A Manual Therapy and Home Stretching Program in Patients With Primary Frozen Shoulder Contracture Syndrome: A Case Series

A Manual Therapy and Home Stretching Program in Patients With Primary Frozen Shoulder Contracture Syndrome: A Case Series

Frozen Shoulder : A Case Series
By Brianna Hurt, SPT

Lirios Dueñas, PT, PhD, Mercè Balasch-Bernat, PT, PhD, Marta Aguilar-Rodríguez, PT, PhD, Filip Struyf, PT, PhD, Mira Meeus, PT, PhD, Enrique Lluch, PT, PhD

Background

Frozen shoulder is a common musculoskeletal disorder that is characterized by a progressive loss of both active and passive mobility of the glenohumeral (shoulder) joint. Muscle strength deficits in external and internal rotation are also common with this condition. Typically, frozen shoulder is thought to follow 3 phases (painful, stiff, and recovery) into a full recovery without any type of treatment. However, recent systematic reviews have found that improvements in mobility and function decrease with time, with the possibility of limitations being present for multiple years.

When managing persons with frozen shoulder, it is important to consider the level of tissue irritability (high, moderate, and low) and adapt treatment strategies based on this. Manual therapy techniques can be used to help restore normal tissue extensibility of the shoulder and help improve range of motion. To restore mobility, improving shoulder rotation should be emphasized over forcing full flexion.

The purpose of this case series was to describe outcomes after the application of manual therapy and a home stretching exercise program for persons with frozen shoulder.

Frozen Shoulder Case Description

Eleven patients diagnosed with frozen shoulder were included in the study. One physical therapist performed all of the baseline measurements and follow up assessments. Measurements were taken before the intervention period, after the 3 month intervention period and at 3 and 6 months after the intervention period. A second physical therapist conducted all of the manual therapy techniques.

Baseline measurements included shoulder pain and disability, range of motion and muscular strength. For the treatment sessions, patients received a 12-session treatment program with treatments lasting 60 minutes, scheduled once a week over 12 weeks. The intervention program consisted of manual therapy techniques based on tissue irritability and shoulder mobility and home stretching exercises.

 Outcomes

For the shoulder pain and disability outcome measures, 8 out of the 11 patients showed improvements in pain by 9 months posttreatment and all but one patient improved in their shoulder disability at posttreatment. For range of motion, there were improvements in shoulder flexion, abduction and external rotation at posttreatment in up to 9 patients. For strength measurements, 8 of 11 patients had improvements in shoulder flexion and internal rotation strength at posttreatment, however, none of the patients had improvements in external rotation strength.

 Conclusion

When treating patients with frozen shoulder, a multimodal manual therapy approach along with a home stretching program based on tissue irritability and specific shoulder mobility impairments should be used. This approach results in reduced shoulder pain, improved range of motion and increased strength.

Physical Therapy First Approach to Frozen Shoulder Treatment

Here at Physical Therapy First, a complete evaluation is conducted and based on those findings a specific treatment plan is designed that best addresses our patient’s needs. Treatment plans typically include advanced manual therapy joint mobilization techniques, soft tissue mobilization, stretching, therapeutic exercises and providing our patients with a unique home exercise program to maximize outcomes. We offer individualized home exercise routines that can be updated and followed by patients on a user friendly app.  Patients at Physical Therapy First can also benefit from a variety of modalities as well as myofascial trigger point dry needling treatment to muscles as indicated.  Our goal is to provide quality patient care and as this study suggests, a manual therapy approach with home stretching can be used to improve pain, mobility, strength and function in those with frozen shoulder.

Original Article

Dueñas L, Balasch-Bernat M, Aguilar-Rodríguez M, Struyf F, Meeus M, Lluch E. A Manual Therapy and Home Stretching Program in Patients With Primary Frozen Shoulder Contracture Syndrome: A Case Series. Journal of Orthopaedic & Sports Physical Therapy. 2019;49(3):192-201. doi:10.2519/jospt.2019.8194

Low-Impact Pinched Nerve Exercises

Back stretches for pinched nerves:

Side bends

  • Start in a standing position with your hands on your hips.
  • Maintain straight posture.
  • Gently stretch your lower back by leaning to the left and the right. Perform five side bends towards each side of your body.

