some ongoing stiffness or restriction.
In our clinical experience, although the pain may eventually settle, it is not unusual for some restriction in movement to remain.
This is why we don’t tend to regard frozen shoulder as simply a condition you have to put up with until it eventually goes away.
So, will a frozen shoulder get better without treatment?
It might.
Pain will often settle with time and movement may gradually return. However, there is no guarantee that the shoulder will return completely to its previous level of movement and function.
The important question for us isn’t simply:
‘Will it eventually get better?’
It is:
‘How can we reduce the pain, restore as much movement as possible and get you using your shoulder normally again?’
That is where treatment can be helpful.
What causes a frozen shoulder?
Sometimes there is no obvious reason why a frozen shoulder develops. In other cases, it can follow an injury, surgery or a period where the arm has not been moving normally.
We also know that frozen shoulder is more common in people with diabetes.
At Corsham Physiotherapy, we also look beyond the shoulder joint itself. The shoulder doesn’t work in isolation. Movement of the shoulder blade, upper back and surrounding muscles all contribute to how comfortably and efficiently you can move your arm.
Posture, upper-back mobility and shoulder-blade mechanics are therefore all things we may consider during an assessment, particularly if they are contributing to the way someone is moving.
What can physiotherapy do for a frozen shoulder?
Treatment depends very much on the individual, and on how irritable and painful the shoulder is when we first see you.
Initially, the priority may simply be to reduce pain and make everyday life more comfortable. As the shoulder settles, the emphasis increasingly moves towards restoring mobility and function.
Physiotherapy may include hands-on treatment and joint mobilisation, exercises to maintain and gradually increase movement, treatment of the surrounding muscles and advice about how much, and what type of movement is appropriate at each stage. Depending on the individual, we may also use treatments such as acupuncture or electrotherapy to help reduce pain and settle symptoms, particularly during the more painful stages. As the shoulder becomes more comfortable, the emphasis increasingly moves towards restoring mobility and function.
One of the important parts of treating frozen shoulder is getting the balance right. Trying to aggressively force movement into a very painful shoulder isn’t necessarily helpful. Equally, avoiding movement altogether can allow the shoulder to become increasingly stiff.
The aim is to work with the shoulder as it changes.
What about steroid injections?
Steroid injections can be useful for some people with frozen shoulder, particularly when pain is a major feature, but they aren’t a guaranteed cure.
Where we feel an injection may be helpful, we would usually recommend an ultrasound-guided injection. This allows the clinician carrying out the procedure to see the structures of the shoulder and accurately guide the injection to the intended area, rather than relying on anatomical landmarks alone.
For this reason, we tend to refer to experienced shoulder specialists who regularly carry out ultrasound-guided injections.
An injection may help to settle the pain and make the shoulder more comfortable, but restoring movement is still important. If the injection successfully reduces pain, it can create a useful opportunity for physiotherapy to work on improving mobility and function.
Does frozen shoulder ever need surgery?
Most frozen shoulders can be managed without surgery.
However, if significant pain and stiffness persist despite appropriate conservative treatment, we may recommend an opinion from a shoulder specialist. Procedures such as manipulation under anaesthetic or arthroscopic capsular release may be considered in selected cases.
Even where surgery is appropriate, rehabilitation afterwards is usually an important part of regaining and maintaining shoulder movement.
So treatment isn’t necessarily a choice between physiotherapy or an injection or surgery. For some people, the best result comes from combining different approaches at different stages.
The end goal is movement
Frozen shoulder can be a long and frustrating condition, but simply waiting for it to disappear isn’t the only option.
Some frozen shoulders do improve considerably on their own. Others leave people with persistent stiffness, and we can’t reliably predict at the outset exactly how an individual shoulder will behave.
Our aims are therefore straightforward… reduce the pain, restore as much movement as possible and help you get back to using your shoulder normally.
If you think you may have a frozen shoulder, a physiotherapy assessment can help establish whether frozen shoulder really is the cause of your symptoms, how restricted the joint has become and what treatment is most appropriate for you.
Looking for help with a frozen shoulder?
Find out more about Frozen Shoulder Treatment at Corsham Physiotherapy, including how we assess frozen shoulder and the different treatment options we may use.
If you are struggling with shoulder pain or stiffness and aren’t sure whether you have a frozen shoulder, our physiotherapists can assess your shoulder and advise you on the most appropriate treatment. Contact us to book an appointment.