Frozen Shoulder Exercises aim to reduce pain, ncrease extensibility of the capsule, and improve strength of the rotator cuff muscles.

The basic aim of exercises are:

• To reduce pain.
• To increase extensibility of the thickened and contracted capsule of the joint at the anteroinferior border and at the attachment of the capsule to the anatomical neck of humerus.
• To improve mobility of the shoulder.
• To improve strength of the muscle. However it may be remembered that strengthening of muscle is secondary to mobilization.

Mobilization is attained by 3 basic approaches:

• Relaxation
• Passive mobilization technique
• Specific shoulder exercises to offer graduated stretching.

Relaxation

Though prior heating of the joint has been found to facilitate relaxation and mobilization, one may use the heat modality suitable to the patient's response. However ultrasound, beside deep heating, has the added advantages of increasing excitability of the contracted soft tissue and is therefore performed.

Relaxed Passive Mobilization

The patient is placed in supine position with the affected shoulder in maximum possible abduction and neutral rotation and elbow in 90 degree of flexion. The physiotherapist grasping the arm above the shoulder joint carries out relaxed passive gliding movement of head of humerus on glenoid. Axial traction and approximation is carried out along with antero-posterior glide and abduction- adduction glide. To induce relaxation, always begin with slow rhythmic movement.

Slow and rhythmic circumduction at the glenohumeral joint, in forward stoop position effectively induces relaxation and promotes mobility. Gentle relaxed passive movements reduces pain and pathologic limits of motion. The reduction in pain occurs because of the neuro-modulation effect on the mechanoreceptors with in the joint.

Mobilization by accessory movements of acromio-clavicular, sterno-clavicular and/or scapulo-thoracic joint articulation is also extremely helpful.
Exercise Programme

Frozen shoulder exercises plays an important role in management of the condition. While planning the frozen shoulder exercises one must give due importance to the fact that contracted soft tissue when objected to repeated prolong mild tension show extensibility and plastic elongation.

An increase in the movement following the session of prolonged stretching was usually associated with a corresponding increase in the other movements too. However improvement in the range of other movements is not always at the same rate.

The specific Frozen shoulder exercises should include the maximum number of combination of various movement by minimising the number of exercises. Graduated relaxed sustained stretching based on the PNF pattern are following types:

    1) Shoulder elevation with flexion, abduction and external rotation.
    2) Shoulder internal rotation with extension, adduction and elbow flexion i.e attaining "hand to lumbar position".

The above mentioned Frozen shoulder exercises can be done in two ways:

    1) By weight and pully- Tolerable weight must be used. This may be done in supine or sitting position.
    2) By self assisted stretching- Method of performing is, the patient uses his normal or contralateral arm for gradually stretching the affected shoulder.

Passive Mobilization Technique

For this, manipulation and mobilising techniques are given by"MAITLAND". By this patient respond very well for acquiring full range by properly guided simple and specific Frozen shoulder exercises which ensures relaxed graduated stretching of the contracted capsule.

Frozen Shoulder Exercises for Home and Cautions:

The importance or necessity of regular stretching must be explained to the patient even after he has recovered from stiffness and pain to avoid the recurrence of periarthritis or stiffness.

Patient having diabetes responds very slow to the treatment and also feel much more pain as compared to those who are non-diabetic.

Patients who complain of pain in the night (nocturnal pain) should be treated by heat therapy or thermo therapy.

The contralateral or normal shoulder should always be examined and given regular stretching exercise programme as a precautionary measure to maintain its functional capacity.