Twist

  • Start in a sitting position while placing the legs at shoulder width.
  • Placing your left hand on your right knee and pull your body forward to gently stretch your back muscles.
  • Hold for five seconds then repeat on the opposite side.

Shoulder shrugs

  • Perform in a standing position.
  • Keeping both arms at your sides, shrug your shoulders backwards in a rotating motion.
  • Return to the original position in a similar movement from the opposite direction. Perform a set of 15.
  • Take a 30 seconds break between each set.

After light stretching, consider low-impact aerobic exercise such as walking, cycling and swimming. These activities will increase blood circulation to the damaged nerve, facilitating healing and reducing the pain associated with a pinched nerve. Try to avoid high-impact exercises that cause you to repeatedly twist your spine. You don’t have to give up on your favorite work outs, but try to substitute them with a low-impact, comparable exercise.

If you love running because it challenges you and helps you build endurance, try cycling instead. You can still set and surpass personal records for speed and/or distance! Unlike running, cycling won’t make your spine absorb the shock of impact every time your foot strikes the ground.
If play competitive contact sports, give swimming a shot. This low impact aerobic exercise is a great full-body workout, and you can still seek out a competition by participating in relays or races amongst your friends.

If you relied on group exercise classes to get your blood pumping, look for a yoga class. Moving from one yoga pose to the next in smooth succession can get your blood flowing in a group setting, but you won’t have to worry about high impact movements like box jumps, kettlebell swings, jumping rope, etc. Yoga can help you increase your flexibility and strengthen the muscles in your neck and back, also helping you facilitate the results of your pinched nerve treatment.

Still experiencing pain? Contact us.

*As a reminder, always discuss any questions or concerns with your physician regarding your own health and dietary needs, as the information written should not replace any medical advice.

Think You Have a Pinched Nerve?

Signs and symptoms of a pinched nerve include:

  • Tingling
  • Burning
  • Numbness
  • Pain
  • Muscle weakness (especially in the arms/hands if you have a pinched nerve in your neck)
  • “Pins and needles”
  • The area may feel like it has “fallen asleep”

You may experience worsened symptoms when lying down or after just waking up. Pinched nerves can be caused by poor posture, staying in the same position for too long, or repetitive motions.

Consider These Home Remedies to Provide Relief:

  1. Be conscious of posture
    • The Problem: Our bodies are designed for very specific movement patterns. If you’re continuously sitting or standing with poor posture for extended periods of time, you’re putting unnecessary stress on your body, which may damage your muscles or spine, eventually leading to a pinched nerve.
    • The Solution: watch your posture. Try using cushions, neck rests, or adjustable chairs to relieve pressure and give the nerve a chance to heal. If possible, try not to remain in the same position for too long and avoid crossing your legs.

  2. Ice and heat packs
    • The Problem: Pinched nerves are a result of swelling and inflammation that compress the nerve. Imagine squeezing a straw and then trying to drink from it.
    • The Solution: try alternating between heat and ice packs to reduce swelling and inflammation. The combination of hot and cold increases the circulation of fresh blood to the area, which may help relieve pain. Hold an ice pack over the affected area for about 15 minutes at a time, three times a day to help reduce inflammation. Heat pads can be applied for a longer period, up to 1 hour, three times a day.
  3. Lifestyle changes
    • The Problem: Being overweight or inactive can add increased stress to the body, leading to inflammation and pressure on the nerves.
    • The Solution: In the long-term, adding a low-impact exercise, such as walking, swimming, or bicycling, to a daily regimen may help reduce symptoms and keep the body in shape. Stretching before or after low-impact exercises can help keep the body flexible and reduce pressure and inflammation near the nerves. For some ideas for a low impact workout, you can check out our low impact routine by clicking the image below:

*As a reminder, always discuss any questions or concerns with your physician regarding your own health and dietary needs, as the information written should not replace any medical advice.

