Rehabilitation for Frozen Shoulder

Frozen shoulder treatment is started according to the stage when the patient comes to you. The treatment usually has phases to go step by step to achieve back to normal functional activities.

The three phases of treatment are: 1. Protection phase, 2. Controlled motion phase and 3. Return to function phase.

Protection Phase: this is an acute phase and there is maximum rest and protection and very limited movement of the glenohumeral joint. In this phase, controlling edema, pain and muscle guarding is of utmost importance. The joint can be immobilized in a sling. Patient should undergo passive movements and assisted exercises. Sprian Strain and other soft tissue injuries and joint integrity should be maintained in this phase along with mobility. Patient should be given grade I and grade II mobilization to improve some range of motion and make the movements painfree. Patient should also be taught pendulum exercises. In this phase, the mobility of the surrounding joints should be maintained.

Controlled Motion Phase: in this phase as well pain, edema and joint effusion is to be controlled. It is very important to avoid substitute scapular movement. Patient should be taught self-assisted range of motion exercises, shoulder arm and wrist pain diagnosis treatment and gradually progress functional activities with all shoulder and scapular range of movements. Joint and soft tissue mobility should be increased. Grade III and grade IV joint mobilization could be started in this phase to increase joint mobility. Patient should be taught self-mobilization techniques. Pendulum exercises can be progressed by adding weights to it. In this phase, muscle spasm and faulty postures are to be avoided. Manual stretches should be started in this phase.

Return to function phase: in this phase, patient should be progressed to more flexibility exercises and strengthening exercises. Patient should be taught exercises related to the important functional activities. Patient should be taught self-stretching. Patient should taught correct mechanics of the joint motion. Patient should not get into substitute movements.  Vigorous manual stretching can be given if there is joint restriction in this phase.

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