My client has been doing very well in treatment for a right sided adhesive capsulitis, otherwise known as a ‘frozen shoulder’. Following a successful integrated treatment approach my client has progressed to the third stage of the frozen shoulder continuum where stiffness as opposed to pain is the main problem.
In this article I demonstrate the effectiveness of treating this condition with a combination of medical acupuncture, also known as dry needling, and manual therapy techniques.
Hands on Physiotherapy vs Surgery
In a journal article titled Management of frozen shoulder – conservative vs surgical? there are some interesting facts to be found about this condition. The term 'Frozen shoulder', coined some 80 years ago by a man named Codman, also described this condition as difficult to define, treat or explain how and why it occurs. Even today, we are still not entirely sure what causes frozen shoulder but we do have effective methods for treating it.
In the referenced article, Physiotherapy is demonstrated to be a crucial element of the rehabilitation process whether or not surgery is considered.
Considerable pain and stiffness in the shoulder results in a loss of movement that can take many years to resolve itself if left untreated. In many cases a conservative treatment approach is usually the preferred first treatment option before considering the need for surgical intervention.
The frozen shoulder often begins after an injury or inflammation of the soft tissues around the shoulder joint and following a period of immobilisation, potentially taking many months to develop. It is important to recognise the three stages of frozen shoulder and tailor treatment including exercises correctly. For example emphasis in the early stages should be to maintain, but not improve range of movement. If you push a frozen shoulder too far too soon this will only aggravate the problem.
Shoulder movement restored
My client is now at a later stage where after four months of treatment, all movement has been restored except for the last 5 degrees of side elevation (abduction) which is still stiff with some mild pain associated with the movement.
4 months may sound like a long time to get to this point however, left alone and with no treatment, a frozen shoulder can easily take 12 -18 months to burn itself out, if it does so at all. So 4 months of treatment is relatively quick in frozen shoulder terms - another example of how the right type of Physiotherapy treatment can help a problem get better, quicker and with a reduced risk of recurrence.
As mentioned we were lacking approximately 5 degrees at the start of her last treatment session. A combination of gentle medical acupuncture, targeting tender and trigger point sites through the posterior rotator cuff, upper trapezius and pectoralis muscles, followed by some gentle soft tissue techniques to help encourage muscle lengthening set a platform for manual mobilisation with movement (MWM) into the restricted elevated position.
By the end of the session, full range had been almost fully restored and was feeling much more comfortable. I have provided a final exercise to help maintain this movement (use it or lose it!) and expect this to be sufficient moving forwards.
I am hoping my client and I have reached the end of her recovery journey which has lead to a discharge from treatment, on the proviso that should any niggles or loss of movement return we should review. I have had no word from my client as yet so I'm keeping my fingers crossed that all is going well.
If you feel you may be suffering from a frozen shoulder condition I urge you to seek a professional assessment by a Chartered Physiotherapist specialised the treatment of musculoskeletal pain as soon as possible.
by Simon Coghlan