Four Tests to Determine if You Have a Pinched Nerve in Your Neck

If you have any of the following symptoms, you may be suffering from a pinched nerve:

  • Pain in the neck that radiates beyond your elbow or to your fingertips
  • Shoulder blade pain
  • Hand, arm, or shoulder weakness
  • Dull aches, numbness, or tingling
  • Pain aggravated by neck movements

If you have any of the aforementioned symptoms, administer this self-movement test to help you determine if a pinched nerve is the cause of your pain:

  1. Arm tension test:
    • First, perform this test on your non-painful arm to determine the natural range of comfortable motion.
    • Extend your non-painful arm directly in front of you, keeping your wrist straight and in-line with your arm.
    • Turn your wrist outward, so your palm is facing away from your body.
    • Extend your arm to the side as far as you can comfortably go. By the end of this movement, your position should look like the image below:
    • Try the same movement with your painful arm. By the time you extend your wrist, if you begin to feel increased symptoms on the path throughout the arm or in the neck, then stop. You have tested positive for arm tension.
    • If you still do not feel increased symptoms, then continue to extend your arm out to the side.
    • If you feel pain, numbness, or tingling in the arm as you extend it, and/or you cannot extend it as far as the non-painful arm, then you have tested positive for arm tension and should continue to the next test.
    • If you did not experience symptoms or limited range of motion throughout this test, then stop. It is likely that the source of your pain is not a pinched nerve.
  2. Neck compression test:
    • You should continue to this test if you tested positive for arm tension. Once again, you want to begin on your non-painful side to get a good baseline.
    • Tilt your head to the non-painful side (if your left side is your good side, then tilt your head to the left and vice versa).
    • Keeping your head titled, rotate your head outwards slightly, as if you were looking over your shoulder
    • Hold this position for 30-60 seconds.
    • Perform the same movement to the painful side
    • If you feel neck pain, pain or tingling that radiates down the arm, or numbness, then you have tested positive.
  3. Head turn test:
    • If you have tested positive for both tests so far, perform this test on your non-painful side first.
    • Turn your head to the non-painful side and hold it there for a few seconds. You should have full motion and no pain.
    • Turn your head to the painful side and hold it there for a few seconds. If you have limited motion or cannot turn your head as far on this side as you could on your non-painful side, then you have tested positive.

  4. Relief test:
    • For this test, you will want to see if relieving tension on the nerve will reduce your symptoms. You can do this by tilting your head AWAY from the painful side (similar to the compression test).
    • Use your non-painful arm to hold it there up to a minute
    • Ask yourself if this relieves your symptoms. Do you feel less numbness and tingling in the arm? Or warmth as if your arm is regaining sensation?

If you have tested positive for all four of these exercises, then it’s likely that a pinched nerve may be the source of your pain. If you tested positive, then you may be interested in these home remedies for nerve pain.

*As a reminder, always discuss any questions or concerns with your physician regarding your own health and dietary needs, as the information written should not replace any medical advice.

Exercises for Toddlers

Although the colder months are quickly approaching, it is still important for you and your family to stay physically active. We’ve previously highlighted exercises that kids can perform using an exercise ball,  and today’s post will focus on simple exercises for toddlers that you can enjoy together. These exercises can encourage your toddler to stay active in a fun and engaging way!

Exercises for Toddlers #PTtip Video

The exercises demonstrated within our #PTtip video include:

  • Seated Hands to Toes Stretch
  • Butterflies
  • Jumping Jacks
  • Frog Hops
  • Wheel Barrow
  • Row-your-Boat

Healthy Diet

In addition to staying active, a diet filled with nutrient rich foods is important for maintaining a healthy lifestyle. Not only can we make physical activity fun and engaging, but healthy eating as well! The holiday season is just around the corner, so now is a great time to get creative in the kitchen. You can make festive healthy foods for you and your family to enjoy together. Fruits and vegetables are also an important part of a healthy diet. However, it may be difficult to convince your picky toddler to eat them. Parents should consider using cookie cutters to make fun shapes out of fruits and vegetables, such as pumpkin shaped sweet potato rounds or snowmen-shaped banana or apple slices. Star or snowflake shaped zucchini or cucumber slices are also another fun way to serve vegetables!

