Treating Frozen Shoulder

By Marcie Bower, Lic.Ac.

This post is copied from our older, original blog. Original post date 10/1/2014.

Frozen Shoulder, or “adhesive capsulitis” refers to a painful musculoskeletal condition characterized by pain and stiffness of the shoulder joint. The tendons, bones, and ligaments that make up the shoulder joint are encased in a connective tissue, fluid-filled capsule. In cases of Frozen Shoulder, this capsule thickens and tightens around the shoulder joint and/or the fluid becomes thicker, restricting movement and causing pain. It is somewhat of a medical mystery – we don’t exactly know why Frozen Shoulder occurs, and it presents differently in different people. Frozen Shoulder tends to gradually get worse with time, and then gradually gets better. Some people have symptoms for up to 2 years. For some patients, the stiffness is merely annoying – for other patients, pain levels can be incredibly severe and the pain can interfere with sleep, work, driving, and activities of daily living.  You are more likely to develop Frozen Shoulder if you are recovering from a procedure that immobilizes the joint for a period of time, such as surgery or a mastectomy. Frozen Shoulder is also more common in middle aged individuals – in certain countries in Asia it is referred to as “40-year shoulder” or “50-year shoulder.”

Frozen Shoulder is usually discussed in 3 stages: Painful Stage, Frozen Stage, and Thawing Stage.

Treatment for Frozen Shoulder often involves physical therapy, anti-inflammatory medications, and sometimes steroid injections or surgery. Manual therapies such as acupuncture and massage have also been shown to be effective treatment options. Several small research studies have shown that acupuncture may have a positive therapeutic effect in reducing the inflammation, stiffness, and pain that are hallmark signs of Frozen Shoulder.

One of the higher quality clinical research studies conducted to date was published in 2001 in the Hong Kong Medical Journal. In this randomized controlled trial, 35 patients with a diagnosis of Frozen Shoulder were randomized to exercise therapy or exercise therapy plus acupuncture, for 6 weeks. The group that received acupuncture treatment in addition to the exercise therapy improved significantly more than the group receiving only exercise therapy. A 2012 review of clinical studies for frozen shoulder decided conclusions could not be drawn about the effectiveness of acupuncture for Frozen Shoulder due to the bias in most clinical research studies. Further well-designed studies are warranted.

Therapeutic massage can also be a useful therapy for dealing with Frozen Shoulder. In addition to increasing blood flow to the joint and reducing inflammation, massage therapy can help to loosen some of the muscles around the shoulder joint that became tense and rigid with Frozen Shoulder.  A 2012 Review and Meta-analysis concluded that there is some “low-quality evidence” that massage therapy improves pain, function, and range of motion in patients with shoulder pain.

Clinically, the combination of massage and acupuncture can be useful in reducing the pain, inflammation, stiffness, and limited range of motion that individuals with Frozen Shoulder experience. At our clinic, we will also use associated therapies such as cupping therapy, gua sha, electro-acupuncture, and kinesiotaping/acutaping as appropriate for the individual patient. Treatment usually focuses on the shoulder, as well as the upper back and arm. With acupuncture, we will also usually treat the opposite leg, which includes acupuncture points that are good for releasing the musculature of the opposite shoulder and reducing pain.