Frozen Shoulder: When the shoulder freezes and the nights become agony

The Three Phases of Frozen Shoulder: Where Are You?

Frozen shoulder typically progresses through three overlapping stages that can last up to two years in total.

• Phase 1: Freezing. The inflammation in the joint capsule is acute. The cardinal symptom: Shoulder pain at night and an extreme, stabbing pain with almost every movement. The joint is beginning to stiffen.

• Phase 2: The Frozen Phase. The pain is slowly subsiding, but the shoulder is now massively stiff. Movements above shoulder height are often impossible.

• Phase 3: Thawing. The inflammation has subsided, the capsule is gradually loosening, and the range of motion is returning month by month.

Why aggressive stretching in phase 1 is harmful

In the first phase, your central nervous system is on extreme alert due to the inflammation. The brain sends a clear signal: „Danger! Do not move!“ Anyone who tries to forcefully stretch the shoulder in this phase is literally adding fuel to the fire. The nervous system reacts with even more muscle guarding.

Here in physical therapy, we initially focus on unloading, gentle manual techniques, and a holistic perspective. When the shoulder hurts, the cervical spine or rib cage often compensates. We release tension in the neck and torso to take the stress off the shoulder. Only in the „frozen“ and „thawing“ phases do we begin with targeted neurocentric training, specific stimuli, and the so-called Nerve gliding (neurodynamics), to rid the brain of the fear of movement and to regain mobility.

Frozen shoulder: What the studies show

• The course is usually good, but not always complete: In a long-term study (Hand et al. 2008) after an average of 4.4 years, 59 percent of those affected had a normal or almost normal shoulder, and 41 percent still had mild to moderate residual complaints. An overview study (Wong et al. 2017) concludes that the idea of complete healing without any treatment is not supported by the evidence.
• Softly instead of with violence: In a study (Diercks and Stevens 2004) 89 percent of those affected who exercised only within the pain threshold achieved normal or near-normal shoulder function after two years. With intensive stretching and mobilization, only 63 percent achieved this.
• Early cortisone injection plus exercises: According to a network meta-analysis (Challoumas et al. 2020, JAMA Network Open) brings a cortisone injection into the joint in the first twelve months, providing the best results, combined with a home exercise program. Have it evaluated by a doctor.
• Operation rarely necessary: In the UK UK-FROST study (Rangan et al. 2020, The LancetAfter twelve months, neither surgery nor mobilization under anesthesia were clinically superior to early, structured physical therapy with cortisone injection. The surgery brought more risks.

For frozen shoulder, that means patience, gentle movement within the pain threshold, and good cooperation with your doctor is the best way to go.

Self-help: Everyday practical tips for a quieter night

• The correct sleeping position: Lie on your healthy side and hug a thick cushion with the affected arm. This prevents the shoulder from dropping forward and putting the joint capsule under tension.

• The gentle swinging: Lean on a table with your healthy arm, bend your upper body forward slightly, and let the affected arm hang completely relaxed. Now swing it gently back and forth without any muscle power (like an elephant's trunk). This gently relaxes the joint capsule and relieves acute pain.

When should you have a medical or physical therapy consultation?

Have the shoulder examined promptly if mobility rapidly and noticeably decreases, severe pain persists even at night or at rest, or the symptoms occurred after a fall or injury – in these cases, a structural injury must first be ruled out.

In addition to individual therapy, our Manual therapy aiming specifically to restore mobility in a gentle way.

Your way out of the pain spiral in Zurich Do you suspect you are suffering from adhesive capsulitis? Do not wait until the pain becomes unbearable. The team at Physiotherapy Waidfuss in Zurich (near Wipkingen and Höngg), we will guide you through all stages of the disease. Contact us online for a thorough assessment and your individual treatment plan!

Sources

• Hand C et al. (2008): Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. PubMed
• Wong CK et al. (2017): Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. PubMed
• Diercks RL, Stevens M (2004): Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. J Shoulder Elbow Surg. PubMed
• Challoumas D et al. (2020): Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis. JAMA Netw Open. PubMed
• Rangan A et al. (2020): Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. Lancet. PubMed