Make sure you watch the PTtip video to learn how to properly perform the above exercises, and if you have any questions or would like to make an appointment with one of our physical therapists, give us a call today at 1-855-PT-FIRST!

 

 

 

 

 

 

 

*As a reminder, always discuss any questions or concerns with your physician regarding your own health and dietary needs, as the information written should not replace any medical advice.

Tips for Relieving Back Pain during your Daily Routine

We hope everyone has been enjoying the fall season! These tips are your first steps to relieving back pain if you experience it throughout the day. If you missed our first post on back pain, which offered three simple stretches for the lower back, you can view it here. The tips provided today within our PTtip video easy to implement and focus on a variety of different circumstances that may contribute to back pain:

The tips offered within our PTtip video focus on relieving back pain by:

  • Using a pillow while sleeping for lumbar support and to relieve knee, hip, & lower back pain.
  • Carrying one’s bag, purse, or briefcase properly to avoid catering to one side of the body.
  • Viewing one’s cellphone screen with proper posture to relieve upper cervical spine pain.
  • How to relieve lower back pain when standing for prolonged periods of time.

Relieve Your Back Pain with These Tips

 

Don’t Forget Healthy Eating

The winter season is approaching and it is a popular time for fall related activities like visiting a local apple orchard or pumpkin patch. There is still time to experiment with different in-season fruits and vegetables that are now at their peak!

One in-season vegetable to consider trying are Brussels sprouts. High in vitamin C and a good source of dietary fiber, Brussels sprouts can be enjoyed in a variety of ways. For example, you can roast them in the oven with a drizzle of olive oil and your favorite spices, or even steam them before adding them to your favorite pasta, stir-fry, or salad dishes!

Of course, it wouldn’t be the fall season without mentioning pumpkin. Pumpkin is an excellent source of vitamin A and vitamin C. Pumpkin can be enjoyed in many ways, either in its whole or pureed form. So, if you’re interested in experimenting with pureed pumpkin, consider making homemade baked goods such as bread or muffins, blending pumpkin into a festive fall smoothie, or even homemade making pumpkin soup- perfect to try during the colder temperatures!

Make sure you watch the PTtip videos to learn different ways to help with relieving back pain, and if you have any questions or would like to make an appointment with one of our physical therapists, give us a call today at 1-855-PT-FIRST!

 

 

 

 

 

 

 

 

 

 

 

*As a reminder, always discuss any questions or concerns with your physician regarding your own health and dietary needs, as the information written should not replace any medical advice.

 

 

References

Produce for Better Health Foundation. (n.d.) Brussels Sprouts. Nutrition. Selection. Storage. Retrieved from https://www.fruitsandveggiesmorematters.org/brussels-sprouts

Produce for Better Health Foundation. (n.d.) Pumpkin. Nutrition. Selection. Storage. Retrieved from https://www.fruitsandveggiesmorematters.org/pumpkin

 

Warm Up Exercises for Runners

The fall season is a popular time for enjoying time outside, training for fall sports, and participating in road races now that the cooler, crisp temperatures are here. Whether you’ve signed up for a local running race or simply just enjoy heading outside for a run, today’s post will highlight some of our favorite warm up exercises that can be added into your workout routine before you head out for your next run:

PTtip Video Warm Up Exercises for Running

The exercises demonstrated within the PTtip video include:

  • Calf and Hip Flexor Stretch
  • Frankenstein Exercise targeting the hamstrings
  • Walking Forward Lunges with Twist targeting the lower extremity & lower back

Tip

Remember to stay properly hydrated! Keeping hydrated is just as important during the cooler months as it is in the warmer months. This may be harder to remember when you’re not sweating, or when you don’t feel as thirsty. To help you keep hydrated, try enjoying some of the fall produce that is now abundantly available. Certain fruits and veggies like broccoli and apples have a high water content.  This can help contribute to your fluid intake. Not only will they help you keep hydrated, but they will supply your body with healthy nutrients as well! For breakfast, try adding fresh apple slices to salads, yogurt, or oatmeal. For lunch or dinner, consider adding and broccoli florets to pasta, garden salads, or casserole dishes. These are just a couple of the many ways to enjoy these in-season produce options. Keeping a reusable water bottle with you is another easy way to help remind you to stay hydrated!

