Why Frozen Shoulder Is So Difficult to Treat
Frozen shoulder is one of the most frustrating problems for patients and doctors alike.
It’s painful, it comes out of nowhere, it causes sleepless nights and it often seems to drag on forever – 12 months is not uncommon.
As doctors we like quick fixes as much as you do. So it’s hard to see a patient come back to you for months on end and the best you can offer is:
“this will get better with time and more stretching…and we will give you some cortisone until it does.” A new technique for treating frozen shoulder may offer some new hope for a speedier recovery.
The Traditional Treatment Approach
Traditionally frozen shoulder is treated with time, physical therapy, anti inflammatory medication (injectable like cortisone or oral like ibuprofen) and surgery in a small percentage of cases. Some doctors also perform a procedure called “manipulation under anesthesia.” I do this, but only in very select cases and usually in combination with a surgical release (see discussion of why I am extra cautious about this procedure HERE).
Understanding the Three Phases of Frozen Shoulder
Frozen shoulder will typically run its course through about 3 continuous phases: a “freezing” phase which is characterized by increased pain and stiffness, a “frozen” phase characterized by a plateau of the pain and stiffness and a “thawing” phase characterized by an increase in your range of motion and decrease in your pain. Each phase can last months and it can be difficult to know when you are heading from one phase to another.
A New Take on Physical Therapy — and Why Group Sessions May Help
The new technique is not all that fancy. It takes a traditional treatment- physical therapy- and puts it into a group setting.
Interestingly doing the therapy in the group setting as opposed to at home by yourself or with a therapist one-on-one made a significant differenc in the speed and magnitude of recovery in this study. Below is a graph demonstrating the results. The bars represent scores for shoulder function (higher number is better) over time.
Frozen Shoulder: a team approach may offer new hope for relief
In this study no group underwent zero therapy. This might sound strange because you would intuitively think that everyine should get therapy if they have a stiff shoulder. But others studies have shown that some patients who have frozen shoulder who have no therapy do just as well as ones that do therapy, given enough time.
The therapy program was only done twice per week for 6 weeks at about 50 minutes per session; not a huge time commitment.
What This Means for Your Frozen Shoulder Treatment
So how should this study impact your care if you have frozen shoulder?
Bottom line for patients: this study introduces a new concept, that group therapy may help patients more than individual therapy or home therapy. Currently I am unaware of any local therapists or hospitals offering frozen shoulder group therapy sessions, but perhaps they should.
If you cannot attend a group therapy class, you still have a very good chance of getting better with time, therapy or nothing at all. And if you have frozen shoulder perhaps you should show your local therapist this study and encourage them to form group classes – i will see what I can do about spreading the word on my end.