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Pain Management







Frozen shoulder (Adhesive Capsulitis) is a condition affecting the shoulder joint capsule and results in stiffness and loss of movement in the shoulder joint. It is different from a rotator cuff injury or shoulder tendonitis because it affects the joint capsule, whereas the two other conditions affect the muscles and tendons of the shoulder joint.

Causes: The exact cause of frozen shoulder is unknown, however in many cases, frozen shoulder occurs after another shoulder injury like rotator cuff tear, arthritis or shoulder surgery. Other causes could be poor posture which causes a shortening of the ligaments around the shoulder joint, or hormonal and genetic conditions like diabetes and hyperthyroidism.

Symptoms: The most common symptoms of frozen shoulder are pain and stiffness. Pain usually takes the form of a persistent dull ache. Stiffness prevents the full range of motion of the shoulder and upper arm. Patients are often unable to lift the arm above their head or rotate their arm inward. The normal progression of frozen shoulder has been described as having phases:

Freezing phase, patient develops mild pain and stiffness in the shoulder joint. Lasts from a few weeks to a few months.
Frozen phase, stiffness remains but the pain begins to decline. Lasts from a few months to nearly a year.
Thawing phase, full range of movement begins to return to the shoulder joint. Lasts a few months.
Full recovery typically occurs within 4 to 6 months but in some extremely rare cases symptoms have lasted for up to three years.

Treatment: Frozen shoulder primary treatment focuses on pain relief and physical therapy. Anti-inflammatory medications are typically used to reduce the pain so that physical therapy can be initiated. Two other forms of therapy should also be considered; heat and massage.

Heat is extremely helpful for increasing blood flow to a particular area. Heat lamps and hot water bottles are the most effective and prefered way to increase blood flow, heat based creams are distant second choice.

Massage is one of the best ways to increase blood flow which includes the oxygen and nutrients. Massage is also beneficial because it helps reduce the amount of scar tissue associated with all muscle, tendon and joint injuries.

Physical Therary should also be initiated during this period of pain relief treatments. This is an extremely important part of the treatment process. Full recovery will not occur without a dedicated approach to physical therapy treatments.

Don't stop moving. Some doctors will often tell patients to keep the injured area still, and this is not always the best advice. Gentle movement will help to keep the blood flowing to the injured area. Of course, if pain is present, limit the amount of moving you do, but don't stop moving all together.

Stretching and strengthening exercises determined by your physical therapist should be started to help loosen the shoulder joint and speed up the recovery process.

Excerpts from Brad Walker (1) who is a leading stretching and sports injury consultant with nearly 20 years experience in the health and fitness industry. For more articles on stretching, flexibility and sports injury, please visit The Stretching Institute.


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