Make sure you watch the PTtip video to learn how to properly perform the above warm up exercises, and if you have any questions or would like to make an appointment with one of our physical therapists, give us a call today at 1-855-PT-FIRST!

 

 

 

 

 

 

 

*As a reminder, always discuss any questions or concerns with your physician regarding your own health and dietary needs, as the information written should not replace any medical advice.

Exercises for Kids using an Exercise Ball

Although the summer is over and the school year has begun, it is still important to remember to get an adequate amount of daily physical activity not only for you but your kids as well! Today on the blog, we’ll be highlighting exercises for kids using an exercise ball. Prior to sitting on and performing exercises using an exercise ball, it is important to determine which size works best for you. Therefore, make sure to watch our PTtip video where Dr. Maureen Ambrose, PT, DPT, OCS, OMPT, shares her own tips on how to choose the right size:

Exercise Ball Tips PTtip Video

Now that you know which size to choose, our PTtip video explains both how to properly sit on an exercise ball while doing schoolwork and demonstrates fun, engaging exercises using the exercise ball, such as a simple game of catch and the classic game of ‘hot potato,’ that your kids can perform that target the core, arm, and back muscles:

Exercises for Kids using an Exercise Ball PTtip Video

The fall season is officially here, and with a new season also comes an array of new in-season produce options to try! For example, you may spot a wide variety of squashes at your local grocery stores or farmer’s markets. One type of squash that is now in-season is delicata squash. Delicata squash is an excellent source of vitamin A and also a good source of vitamin C. Simply roasting in the oven by halving the squash, scooping out the seeds, and seasoning with a drizzle of olive oil can be an easy way to try this vegetable to see if you like it! Another in-season produce option to enjoy this time of year is pears. Several varieties are available, and this fruit supplies a great amount of dietary fiber. One creative way to enjoy pears is by making homemade pear sauce just as you would with apples!

Make sure you watch both PTtip videos to learn how to choose the right size exercise ball and how to properly perform exercises that your kids can do with an exercise ball. If you have any questions or would like to make an appointment with one of our physical therapists, give us a call today at 1-855-PT-FIRST!

 

 

 

 

 

 

 

 

 

 

 

 

References

Produce for Better Health Foundation. (n.d.). Delicata Squash: Nutrition. Selection. Storage. Retrieved from https://www.fruitsandveggiesmorematters.org/delicata-squash-nutrition-selection-storage

Produce for Better Health Foundation. (n.d.). Pear: Nutrition. Selection. Storage. Retrieved from https://www.fruitsandveggiesmorematters.org/pear

 

 

 

 

*As a reminder, always discuss any questions or concerns with your physician regarding your own health and dietary needs, as the information written should not replace any medical advice.

Lower Body Exercises

We hope September has been off to a great start for everyone! Last month’s post highlighted several quick and easy lower body exercises that you can incorporate into your exercise routine. In case you missed it, you can read it here.

For today’s post, we’ll be sharing additional exercises that specifically target the lower body. Try adding these into your exercise routine for a revamped workout!

