FROZEN SHOULDER EXERCISES

Frozen shoulder exercises are a crucial part of the treatment plan for patients diagnosed with frozen shoulder.

Frozen shoulder exercises are intended to:

• reduce pain
• increase the elasticity of the contracted capsule
• promote shoulder mobility
• improve the strength of the rotator cuff muscles

Frozen shoulder exercises are also essential in the prevention of further injuries in the shoulder joint.

Prior to the Frozen Shoulder Exercises

Pain Management

Before proceeding with the exercises, it is important to manage the pain and the stiffness associated with frozen shoulder. Your physician may recommend oral non-steroidal anti-inflammatory or intra-articular cortisone injections combined with long-acting anesthetics to decrease the inflammation and pain. Your physical therapist may initially apply heat and hands-on treatments that aim to loosen up the contracted joint capsule and the tense muscles supporting the shoulder joint.

At home, you can take a warm shower for 10 to 15 minutes before exercising to relax your shoulder joint. Application of a moist heating pad or warm towel to the affected shoulder is a good alternative.

Activity Restrictions

During the treatment and recovery phase, a healthcare professional may advise you to modify your activities. It is commonly recommended to avoid abrupt and jerking motions and heaving lifting with the injured shoulder. Reaching and overhead movements one must be cautious of.

During the rehabilitation period, one of the main goals is to avoid re-injuring the shoulder tissues. This is to prevent aggravating the existing injury and worsening the pain and stiffness associated with frozen shoulder.

Warm Up Exercises

Warm up exercises are often overlooked, but it is essential to perform these exercises before proceeding with your frozen shoulder exercise program.

Warming up for 5 to 10 minutes improves the flow of blood to the muscles, facilitating their contraction and relaxation. Gentle and stretching shoulder exercises increase the elasticity of the tendons, ligaments, and other connective tissues in the area. Warm ups are essential in preventing muscular and connective tissue injuries. Pendulum exercises can be used to warm up your muscles and joints.

Frozen Shoulder Exercises

The following types of exercises are performed for the treatment of frozen shoulder:

Range-of-motion Exercises

This group of exercises is recommended early in the recovery period. Range-of-motion (ROM) exercises regain and maintain mobility of the shoulder joint and flexibility of the muscles and tendons in the shoulder area.

Weighted pendulum stretches, a ROM exercise, aim to stretch the space where the tendons pass through to relieve the pressure applied on them. These stretches may also be used to prevent the development of frozen shoulder.

Weighted pendulum stretches can be initiated almost immediately after an injury or after receiving a corticosteroid injection. At home, these stretching exercises should be performed after warming the affected shoulder.

Pendulum Exercise

Pendulum exercises are performed for 20 repetitions, 1 to 2 times per day. 1. Stand or sit tall, and relax your shoulders. Keep your arms close to your body. The arms must be in a relaxed vertical position. 2. Let your arms swing back and forth and side to side like a pendulum. 3. Make small circles in each direction with the hand of the affected arm. Minimal pain may occur; if you feel moderate to severe pain, discontinue the exercise. The diameter of circular movements should be less than 1 foot in all directions. 4. Perform Steps 1 to 3 for 3 to 7 days. Gradually progress the intensity of the exercise by adding 1 to 2 pounds of weight each week. As you advance the exercise, increase the diameter of the circular movements.

Passive Stretching Exercises

Passive stretching exercises are performed after the pendulum stretches. In general, passive stretching exercises are implemented once pendulum exercises are performed without discomfort.

Passive stretching exercises are stretches that do not require active contraction of the shoulder muscles. These exercises aim to further loosen the contracted shoulder joint capsule and relax the tense muscle shoulders and to restore the shoulder’s normal range of motion. Each passive stretching exercise is performed in sets of 2 to 3 repetitions, 1 to 2 times a day. Hold the stretch for 5 seconds and progress to 30 seconds.

Armpit Stretch

1. Stand tall and position both feet on the ground. 2. Using your good arm, lift the affected arm onto a shelf or any object with a good support that is chest-high or to a level that you can. 3. Gradually bend your knees as you open up the armpit of the affected arm. 4. Hold the stretch. 5. Gently return to your starting position.

Finger Walk Stretch

1. Stand tall, and face a wall. Place the hand of the affected arm on the wall in front of you. 2. Use the fingers of the affected arm to gently finger-walk up the wall as high as you can reach, without increasing the severity of your symptoms.

External Rotation Stretch

1. Stand tall in a doorway. Bend the affected arm at 90-degrees to reach for door jamb, or the vertical portion of the door frame. The elbow should be placed close to your side. 2. Keep the hand in place as you rotate your body away from the midline. 3. Hold the position when feel a stretch in front of your shoulder and chest. 4. Relax, and repeat the exercise.

Towel Stretch

1. Stand tall as you position the affected arm behind your back. 2. With the good arm, dangle a towel behind your back. Grasp the towel with the hand of the affected arm. 3. Gently pull the affected arm upward by lifting the good arm to stretch the affected shoulder. Pull until the towel is in vertical position or until you feel a stretch in the upper neck, shoulder, and upper back without aggravating your symptoms. Hold the position. 4. Return the affected arm to its starting position.

Crossover Stretch

1. Stand tall and keep your feet about hip-width apart. 2. Hold the affected arm straight out in front at the shoulder level or at a level you can. Place the back of the opposite hand above the elbow of the affected arm. 3. Gently pull the affected arm across your chest. You must feel a stretch in the back of your shoulder. Hold the stretch.

Strengthening Exercises

Strengthening exercises should be initiated as you make progress with stretching exercises. Shoulder strengthening exercises play an essential role in your recovery from frozen shoulder.

Each strengthening exercise is performed 10 to 15 times, once per day. The exercise must be held in position for 6 seconds. A 2-minute rest in between exercises is recommended. A flexible, rubber tubing or surgical tubing may be used to perform the exercises.

Isometric Internal Rotation

1. Stand tall, and face the outside corner of a wall that will provide resistance to the affected arm. You may also stand next to a doorway. 2. Bend the elbow of the affected arm to a 90-degree angle until the forearm is parallel with the ground. Keep the upper arm at your side. 3. Firmly push the palm against the wall, as if trying to rotate the affected shoulder so the forearm would move toward the stomach. Hold the position. 4. Relax, and repeat the exercise.

Isometric External Rotation

1. Stand tall in a doorway with the affected elbow bent to 90-degrees. Press the back of your wrist against the door frame. 2. With the back of your wrist pressed against the door frame, press your hand going outward into the door frame. Hold the position. 3. Relax, and repeat the exercise.

Isometric Abduction

1. Stand tall with the side affected facing the wall. 2. Bend the elbow of the affected arm at a 90-degree angle. 3. Press the affected arm into the wall, as if trying to lift it. Hold the position. 4. Relax, and repeat the exercise.

Isometric Shoulder Extension 1. Stand tall facing away from the wall. The elbow of the affected arm should be touching the wall. 2. Push the back of your elbow against the wall. Hold the position. 3. Relax, and repeat the exercise.

Isometric Shoulder Flexion

1. Stand tall facing a wall, and keep your feet a hip-width apart. The elbow of the affected arm is bent at a right angle. The upper arm is kept close to your body. 2. Press your fist forward against the wall. Hold the position. 3. Relax, and repeat the exercise.

Rick Kaselj, MS