Joints and bones

Frozen shoulder: forcing it makes it worse

This is the one shoulder problem where pushing into range is not brave, it is counterproductive, and the guideline says so explicitly.

What it is

Frozen shoulder, or adhesive capsulitis, is inflammation and then tightening of the capsule that surrounds the shoulder joint. The distinguishing feature is that range is lost in every direction, including when somebody else moves your arm for you. That is what separates it from rotator cuff related shoulder pain, where you can usually be moved further than you can move yourself, and the distinction changes what is safe to do. It commonly runs in phases: a painful phase driven by inflammation, a stiff phase driven by the tightened capsule, and a gradual thawing.

How it behaves day to day

Early on, pain dominates: sharp at the end of movement, aching at rest, and night pain that disturbs sleep. Loss of external rotation, meaning turning the forearm outwards with the elbow at your side, is an early hallmark. Later the pain often settles while the stiffness remains, and everyday actions like reaching behind your back or into a coat sleeve become the obvious problems.

What tends to feed it

• ·Forcing the arm into range, particularly while it is still painful
• ·Overhead loading while the shoulder is irritable
• ·Lying on that side at night
• ·Stopping all use of the arm, which adds general stiffness to the capsular stiffness

What the research recommends

The reference document is the shoulder pain and mobility deficits guideline covering adhesive capsulitis, from the Orthopaedic Section of the American Physical Therapy Association, published in JOSPT. Two things in it matter more than anything else for someone practising at home. First, the staging: stages one and two are driven by inflammation of the joint lining, while stages three and four are driven by contracture of the capsule, and they are not the same problem. Second, and directly practical, high-intensity stretching in the early stages is contraindicated. Forcing range into an acutely inflamed structure increases pain, increases guarding and can prolong the inflammatory phase. The rehabilitation model built on this evidence matches the intensity of exercise and manual technique to the person's current irritability, progressing as irritability falls rather than on a schedule.

Sources

1. 1
   Shoulder Pain and Mobility Deficits: Adhesive Capsulitis, clinical practice guideline, Orthopaedic Section APTA (JOSPT 43(5), 2013)

   Stages one and two reflect synovitis and stages three and four capsular contracture; high-intensity stretching in the early stages is contraindicated, and intervention intensity is matched to irritability.

2. 2
   Kelley et al., frozen shoulder: evidence and a proposed model guiding rehabilitation (JOSPT 2009)

   Proposes matching exercise and manual technique intensity to the patient's irritability level, progressing as irritability reduces.

Where Vinys is different

• ·Vinys treats frozen shoulder as a different condition from ordinary shoulder pain, with its own entry in the assessment, because the guideline's advice for the two is close to opposite on the question of forcing range.
• ·Selecting it keeps overhead loading and forced end-of-range positions out of the session. That is a small, specific change to the pose list, not a wholesale gentler session, and it is the change the guideline actually asks for.
• ·Nothing is removed from your legs, back or breath work because of a shoulder. Over-protecting the whole body for a regional problem is a mistake Vinys deliberately avoids.
• ·The session adapts on a day when the shoulder is more irritable, which is the closest an app can honestly get to the irritability-matched progression the rehabilitation model describes.
• ·Vinys is clear about its limit: it cannot stage your shoulder. It applies the cautious version for everyone, which is right early on and is more conservative than you may need later.

A short session to try

1. 1

   Extended exhale breathing · 2 to 3 minutes

   Night pain and guarding travel with this, and starting here settles the shoulder before you ask anything of it.

2. 2

   Cat-Cow · 8 slow rounds

   Moves the upper back, which has to work harder while the shoulder is not contributing.

3. 3

   Scapular wall slide · 6 to 8 slow reps, low range

   Shoulder blade control at a height that stays comfortable, with the wall taking the weight of the arm.

4. 4

   External rotation isometric at the wall · Hold 10 seconds, 5 times, gently

   External rotation is the first movement lost, and an isometric loads it without travelling into range.

5. 5

   Thread the needle · 5 each side, small range

   Gentle movement through the upper back and shoulder blade, kept well short of the end of the range.

Movements often used for this

These are movements the clinical library marks as especially beneficial for this movement pattern, with anything it flags as a caution for the same pattern removed. A pattern is not a diagnosis, and your own session is built from your answers on the day.

Common questions

Get it assessed rather than self-managing if you have not had this diagnosed, if the shoulder followed a fall or injury, if there is real weakness rather than stiffness, or if you have diabetes, which is strongly associated with frozen shoulder and worth mentioning to your clinician.

Also called adhesive capsulitis, stiff shoulder, frozen shoulder syndrome. Movements are drawn from the clinically authored Vinys library, and the guidance above is sourced to the publications listed. This page is general movement information, not medical advice, and it is not a diagnosis. How the method works.

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