The Lower Body Exercises Demonstrated Within the Video Include:

  • Lower Leg Stretch with a Thera-Band
  • Heel Raises with and without Weights
  • Farmer’s Walk on Toes
  • Pivoting Curtsy Lunge
  • Dumbbell Split Jumps

Leg Exercises PTtip Video

 

Additional Tip

Now that September is officially here, many of us are gearing up for the upcoming football season. Are you planning on hosting weekly game day gatherings to cheer on your favorite team? If so, consider incorporating healthier versions of your favorite game day snacks! These are not only tasty, but easy-to-make as well! There are several varieties of apples available throughout the fall months. One creative way to incorporate them into your game day party is by baking homemade apple chips. You can also bake homemade chips using sweet potatoes, another in-season produce option! Another idea to consider is baking sliced zucchini topped with tomato sauce and a sprinkle of cheese to serve as mini ‘pizza’ bites. Lastly, cauliflower is highly versatile and can be another great option to incorporate when planning your menu. An easy way to enjoy cauliflower is by oven-roasting florets and seasoning them with your favorite spices and Parmesan cheese!

Make sure you watch the PTtip video to learn how to properly perform the above exercises, and if you have any questions or would like to make an appointment with one of our physical therapists, give us a call today at 1-855-PT-FIRST!

 

 

 

 

 

 

 

*As a reminder, always discuss any questions or concerns with your physician regarding your own health and dietary needs, as the information written should not replace any medical advice.

 

How to Use a Suspension Trainer

 

Today we’ll be highlighting another great tool that can be added to your exercise routine: a suspension trainer. Commonly referred to as TRX, the suspension trainer can be a great tool for using your own body weight as resistance.

In our PTtip video, Dr. Alex Tan, PT, DPT, demonstrates how to perform a full body workout with the use of a suspension trainer:

How to Use a Suspension Trainer PTtip Video

With the recommended tips for each exercise:

*Always make sure the suspension trainer is securely attached to your doorframe before beginning any exercise*

Suspension Trainer Rows:

  • While holding the handles of the trainer in each hand, keep your feet flat on the floor, and slowly lean back with your arms straight out in front.
  • In a slow and controlled movement, pull yourself toward the door and then slowly come back to start.
  • Perform 3 sets of 15 repetitions.
  • For added resistance and difficulty, you can increase the angle in which you’re leaning back.
  • For an even greater challenge, you can perform the row with one arm while adding a trunk rotation, as demonstrated in the video.
  • Again, aim for 3 sets of 15 repetitions.

Suspension Trainer Squats Tips:

  • Good for helping to perfect your squat form, as the suspension trainer allows you to sit back into the squat.
  • While holding the handles of the trainer in each hand, remember to keep your movement nice and controlled when lowering down.
  • Aim for 3 sets of 15 repetitions.
  • Single Leg Squats Tips:
  • If regular squats are no longer a challenge for you, you can switch to single leg squats.
  • Again, aim to sit back into the squat as you come down and to not inch forward where your knee comes past your toes.

External Rotation Strengthening of the Shoulder:

  • While holding the handles of the trainer in each hand, start with your arms up at your sides and pull your hands backward in order to pull yourself forward, as shown in the video.
  • Perform 3 sets of 15 repetitions.
  • Again, remember to keep your movements nice and controlled.

Additional Tip

Although the start of a new school year can be a busy (and exciting!) time, it’s still important to make sure you and your family are maintaining a well-balanced healthy diet. This includes starting your day with a nutritious breakfast. When you’re crunched for time in the morning, consider homemade breakfast parfaits. You can make these with ingredients like Greek yogurt, nuts, your favorite fruit, whole grain cereal, and a dash of cinnamon and vanilla extract for added flavor!

Homemade breakfast wraps or sandwiches are another option to consider. These are quick and easy to prepare, especially if you plan ahead! Sandwiches made with a whole-grain wrap, English muffin, or bread, eggs, and a sprinkle of shredded cheese make for a tasty breakfast option. Sneak some spinach or sliced tomatoes into your sandwich for added veggies and nutrients!

A new season is approaching which means an array of new in-season produce will be available soon, so be on the look out for new fruits and vegetables to incorporate into your diet!

Make sure you watch the PTtip video to learn how to properly perform the above exercises, and if you have any questions or would like to make an appointment with one of our physical therapists, give us a call today at 1-855-PT-FIRST!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*As a reminder, always discuss any questions or concerns with your physician regarding your own health and dietary needs, as the information written should not replace any medical advice.