Massage Therapy for Frozen Shoulder

What the research says...

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain and stiffness in the shoulder joint, leading to limited range of motion. Research has shown that various manual therapies, including massage therapy, joint mobilizations, myofascial release, trigger point therapy, and stretching, can be beneficial in managing frozen shoulder.

Incorporating stretching and exercise into treatment plans, which is generally within the scope of massage therapy, has been found to be beneficial for frozen shoulder. Muscle energy technique (MET) has been shown to effectively improve range of motion, functional ability, and pain in patients with frozen shoulder (Mallick et al., 2023). Moreover, therapeutic exercises combined with mobilization therapy have been recommended for reducing pain, improving range of motion, and enhancing function in patients with stages II and III frozen shoulder (Ibrahim et al., 2020).

Joint mobilization techniques, which are in the scope of practice of massage therapy in some jurisdictions, have been studied for effectiveness in treating frozen shoulder. Studies have indicated that adding mobilization to stretching can improve outcomes for individuals with frozen shoulder (Çelik & Mutlu, 2016). Joint mobilization techniques have also shown promise in managing frozen shoulder by improving range of motion and reducing pain (Çelik & Mutlu, 2016). Additionally, Maitland techniques, which involve joint mobilization, have been found to be effective in treating idiopathic shoulder adhesive capsulitis (Kumar et al., 2012).

Myofascial release (MFR) and trigger point therapy have been investigated for their impact on frozen shoulder. Stuck-moving needle acupuncture myofascial trigger point therapy has been shown to be effective in improving pain and movement limitation in patients with idiopathic frozen shoulder (Bai et al., 2020). Furthermore, the additional effect of trigger point therapy and myofascial release has been studied in the second stage of frozen shoulder among industrial workers, demonstrating positive outcomes (Nambi & Kamal, 2017).

Overall, manual therapies such as massage therapy, joint mobilizations, myofascial release, trigger point therapy, stretching, and exercise play a crucial role in the management of frozen shoulder. These modalities can help improve range of motion, reduce pain, and enhance functional outcomes in individuals with this condition.

Reviewed by Predrag Jancic, MD

References

Does adding mobilization to stretching improve outcomes for people with frozen shoulder? A rand...

“…Management of frozen shoulder has been attempted via many strategies, including joint mobilization, which improves tissue extensibility, increases the range of motion, modulates pain, reduces soft tissue swelling and inflammation, increases synovial fluid levels, and stimulates peripheral mechanoreceptors. 1, 7 Furthermore, there is growing evidence supporting the effectiveness of joint mobilization techniques in the management of frozen shoulder. Most reports in the literature either compare different mobilization techniques to each other or compare joint mobilization to physical therapy modalities.…”

Derya Çelik, Ebru Kaya Mutlu 2016

Clin Rehabil

Effectiveness of Maitland Techniques in Idiopathic Shoulder Adhesive Capsulitis

"…Objective. To study the effectiveness of Maitland techniques in the treatment of idiopathic shoulder adhesive capsulitis. Methods. total of 40 patients diagnosed with idiopathic shoulder adhesive capsulitis were recruited and randomly allocated into two groups. In Group A (n = 20) subjects were treated with Maitland mobilization technique and common supervised exercises, whereas subjects in Group B (n = 20) only received common supervised exercises. Variables. Shoulder pain and disability index (SPADI), VAS and shoulder ROM (external rotation and abduction) were variables of the study. These were recorded before and after the session of the training. Total duration of the study was four weeks. Result. Statistical analysis of the data revealed that within-group comparison both groups showed significant improvement for all the parameters, whereas between-group comparison revealed higher improvement in Group A compared to the Group B. Conclusion. The study confirmed that addition of the Maitland mobilization technique with the combination of exercises have proved their efficacy in relieving pain and improving R.O.M. and shoulder function and hence should form a part of the treatment plan.…”

Abhay Kumar, Suraj Kumar, Ambili Anoop et al. 2012

ISRN Rehabilitation

Stuck-moving needle acupuncture myofascial trigger point to treat idiopathic frozen shoulder: study

“…Our pilot study showed that stuck-moving needle was used to acupuncture myofascial trigger point and was effective in improving the pain and movement limitation of the patients with idiopathic frozen shoulder. Physical exercise programs are widely used to resolve the shoulder joint pain which ultimately limits the frozen shoulder, and considered as the effective basic therapy [ 14 ] which is also supported by clinical evidences [ 13 ]. This information permits the use of physical exercise programs as the basic therapy for a control treatment.…”

Yang Bai1, Ying Wang2, Bo Chen3 et al. 2020

Trials

Additional effect of trigger point therapy and myofascial release on second stage Frozen shoulder am

"Introduction and Objective: Frozen shoulder syndrome is a common condition that usually affects 2-5% of the industrial population, typically between 40-60 years of age. Most studies analyzed on the basis of a single intervention, and did not examine combinations of interventions. The aim of this work was to examine two different massage techniques, trigger point therapy and myofascial release technique, in the second stage of frozen shoulder, in order to reduce pain and increase range of motion.

