Physical Therapy for Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. It occurs when the connective tissue surrounding the shoulder joint becomes inflamed and thickened, restricting motion and causing discomfort. Frozen shoulder affects around 2-5% of the general population and is more common in people between the ages of 40-60 years old. The condition can last from several months up to 3 years if left untreated. Fortunately, physical therapy and targeted exercises can help restore mobility and function to the shoulder.

In the early stages of a frozen shoulder, inflammation causes pain and limited range of motion in all directions. As the condition progresses, shoulder mobility diminishes further. The shoulder joint capsule tightens and contracts, severely restricting the external rotation of the arm. This loss of external rotation is a hallmark of a frozen shoulder. Physical therapists employ stretching and strengthening exercises that help relax the contracted tissues and restore normal joint mechanics. Here are some of the most effective physical therapy exercises for frozen shoulder.

Passive Stretching

Gentle passive stretching helps relax the shoulder capsule and gradually increase the range of motion. A physical therapist will manually move the arm through its full range, applying a steady stretch to the restricted tissues. This hands-on approach helps release adhesions and scar tissue in the joint. Passive stretches should be done slowly and held for 20-30 seconds. Pushing too hard increases inflammation and stiffness. The goal is to gently stretch to the point of feeling slight resistance or mild discomfort.

Common passive stretches target external rotation and include:

• Passive external rotation – The therapist holds the arm at the elbow and slowly rotates it outwards away from the body.
• Passive cross-body stretch – The therapist lifts the affected arm across the front of the body at shoulder height and applies a gentle stretch by slowly pulling on the wrist.
• Behind-the-back internal rotation – The therapist lifts the affected arm behind the back and applies an internal rotation stretch.

Performing these passive stretches 2-3 times per week helps increase flexibility and range of motion. It’s important to communicate with the therapist about pain levels during stretching.

Active-Assisted Exercises

Once the initial inflammation has decreased, active-assisted exercises promote continued mobility. A physical therapist or assistant provides light, hands-on guidance as the patient actively moves the arm. This builds strength and motor control in new ranges of motion.

Useful active-assist exercises include:

• Assisted forward flexion – The therapist provides gentle resistance as the patient lifts their affected arm forward and upward.
• Assisted external rotation – The therapist holds the elbow while the patient rotates their arm outwards. The therapist applies light pressure in the direction of the stretch.
• Assisted internal rotation – The patient uses their unaffected arm to gently push the affected arm across the body into internal rotation until a stretch is felt.

Perform 2-3 sets of 10-15 repetitions for each active-assisted motion 1-2 times per week. Focus on proper form and slowly increasing reach.

Active Range of Motion

As mobility improves, perform exercises that strengthen the active range of motion without assistance. Movements should be pain-free and relatively smooth. Exercises can be done at home or with a therapist.

Useful active range of motion exercises include:

• Forward arm raises – Raise the affected arm straight in front of the body to shoulder height. Slowly lower back down. Repeat 10 times.
• Lateral arm raises – Raise the affected arm straight out to the side to shoulder height. Slowly lower back down. Repeat 10 times.
• External rotation – Keeping the elbow bent at 90 degrees, rotate the arm outward. Hold for 5 seconds. Return to the start position. Repeat 10 times.
• Internal rotation – Bend elbow at 90 degrees. Rotate the affected arm across the body using the opposite arm for resistance. Hold for 5 seconds. Return to the start position. Repeat 10 times.
• Behind-the-back reach – Reach the affected hand as high up the back as possible while keeping an upright posture. Hold for 10 seconds. Repeat 5 times.

Perform exercises within a comfortable range of motion. Move slowly and with control. Completing 2-3 sets for 10-15 reps, 1-2 times daily, helps build strength.

Scapular Stabilization

The scapula forms the back corner of the shoulder girdle. Poor scapular stability can contribute to a frozen shoulder by altering shoulder joint mechanics. Exercises that target the scapular muscles help re-establish normal motion patterns.

Useful scapular exercises include:

• Scapular retraction – Pinch shoulder blades back and down. Hold for 5 seconds. Repeat 10 times.
• Scapular rows – Tie the exercise band to a fixed object at waist height. Grasp the band with both hands and pull your elbows back, squeezing your shoulder blades together. Hold for 2 seconds. Repeat 10-15 times.
• Prone Y raises – Lie face down with arms extended straight out to the sides. Raise arms to shoulder height at a 45-degree angle. Squeeze shoulder blades down and together. Hold for 2 seconds. Lower slowly. Repeat 10 times.

Perform exercises with good posture, avoiding shoulder hiking. Complete 2-3 sets of 10-15 repetitions, 1-2 times per day.

Strengthening Exercises

Improving strength is a key part of managing a frozen shoulder long-term. Weakness of the rotator cuff muscles allows poor shoulder mechanics to develop. A physical therapist prescribes shoulder strengthening exercises when the range of motion approaches normal and the joint can move without significant pain.

Useful rotator cuff strengthening exercises include:

• External rotation – Hold arm at 90 degrees of elbow flexion. Tie the exercise band to a fixed point and grasp the other end. Pull the band outward, keeping the elbow close to the side. Hold 2 seconds. Return to the start position. Repeat 10-15 times.
• Internal rotation – Secure exercise band at waist height. Stand with the elbow at 90-degree flexion. Pull the hand upward and across the body. Hold 2 seconds. Return to the start position. Repeat 10-15 times.
• Lateral raises – Hold arm straight at side. Keeping the elbow straight, raise the arm to the side, leading with the thumb. Slowly lower back down. Repeat 10 times.

When performed correctly, these exercises strengthen the rotator cuff muscles – supraspinatus, infraspinatus, teres minor, and subscapularis. Building strength improves stability and prevents future frozen shoulder episodes.

Other Helpful Strategies

In addition to targeted exercises, other physical therapy interventions help restore function in a frozen shoulder:

• Modalities like heat, ice, and electrical stimulation help reduce pain and inflammation. Applying heat before exercise sessions enhances tissue elasticity.
• Joint mobilization performed by the therapist stretches stiff shoulder tissues and reduces pain. Gentle joint movement techniques improve mobility.
• Soft tissue massage releases muscle tightness and scar tissue adhesions that restrict normal shoulder joint mechanics.
• Posture correction and shoulder taping techniques provide sensory feedback about proper shoulder positioning. This facilitates more normal motion patterns.

An individualized physical therapy program that combines stretching, strengthening, and modalities offers the best outcome for a frozen shoulder. Exercise consistency and increasing activity levels are key principles. Close communication with the physical therapist ensures exercises are paced appropriately to restore full shoulder mobility and strength. With commitment to therapy, range of motion and use of the affected shoulder can be restored, avoiding the need for surgical intervention in most cases.