What we treat - Frozen Shoulder

Frozen Shoulder Treatment includes Laser Therapy

Frozen shoulder, or “Adhesive Capsulitis” is one of the most challenging conditions we see in a physio clinic, because treatment efforts can seem fruitless. Pain is centered around the shoulder cap; motion is restricted and attempts to move increase pain; and it interferes with sleep.

Adhesive Capsulitis is an uncontrolled and exaggerated inflammatory response associated with an equally uncontrolled and exaggerated healing response. This results in an excessive amount of scar tissue in the generally loose capsule of the shoulder joint. The exact cause of adhesive capsulitis is unknown. It is commonly labelled ‘frozen shoulder’, but this may cause confusion, as so many other causes for stiffness and pain in the shoulder are also called ‘frozen shoulder’. While all instances of shoulder pain and stiffness should be treated, adhesive capsulitis presents a special challenge because recovery can be very slow.

Some things we know:

Adhesive capsulitis often follows a predictable pattern: You wake up one morning with a stiff and painful shoulder joint, and are unable to pinpoint specific injury. The pain increases quickly over time and your shoulder becomes progressively stiffer. This is the “freezing” phase which lasts between 6 weeks and 9 months. The subsequent “thawing” phase brings a welcome reduction in pain and some improved mobility.

By the time the injury has reached the “thawing” phase, it is clear that the joint will need rehab to restore strength and function. Earlier attempts to exercise have not generally been shown to be helpful during the freezing phase of the development of frozen shoulder.

The pain associated with the freezing phase can be severe, and typical treatment options for pain management range from anti-inflammatory and pain medication, often in high doses, to steroid injections, and sometimes to surgical options.

But…..there is an accumulating number of high quality of research studies, including one from an acclaimed Cochrane Review, that indicates that low intensity laser is effective in decreasing pain during the freezing phase! For those who don’t like to (or can’t) ingest large amounts of pain or anti-inflammatory medications, this is excellent news.

From our own records, two recent clients required 9 and 21 laser treatments, respectively, to achieve 80% clinical improvement. This underscores the variability in response to treatment, which is a typical and frustrating characteristic of adhesive capsulitis. Whether a client’s recovery tracks long or short, low intensity laser accelerates healing. It is the only physiotherapy modality capable of directly supplying underperforming or damaged cells with the additional cell fuel (ATP) needed to restore cell function and structure.

The laser stimulates the healing process through a cascade of biochemical events, one of the most important being it’s ability to directly stimulate cell metabolism and function. This differs from most other modalities which usually depend upon the indirect effects of blood circulation.

Our recommendations for treating these frozen shoulders start with a physiotherapy assessment and home exercise program to encourage motion. Early in-clinic treatment centers on laser and massage, but will include physio assisted, then progressive exercise, as tolerated once pain has subsided about 50%.