By Brianna Hurt, SPT
Lirios Dueñas, PT, PhD, Mercè Balasch-Bernat, PT, PhD, Marta Aguilar-Rodríguez, PT, PhD, Filip Struyf, PT, PhD, Mira Meeus, PT, PhD, Enrique Lluch, PT, PhD
Background
Frozen shoulder is a common musculoskeletal disorder that is characterized by a progressive loss of both active and passive mobility of the glenohumeral (shoulder) joint. Muscle strength deficits in external and internal rotation are also common with this condition. Typically, frozen shoulder is thought to follow 3 phases (painful, stiff, and recovery) into a full recovery without any type of treatment. However, recent systematic reviews have found that improvements in mobility and function decrease with time, with the possibility of limitations being present for multiple years.
When managing persons with frozen shoulder, it is important to consider the level of tissue irritability (high, moderate, and low) and adapt treatment strategies based on this. Manual therapy techniques can be used to help restore normal tissue extensibility of the shoulder and help improve range of motion. To restore mobility, improving shoulder rotation should be emphasized over forcing full flexion.
The purpose of this case series was to describe outcomes after the application of manual therapy and a home stretching exercise program for persons with frozen shoulder.
Frozen Shoulder Case Description
Eleven patients diagnosed with frozen shoulder were included in the study. One physical therapist performed all of the baseline measurements and follow up assessments. Measurements were taken before the intervention period, after the 3 month intervention period and at 3 and 6 months after the intervention period. A second physical therapist conducted all of the manual therapy techniques.
Baseline measurements included shoulder pain and disability, range of motion and muscular strength. For the treatment sessions, patients received a 12-session treatment program with treatments lasting 60 minutes, scheduled once a week over 12 weeks. The intervention program consisted of manual therapy techniques based on tissue irritability and shoulder mobility and home stretching exercises.
Outcomes
For the shoulder pain and disability outcome measures, 8 out of the 11 patients showed improvements in pain by 9 months posttreatment and all but one patient improved in their shoulder disability at posttreatment. For range of motion, there were improvements in shoulder flexion, abduction and external rotation at posttreatment in up to 9 patients. For strength measurements, 8 of 11 patients had improvements in shoulder flexion and internal rotation strength at posttreatment, however, none of the patients had improvements in external rotation strength.
Conclusion
When treating patients with frozen shoulder, a multimodal manual therapy approach along with a home stretching program based on tissue irritability and specific shoulder mobility impairments should be used. This approach results in reduced shoulder pain, improved range of motion and increased strength.
Physical Therapy First Approach to Frozen Shoulder Treatment
Here at Physical Therapy First, a complete evaluation is conducted and based on those findings a specific treatment plan is designed that best addresses our patient’s needs. Treatment plans typically include advanced manual therapy joint mobilization techniques, soft tissue mobilization, stretching, therapeutic exercises and providing our patients with a unique home exercise program to maximize outcomes. We offer individualized home exercise routines that can be updated and followed by patients on a user friendly app. Patients at Physical Therapy First can also benefit from a variety of modalities as well as myofascial trigger point dry needling treatment to muscles as indicated. Our goal is to provide quality patient care and as this study suggests, a manual therapy approach with home stretching can be used to improve pain, mobility, strength and function in those with frozen shoulder.
Original Article
Dueñas L, Balasch-Bernat M, Aguilar-Rodríguez M, Struyf F, Meeus M, Lluch E. A Manual Therapy and Home Stretching Program in Patients With Primary Frozen Shoulder Contracture Syndrome: A Case Series. Journal of Orthopaedic & Sports Physical Therapy. 2019;49(3):192-201. doi:10.2519/jospt.2019.8194