There are now four stages of AC. Stage 1- is characterized by a gradual onset of pain, typically referred tothe deltoid. It is usually achy at rest and sharper with movement. Pain common at night and an inability to sleep on the side. With an early loss of external rotation noticed.
Stage 2-represents the combination of acute synovitis and progressive capsular contracture, which some have called the freezing stage. Pain persists more at night, motion is restricted particular with forward flexion, abduction and external rotation.
Stage 3-is stage of maturation also as the frozen stage. Predominant complaint is significant stiffness. Pain persists at the end of range of movement occasional pain at night.
Stage 4-chronic stage also noticed or called the thawing stage. Pain is minimal with improvement in motion.
Effecive mgt includes patient education, soft tissue, myofascial release, STM to resore mobility As mobility improves introduction of joint mobilizations by the physiotherapist. Neuromuscular reeducation of posterior shoulder to provide stability, continued posterior capsule stretching, pecs are ideal. Strengthening scapular stabilizers such as low traps, rhomboids, ER are vital to unload the anterior shoulder.
Exercises to avoid based on science are shoudler press due to the increased axial load that could reproduce or reinstate a new inflammatory process, lat pulldowns because at end range the infraspinatus and teresminor or co contracting which places a great deal of stress onthe
superior, medial and inferior GH ligaments.
Ho, Cecilia, , C. et al, 2009, ‘the effectiveness of manual therapy in the management of musculoskeletal disorders of the shoudler:a systematic review,’ Journal of manual therapy, vol. 14, pp.463-479.
Jewell,D, & Riddle, D, 2009, Interventions associated with an increased or decreased risk likelihood of pain reduction and improved function in patients with adhesive capsulitis.’ a retospective study, Physical Therapy Journal, vol. 89, no 5, pp. 419-427.
Shah, N & Lewis, M, 2007, Shoudler adhesive capsulitis: Systematic review of randomized controlled trials using multiple corticosteroid injections. British Journal of General Practice, pp. 662-667.
From what I know of adhesive capsulitis (frozen shoulder) it takes between 12-18 months to improve and at times it can take longer. Generally a physical therapist treats the individual with frozen shoulder.
Mobility is severely restricted. There is much the individual with the condition cannot do. Hence the focus ought to be on improving range of motion and flexibility. Vigorous stretching is recommended, strengthening of the posterior shoulder girdle and the rotator cuff is recommended as well as performing the pendulum exercise in order to increase subacromial space.
Thank you guys. Based on the science and biomechanics, OH press should be avoided as it recreate pain anteromedially. Lateral raises are not contraindicated and think that how can we strengthen the side of our shoulder which we need to reach and grab for something.
Behind the neck pulldowns and upright rows will place more pressure on the superior aspect of the GH joint and into the AC joint. WHich should be avoided.
Stretching the posteior capsule is key also!
I also had very personal and very painful experience with a frozen shoulder. Even now, after surgery and great range of motion, you will not see me do an upright row and a lateral raise truly out to the side. I am careful with overhead presses. I also avoid (and tell my clients) to reach to the backseat of the car to retrieve anything. When traveling, I have a rollerboard with 4 wheels so that I do not need to pull it behind me.
From my own personal experience I would say anything overhead, lateral or anything that is a jerky type motion should be avoided. Foam rolling, stretching, simple movements of the shoulder joint such as shrugs, retraction, rotations can be incorporated in order to keep blood flow and muscle tissue activated.