Frozen Shoulder: Outdated myths debunked!

It is surprising to read that we are still using the term Frozen Shoulder based on an idea stemming back to the 1930's! And we are still basing our treatment on unfounded research that dates back over 40 years!

For those not in the know, Physiotherapy is based upon evidence-based best practice.

One thing that is for sure, the correct term for a frozen shoulder is Adhesive Capsulitis.

Adhesive Capsulitis

The fibres of the shoulder capsule fibrose, leading to shoulder stiffness and thickening. To the sufferer, this means limited movement, sometimes painful. It was, and has up to now been believe that frozen shoulder is a self -limiting condition. By this, we mean it fully rights itself over time, by undergoing painful, stiff and recovery phases. Because this has always been perceived as self-limiting, clinicians have been lacking in giving exercise and treatment and patients have been reticent to report them to their physicians.

However, a new systematic review of all of the current research by Wong et al (2017) has allowed clinicians like myself to better treat and rehabilitate people with frozen shoulder. The researchers soon highlighted that none of the articles reviewed followed the pattern hypothesised back in the 1970's. They have been able to identify that a frozen shoulder shows greater gains with regards to increased movement in the earlier stages which lessens over time. The researchers did report than although functional movement can be seen, it is not clear whether full range of motion is achieved. In additional to this, the researchers were able to identify only low quality evidence that frozen shoulder could improve without intervention.

A change in professional and the public's' understanding.

The researchers have been quite clear that physicians, clinicians (including physiotherapists) much change their beliefs on frozen shoulder immediately to allow the general public to change their understanding of frozen shoulders. By doing so, the general public will be more inclined to seek treatment for this condition.

Reeves (1975) undertook what was considered seminal work into frozen shoulder, which has been what treatment protocol has been based on for 41 years. However Wong et al (2017) have been able to identify numerous flaws in this work. It has transpired that the volunteers in Reeves work had their shoulders immobilised for 9 months! Is it any wonder that their shoulders were stiff thereafter? it is now hypothesised that Reeves had a notion and wanted to demonstrate his idea, and skewed his study to support this! So, can people with frozen shoulders expect full "thawing", in other words: return to full movement?

In short, no! There has been no longitudinal studies that can demonstrate people suffering frozen shoulder recover fully. The evidence only shows improved, functional movement in the early phases (mean:12-48 months) which diminishes as time progresses. There are no guarantees of full movement.

It is important that we change our beliefs about frozen shoulders without delay. This is not a self-limiting condition that corrects itself over time. Sufferers need to be encouraged to visit their GP and physiotherapist subsequently for exercises to encourage increased range of movement. Sadly, this is not a condition that you can ignore and it will go away. If you believe you suffer from a frozen shoulder, be sure you are assessed by a clinician who is practicing the most up-to-date evidence based practice. Article. Natural History of frozen shoulder: fact or fiction? A systematic review. Wong et al (2017) is available from physiotherapy. I have a hard copy if anyone is interested.