Patients: The study included 30 industrial workers with stage 2 unilateral frozen shoulder of 3 or more months' duration and a decrease in passive joint range of motion of 25% of total joint range of motion compared to the range of motion of the other side. .

Methods: Eligible patients voluntarily agreed to participate in the study, and were randomly assigned to two groups, A and B. Group A was treated with trigger point therapy, myofascial release technique, scapular stabilization exercises, and interference therapy (IFT). , and Group B was treated only with scapular stabilization exercises and IFT. The length of treatment was 4 weeks, and the degree of joint mobility was assessed at the beginning and 4 weeks after the start of the respective therapy. Outcome measures included the Visual Analogue Scale (VAS) and range of motion (ROM) using a goniometer.

Results: Patients in both groups improved during the 4 weeks after the intervention. A significant difference was found when comparing both groups after 4 weeks in both VAS and ROM parameters. But a statistically significantly higher change score was found in Group A for VAS and ROM than in Group B.

Discussion and conclusion: The treatment applied to groups A and B was effective in reducing pain and improving range of motion (ROM) in patients in the second stage. frozen shoulder. However, patients in Group A, who had trigger point therapy and myofascial release technique, showed better progress in pain reduction and ROM progression than in Group B. In conclusion, it can be said that the treatment that consisted of trigger point therapy and myofascial release technique was more effective in reducing pain and improving range of motion in the second stage of frozen shoulder syndrome among industrial workers. (translated by Google translate)"

Gopal Nambi, Walid Kamal 2017

Sanamed

Effects of muscle energy technique on improving the range of motion and pain in patients with frozen

“…Introduction and Aim: Muscle Energy Technique (MET) is a type of manual treatment that utilises the energy of the muscle in the form of a mild isometric contraction to stretch the muscle and relax the muscles through reciprocal or autogenic inhibition. An idiopathic ailment of the shoulder joint known as frozen shoulder is characterised by a rapid onset of shoulder discomfort and a limitation in mobility. Much research has been conducted to determine how various manual approaches affect shoulder discomfort. This study focuses on how MET affects pain and range of motion during the initial stages of rehabilitation. Materials and Methods: Patients who are diagnosed with frozen shoulders with fulfilling the inclusion and exclusion criteria were selected for the study. In the current study, thirty patients who had a prevalence of musculoskeletal complications of the frozen shoulder were selected. Out of which eighteen are male and twelve are female. To identify the prevalence each patient's range of motion and VAS Score for pain sensation were recorded. The same patients have been introduced to MET for another seven days. MET includes 5 repetitions/sets, 3 sets/session, and 1 session/day. A statistical test was performed to identify the significant difference between pre and post-values. Results: Most of the patients had an average range of motion (Flexion) (of 132±18.96), range of motion (Abduction) of (107.00±12.77), range of motion (Rotation) of (63.50±9.39) and VAS score was (5.96±1.29). Most patients showed the improvement in range of motion and a decrease in pain sensation as per the VAS Score. Conclusion: This study shows that MET effectively improves the range of motion and functional ability, relieving pain in Frozen Shoulder patients in the early stage of rehabilitation. …”

Deepak Kumar Mallick, Sohini Paul, Tirthankar Ghosh3 2023

Biomedicine

Comparative Study of the Combined Effect of Therapeutic Exercises and Mobilization between Stage II

“…The findings of current study agree with that of Jain and Sharma (2014) [31] who concluded that therapeutic exercises and mobilization therapy are strongly recommended for reducing pain, improving ROM and function in patients with stages II and III frozen shoulder. In addition to that present study agrees with the work of Neviaser & Hannafin (2010) [32] who recommend stage-based treatment protocol for FS and recommended passive joint glides to increase capsular mobility and active exercises aimed at preserving motion for stage II frozen shoulder patients.…”

Ola I. Ibrahim, Salwa F. Abdel-Majid, Walid R. Mohamed et al. 2020

The Medical Journal of Cairo University