IF YOU have a pain in your shoulder and are not able to lift your arm above your head, it’s time to see the doctor or a physiotherapist.
Alisha Bajerai, principal physiotherapist at Physio Savvy physiotherapy clinic, explains that a frozen shoulder is not just something that afflicts the older population.
“It actually happens to those 40 and above and it usually comes about after some sort of shoulder injury or immobilisation. The reason for why it happens is still unknown.
“It is fairly common and more common in women. If they’ve had mastitis or breast cancer and had any surgery in the area, or they’ve done shoulder surgery like a rotator cuff repair and it’s immobilised for a long time, that’s where the risk increases for the frozen shoulder,” says Alisha.
It can also happen if you have injured yourself while exercising; the most common one would be a rotator cuff tear. When a rotator cuff tear is protected for a long time, it can develop into a stiff, sore inflamed joint, progressing into a frozen shoulder.
According to Alisha, a frozen shoulder or some other problem in the shoulder would result in pain which would stop you from moving the arm too much.
“For example, you would usually have pain in an arc, so usually (if you’re swinging your arm from a downward pointing position to straight up) you would experience pain at 60-90 degrees and it would disappear somewhere up (when your arm is pointing straight up),” says Alisha.
Because of the pain in the shoulder, most people would avoid doing their hair, or the clasp of their bra for women and any movement that involves their arm going behind their back. Anything functional that’s above the chest area, would be painful and hard for the person to do.
Most people would go to the doctor who would do an assessment of their range, how much movement they have, and whether it’s stuck or if there is still movement.
“Generally, if you have a frozen shoulder, you wouldn’t be able to get any movement above 90 degrees, whether you do it yourself or somebody does it for you. That would be one way to detect it.
“The other way would be by doing an X-ray. Maybe not in the early stage, but later on, you would be able to see on the X-ray that the area is sort of white where it’s thickened around the joint capsule,” explains Alisha.
As soon as you notice shoulder pain, you should get a diagnosis.
Alisha says you can go to the doctor or straight to the physiotherapist as the diagnostic tests are very similar except for the X-ray. They would both check for range of movement and strength testing to see if there has been a partial or complete tear. If you go to the doctor, they may refer you to imaging (to get an X-ray done) or the physioherapist. Whichever option you choose, ultimately you would end up at the physiotherapist.
If you come in early after the injury to see the physiotherapist, you would be instructed on stretching exercises to stop it from turning into a frozen shoulder.
Once you get a frozen shoulder, it can take anywhere from a year to two years for a full recovery.
The exercises that the physio would ask you to do are to stretch out the muscles. It might involve pulleys or the wall to help stretch it out, explains Alisha. “It’s not necessary for you to use weights – in fact, weights will probably make the rotator cuff worse.
“So, you would be stretching it as much as possible to get that capsule opened up because if you’re not doing that, the risk of you needing something like a steroid injection or a surgical repair (where the doctor would go in and clean up the joint) is higher, so you want to avoid that.
“If it’s in that stiff phase, we want to get in there using our hands to mobilise that joint. Usually when you’re moving it around it doesn’t need that extra help but when it is stiff, we would actually need to get in there and break apart the adhesions,” says Alisha, explaining that patients can expect some pain as the physio loosens the muscles.
Going to the physio immediately might result in a shorter recovery period.
Can you heal yourself using medicated oils, massage and an infrared lamp?
According to Alisha, when the injury happens and the muscle is inflamed and really painful is when you should not apply heat. That’s when ice should be applied.
When the pain has settled and it’s no longer acute and inflamed, but it is now stiff, that’s when you would apply heat.
“Research-wise I’m not sure if infrared lamps would help specifically, but in general heat would help during that stiff period, when it’s no longer inflamed. So, even moving the arm when you’re in a hot shower is better than moving it in a cold room,” says Alisha.
While you might try home remedies, Alisha says it’s best to have it looked at by medical professionals as the three main methods of treatment would be heat, ultrasound and exercise.
Her best advice for prevention of a frozen shoulder is to keep active and keep all the joints moving.
And, if you are experiencing pain in the arm or shoulder, have it looked at by a medical professional as soon as possible, before it progresses into a frozen shoulder.
Main photo: Alisha demonstrating one of the stretching exercises to alleviate a frozen shoulder.