Frozen shoulder—clinically known as adhesive capsulitis—is a debilitating condition marked by pain and restricted mobility in the shoulder capsule. Affecting approximately 2–5% of adults between 40 and 70 years old, it significantly impacts daily life.
1. Understanding Frozen Shoulder: Definition & Stages
- Definition: Frozen shoulder (adhesive capsulitis) occurs when the shoulder capsule becomes inflamed, thickened, and stiff, limiting both active and passive joint movement.
- Progression:
- Freezing Phase: Severe pain, particularly at night, with gradually decreasing range of motion (ROM).
- Frozen Phase: Marked stiffness and limited movement, often with reduced pain at rest.
- Thawing Phase: Gradual improvement in pain and mobility.
2. Evidence-Based Physiotherapy Interventions for Pain Relief
Multiple non-surgical interventions have demonstrated efficacy in improving pain, ROM, and functional status.
a) Manual Therapy & Exercise
Systematic reviews show that structured physical therapy—including manual mobilization and targeted exercises—strongly improves shoulder pain relief and range of motion.
b) Electrotherapy Modalities
Tools such as TENS, interferential therapy (IFT), Class 4 laser, and ultrasound are frequently used to reduce pain and improve tissue extensibility:
- TENS: Stimulates sensory nerves to block pain and reduce muscle spasm. Typical use: 20–30 minutes, 2–3 times per day.
- IFT: Targets deeper pain and inflammation to enhance circulation—20–30 minutes per session.
- Laser Therapy: Promotes tissue healing and reduces inflammation—used during the frozen phase.
- Ultrasound Therapy: Enhances soft tissue extensibility, aids collagen remodeling, and alleviates capsule stiffness—1 MHz, 1.0–1.5 W/cm² for 8–10 minutes.
3. Home-Based Strategies & Patient Engagement
For sustained shoulder pain relief, patient participation in home exercises is essential. Though adherence varies, multimodal exercise programs yield solid benefits. Physiotherapists should employ educational tools, regular check-ins, and tailored progressions to improve compliance.
Conclusion
Frozen shoulder is a challenging but manageable condition. Physiotherapy offers effective shoulder pain relief through stage-specific strategies—ranging from manual mobilisation and exercises to electrotherapy and home engagement. Supporting evidence and real-world experiences reinforce the benefits of tailored, patient-centered care.