Massage Therapy for Frozen Shoulder

Massage Therapy for Frozen Shoulder


by: Dylan Crake 

Frozen shoulder, also known as Adhesive Capsulitis, is a shoulder impairment with idiopathic origins that effects mainly women between the ages of 40-60. This condition is characterized by significant restrictions in shoulder motion, both active and passive, along with pain due to the thickening of the joint capsule.         

There are two known types of frozen shoulder. The first is Primary Idiopathic Adhesive Capsulitis. This form has been associated with other impairments, such as Diabetes Mellitus and Thyroid Disease. The second form is known as Secondary Idiopathic Adhesive Capsulitis and is usually the result of  long-term immobilization of the shoulder, subacromial impingement or a rotator cuff tear. Essentially, the lack of movement in the shoulder causes it to “freeze”. As Wolff’s Law is essentially trying to say, you use it or lose it.

When it comes to frozen shoulder, there are three stages to this impairment, which all have different manual therapy and remedial exercise guidelines.

The first stage is known as the Freezing Stage. This stage can last anywhere from 2-9 months. This stage is characterized by diffused pain, often worse at night. It can be speculated that it is worse at night because of the increase lack of shoulder use, while we sleep.

This stage can create a nasty cycle for the shoulder, as it is the lack of movement that can cause frozen shoulder to occur. Since the impairment is causing pain, this can lead the impacted person to not move their shoulder- leading to more restriction of the shoulder joint. Therefore, it’s important to inform the patient of the importance of gentle movements at this stage.

When it comes to remedial exercises for this stage, the focus should be on gentle stretches and active range of motion (AAROM) exercises, within a pain free range and for brief durations. Some examples include:

  • shoulder pendulum
  • AAROM for shoulder flexion
  • upper trap stretch.

It is ideal to have deep moist heat used before and after the exercises to create more laxity in the joint capsule, as well as help with pain relief.

The next stage is the Frozen Stage. This stage lasts from 4-12 months. Pain has decreased during this time, but there are significant restrictions in shoulder external and internal rotation, shoulder flexion and shoulder abduction. During this phase, the introduction of isometric strengthening exercises should be taught, as well as the continued use of the shoulder mobility and stretching exercises previously given. Common strengthening exercises that can be taught are:

  • Isometric shoulder external rotation
  • Isometric shoulder flexion
  • Isometric shoulder abduction

All should be held for 10 seconds, repeating 5 times. Heat before and after exercises is also encouraged.

The final stage of frozen shoulder, is the Thawing Stage. This is where strengthening of the shoulder and postural muscles become the most important. This stage can last anywhere from 5-26 months. During this stage, the patient can progress from isometric strengthening exercises to strength training with resistance bands and later on, to free weights. It’s important to focus on:

  • Shoulder flexion
  • Shoulder abduction
  • Shoulder external and internal rotation
  • Rows
  • Chest press
  • Continuation of stretching of back, neck and shoulder muscles

All should be done in 3 sets of 10, and should be done very slowly.

Overall, frozen shoulder can take a long time to heal. It’s important for you, as a clinician, to remain positive and provide the support your patient may need during their recovery.

Join me in my webinar on July 12th for more in depth discussion on how you can best help your patients with frozen shoulder.

Register online for the webinar

Tags: frozen shoulder, shoulder pain, benefits of massage therapy