Frozen Shoulder Syndrome (FSS) or Adhesive Capsulitis is a condition of the shoulder capsule. The capsule is a thick piece of fibrous tissue that covers the whole ball and socket joint. In FSS it becomes tight, limiting movement and causing pain.

Frozen Shoulder

Symptoms of Frozen Shoulder Syndrome

Over months the shoulder becomes painful and movement is lost. Importantly, this movement is reduced whether you do the movement yourself or let someone do it for you. This is because the tight capsule blocks the range- it’s not the muscles. This is different to most other causes of shoulder pain.

Three movements are particularly limited by FSS as shown above:

  • Abduction: bringing the arm straight out to the side
  • Internal rotation: rotating the arm towards the body
  • External rotation: rotating the arm away from the body

The phases of Frozen Shoulder Syndrome

These symptoms progress throughout the first stage: the “freezing phase”. This can last up to nine months and is primarily characterised by pain.

As pain reaches its peak, we enter the “frozen phase”. Pain either starts to ease off or simply plateaus. Movement is now at its most limited. This phase lasts between 4 months and almost two years.

As symptoms subside, you move to the “thawing phase”. Pain and movement both begin to improve.

You may also find that beyond movement, other things are uncomfortable. People with FSS often report being unable to sleep on the painful side. Despite all of this, X-Ray findings will be clear. Your osteopath may like to refer you for a scan anyway, just to rule out anything beyond FSS.

What can be done?

Manual therapy including osteopathy has been shown to be effective in managing Frozen Shoulder Syndrome. Although we can’t stop it once it starts, treatment appears to speed up the process and bring the end forward. We know one risk factor for developing FSS is to have had it in the other shoulder. So we can address both shoulders during treatment in an effort to minimise the risk of the other shoulder following suit.

Risk factors

Although we don’t know why some cases of FSS start, we do know some of the risk factors:

  • Diabetes, especially poorly controlled diabetes
  • High blood pressure
  • Thyroid disease
  • Immobilisation of the shoulder (such as after injury or surgery)

Prevention and rehabilitation

Sometimes immobilisation is necessary, but it’s also important to have proper rehabilitation after this. Your osteopath can help here. With fractures, sprains, and strains, there is a window during healing in which the tissues remodel. At this point there needs to be some stress applied to the healing area to remind it how to heal properly. This stress encourages fibres to knit back together in a way that supports their function. Well healed injuries are stronger and less likely to reoccur. With regards to shoulders, well healed injuries may also be less likely to develop into Frozen Shoulders.

If you’re at any stage of FSS, come and see an osteopath to help speed it along.