Therapist should be able to customize the rehabilitation program based on each individual symptoms and clinical stage of the frozen shoulder
A) Initial Phase; acute, freezing or painful stage
Since this is a painful stage any activities that cause pain is avoided. Dias R et al 2005, has reported simple pain free exercise as more effective intervention than intensive physical therapy.
Dundar et al (2009) (32) compared the effects of continuous passive motion (CPM) or dynamic splinting with conventional ROM exercises among 57 patients with frozen shoulder. The study reported a greater reduction in pain levels among the CPM users. Elongation of collagen fibers may have improved the mobility of the shoulder joint and hence the greater reduction of pain. Similarly, Gaspar et al (2009), (33) found better results when physical therapy interventions are combined with the Dynasplint protocol rather than using each of them separately.
Active assisted range of motion exercises (AAROM) is the most commonly used form of exercises for adhesive capsulitis. AAROM exercises typically include the range of motion exercises of low intensity using equipment such as a pulley, wand /T-bar, or exercise balls. ROM exercises of low intensity and short duration can alter receptor input, reduce pain, and decrease muscle guarding (Kelly et al 2009). The study suggested performing stretches or ROM exercises (pendulum exercise, passive supine forward elevation, passive external rotation with the arm in approximately 40 degrees of abduction in the plane of scapula, and AAROM in extension, horizontal adduction, and internal rotation) in a pain free range which may be held for 1 to 5 seconds, 2 to 3 times a day.
Rigid and Kinesiology Taping
Although no evidence has been published on the efficacy of taping in adhesive capsulitis, different forms of taping such as rigid strapping tape or kinesiology taping (KT) is widely used. The rationale behind this may be that the taping may help to reduce pain and provide tactile cues through proprioceptive and afferent mechanisms. Also, KT may provide postural cues and assist with promoting proper scapular motion thereby correcting the problem of poor posture and scapular mechanics common in patients with frozen shoulder (Page et al 2010).
Soft tissue mobilization
Guler-Uysal et al 2004, compared the early response of deep friction massage using the Cyriax method to superficial heat and diathermy in the treatment of frozen shoulder. The study reported the deep friction massage to be more effective.
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