STRETCHING AND STRENGTHENING EXERCISES FOR A FROZEN SHOULDER
APRIL 15, 2019 @ 6.34 PM
Frozen shoulder is a condition that causes the shoulder to stiffen thus reducing its mobility. Women 50 years and above are more susceptible – especially those with diabetes. While the condition is usually caused by trauma, it can also occur without any given reason.
Three stages of frozen shoulders
Frozen shoulder can be divided into three stages - the first one is what we call the inflammatory stage or the freezing stage.
“Patient would usually complain of recurrent shoulder pain between a month to six weeks. This is the initial yet most painful stage and although an X-Ray imaging show that the patient is perfectly normal, she would complain of pain,” explained Dr Mohd Ikraam Ibrahim, Consultant Orthopaedics & Traumatology at Kelana Jaya Medical Centre.
“As the patient navigates towards the next stage, the shoulder is locked – frozen. Although pain is less intense, she would suffer a reduced range of motion – also known as the reduction of global range of motion – meaning that almost all movements are limited," he added.
During this time, patient would point out that the shoulder is stuck - can’t be lifted up or moved forward. These would happen for three to four months.
Towards the last stage - the thawing stage; the shoulder starts to regain its range of motion. This usually happens within six months to a year.
While painkillers and physiotherapy helps to regain the range of motion in certain patients, there are also those who do not respond to these, thus a less invasive or invasive procedure might be required.
When painkillers and physiotherapy no longer work
Less invasive procedure consists of a steroid injection into the joint to reduce the inflammation and to expand the capsule thus gaining back the range of motion.
Invasive procedure, on the other hand, involves manipulation under anaesthetics – using an arthroscopic capsular release where a keyhole surgery is done to divide the capsule open with the intention that the patient gain back her range of motion. However, these treatments need to be complemented with physio to see improvement.
On the hindsight, frozen shoulder is self-limiting and resolves spontaneously. It is only a time factor, but the range of motion, as compared to early intervention, would be less with patient affected.
Exercises for a frozen shoulder
Stretching exercises are essential to treating frozen shoulder. Start by performing warm up exercises such as taking a warm shower for 10 – 15 minutes. A moist heating pad or a damp towel heated in the microwave could also be used although it might not be as effective.
In performing these exercises, stretch to the point of tension but not pain.
1. Pendulum stretch
Relax your shoulders first. Then, stand and lean over slightly, allowing the affected arm to hang down. Swing the arm in a small circle – making 10 revolutions in each direction once a day.
Increase the diameter of your swing as your symptoms improve. You may increase the stretch by holding a light weight (three to five pounds) in the swinging arm when you’re ready for more.
2. Towel stretch
Hold a three-foot-long towel in a horizontal position behind your back. Use your good arm to pull the affected arm upward to stretch it. The more advanced version of this exercise is to have the towel draped over your good shoulder – with the affected arm holding the bottom of the towel and pulling it toward the lower back with the unaffected arm; 10 – 20 times a day.
3. Finger walk
Face a wall three-quarters of an arm's length away, reach out and touch the wall at waist level with the fingertips of the affected arm. Slowly walk your fingers up the wall with your elbow slightly bent until you’ve raised your arm (not shoulder muscles) as far as you can. Slowly lower the arm and repeat for 10 – 20 times a day.
4. Cross-body reach
Cross-body reach can be done seated or while standing. Use your good arm to lift your affected arm at the elbow, bringing it up and across your body. Hold the stretch 15 - 20 seconds, repeating this move 10 – 20 times per day.
5. Armpit stretch
Lift the affected arm onto a shelf breast-high with your good arm. Bend your knees gently, opening up at the armpit. Deepen your knee bend slightly – stretching the armpit and straighten. Stretch a little further with each knee bend for 10 – 20 times a day.
Slowly add rotator cuff-strengthening exercises as your range of motion improves. However, start by warming up your shoulders and stretching exercises first.
6. Outward rotation
Hold a rubber exercise band in your hands with elbows at a 90-degree angle; close to your sides. Rotate the lower part of the affected arm outward; approximately two inches and hold for five seconds. Repeat 10 to 15 times, once a day.
7. Inward rotation
Stand next to a closed door with one end of a rubber exercise band hooked around the doorknob. Using the affected arm, hold the other end with your elbow at a 90-degree angle. Pull the band toward your body two or three inches and hold for five seconds. Repeat 10 to 15 times, once a day.
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