First accompanying symptom of the frozen shoulder is a strong and sharp pain in the shoulder joint and arm along with a restricted movement ability. Problems emerge with higher age and are also not exception when we reach 30 years of age. Arm movement (either active or passive) by this diagnosis is nearly impossible because of the strong pain, which can wake the client wake up from a sleep. Arm abduction becomes problematic as well as rotation to either side, bending or stretching the elbow as well.
WHAT CAUSES FROZEN SHOULDER
- Functional disorder of the soft tissue, even in case where was no mechanical damage in the shoulder joint. For example: disorder in the acromioclavicular joints (the joint between shoulder blade and collarbone).
- Functional disorder of the cervical spine.
- Functional disorder of the rotator cuffs, inflamed or degenerative changes in the soft tissues.
- inflammatory or degenerative changes in the soft tissues.
- So called “capsulitis” (inflamed joint capsule), bursitis, inflamed bursae.
- Shoulder injury or functionally related tissues (overload, injury, chills).
On orthopedics or rheumatology you will get examined and instructed to keep a peaceful regime, alternately you will have prescribed corticoids, steroid or non steroid based antirheumatics or analgesics. Then you will be sent to a rehabilitation, where you will be advised to actively exercise. They will also apply physical treatment according to doctors prescription.
Exercise for increasing the movement in the shoulder joint is very painful and not very effective as well as often prescribed electromagnetic therapy, laser, ultrasound and electrotherapy. Such rehabilitation is often stressful and frustrating because of the long lasting pain restriction which can last for several months and even a whole year. After unsuccessful conservative therapy, the doctors usually choose to operate.
PHYSIOTHERAPY, SHOCK WAVE THERAPY AND FROZEN SHOULDER
Differential diagnosis with the X-ray and ultrasound examination of the shoulder joint, cervical spine, area around the collarbone and its joints can reveal a fracture of the bone, disorder in tendons, ligaments, bursae. Blood tests exclude or confirm for example chlamydia infection and borreliosis. Internists can exclude ischemic stroke, peptic ulcer, oncological disease (bones, lungs,...).
By the physiotherapist you must then undergo a detailed kinesiological examination focused on the functional changes in the body posture and muscle chains (changes in the muscle tension directly affects the tension in following muscles). For your information, during complexive kinesiological analysis, which is important for correct diagnosis and correct therapy leading, we can reveal functional changes in the area of the shoulder joint, shoulder blade, arm and forearm muscles. Furthermore we can also reveal reflex changes in form of painful skin in the hand area, blockage in the the cervical and thoracic spine area and ribs. Functional changes are usually revealed in the area of swallowing and chewing muscles, then also in the lower back, thoracic diaphragm, pelvic floor and legs.
Physiotherapist can continue to use a functional solution according to the kinesiological find around the head area, arms, spine and pelvis, and deep stabilization system area (more about deep stabilization system).
It is reasonable to choose physiotherapeutic techniques based on the so called “neurophysiological basis”. For example Kabat technique, Vojta therapy, sensorimotor therapy, method according to Roswitha Brunkow, exercising on BOSU, Posturomed, flexi bar (Propriomed) and thera bands. Ideal combination between manual techniques of the soft tissues, mobilization and manipulation with joints which have a functional connection to the painful shoulder.
Modernly led physiotherapy in treatment of a frozen shoulder can not do without application of shock wave therapy in combination with deep vibrational massage in the shoulder area and muscles with functional connection to the painful shoulder.
For increased effectivity of the therapy we can offer our clients application of “functional tape” (special tape applied on your body). There’s a constant effect on the soft tissues without a pause until your next visit by our physiotherapist. More about “functional tape”.
PRACTICAL EFFECT OF COMBINATION OF PHYSIOTHERAPY AND SHOCK WAVE THERAPY
Therapy led that way has a much higher effectivity. Clients often feels relief after first therapy. Decreased pain gradually leads to an undisturbed sleep. It is no exception that you may spontaneously stop taking analgesics. There is also quite fast improvement in the movement ability of the shoulder joint. Analgesic and corticoid treatment can be also discontinued, because the shockwave therapy has a painkilling and anti-inflammatory effect.
In case there is a formation of a fresh calcification (in organism only for short period of time and relatively soft) in the shoulder joint, the shockwave therapy will effectively dissolve it and transfer it by a natural process to the bloodstream, which can be seen on the x-ray imagine (long-term calcification stays on the x-ray image, shockwave therapy doesn’t have such power to remove a bone).
WHEN TO START WITH PHYSIOTHERAPY AND SHOCKWAVE THERAPY?
Physiotherapy and shockwave therapy should be performed immediately without any delay in acute phase of pain. We recommend 3-4 days in between the application in length of 2 weeks. Furthermore, we plan the therapy once a week in case we decide for treatment with radial shockwave therapy by focused shockwave therapy once in two weeks. During the shockwave therapy it is better to start with a smaller intensity of impulses with the most gentle handpiece of the machine because the shoulder joint is very painful. Continually with lowered sensitivity, you can increase the number of impulses, pressure and frequency, or you can use a handpiece with higher performance. This procedure will then speed up the process of treatment. (more information about application with shockwave therapy).
It’s not an exception that the client feels relief already after the first therapy. The pain is not so intensive at night or it disappears completely, and the client can peacefully sleep. The movement of the shoulder increases after few weeks, and after 4-7 weeks the client is usually healed, without any pain, with smooth movement in the shoulder joint and without the use of corticoids and analgesics…
Author: Mgr. Iva Bílková, FYZIOklinika physiotherapy Ltd., Prague, Czech Republic
Source: clinical experience from a private practice in physiotherapeutic field