Frozen Shoulder in Athletes

An all-too-common malaise that is faced by many athletes is the pain of a frozen shoulder. This injury is often experienced following excessive use of the arm and shoulder during workouts and/or during competition or may even simply arise suddenly with little indication as to how the injury occurred.

What Is Frozen Shoulder?

Frozen shoulder is the gradual development of stiffness and pain in and around the shoulder joint area. This stiffness and pain are caused by the inflammation of the joint capsule of the shoulder. 

Frozen shoulder pain is often felt when rotating the shoulder joint or moving one’s arm away from the body. This pain causes limited reaching of the arms above the head or to the side. 

The initial stiffness and pain of a frozen shoulder often lead to the patient reducing shoulder movement, which in turn causes contraction of the joint capsule and decreased elasticity. As the joint capsule shrinks, it diminishes the protective lubricating fluid (synovial fluid) that is present between the upper arm bone (the humerus) and the joint capsule.

As the condition progresses, this joint capsule thickens, becomes inflamed and eventually inelastic. This results in the formation of thick bands of scar tissue forming between the joint capsule and the head of the humerus. 

These bands of scar tissue are referred to as adhesions and are the reason for the medical term for frozen shoulder – Adhesive Capsulitis (AC). 

Who Is at Risk of Developing Frozen Shoulder?

Frozen shoulder is predominantly felt by women (4 times more often) between the ages of 40 – 70. People with vascular diseases, diabetes, cancer, and Parkinson’s Disease are also at higher risk. 

It’s important to note here that people with diabetes are at a significantly higher risk compared to the other diseases. This is thought to be because diabetics have an increased formation of collagen due to having a high blood sugar level. This excess collagen goes on to form more numerous and thicker adhesions that are responsible for frozen shoulder.

Individuals who have bad posture or are immobile for long periods due to fractures, broken bones or other sports-related injuries are also at greater risk of developing frozen shoulder.

However, this does not mean that young people, including male athletes, are not at risk. It has been documented that athletes whose workout regime focuses on excessive pectoral (chest) and deltoid (shoulder) training can sometimes increase the risk of frozen shoulder. It is recommended to include periods of stretching before and after exercising to prevent damage to these muscles and the development of a frozen shoulder.

Athletes who are most at risk of frozen shoulder are those who use these muscles the most. Athletes playing games or participating in activities such as tennis, ping-pong, badminton, squash, rock climbing, golf, baseball, volleyball, and swimming will find themselves at the greatest risk. Essentially, any activity that requires intense use of the upper body.

Can You Stop Frozen Shoulder From Progressing?

There are three different phases of frozen shoulder; the freezing phase, frozen phase, and thawing phase. It is possible to accelerate the transition from each phase, shorten the time spent in each, and even stop frozen shoulder from progressing if treated quickly and adequately.

• The Freezing Phase (Stage One)
  This is the primary stage whereby the shoulder begins to stiffen up or freeze, and pain is experienced upon movement of the arms and shoulder. Pain will continue to worsen during this phase as the shoulder gets more and more stiff. This phase can last anywhere between 2 to 9 months on average.
  
• The Frozen Phase (Stage Two)
  This is the intermediate stage when pain begins to teeter off, but stiffness continues to increase, and those suffering will find their range of movement reduced tremendously. This phase can last anywhere between 4 to 12 months on average.
• The Thawing Phase (Stage Three)
  This is the final stage and is the beginning of the healing process. Range of movement will improve, and there will be almost no pain at all. This phase can last anywhere between 12 to 42 months on average.
  A small percentage of people may not fully regain the complete range of movement of their shoulder even at the end of this phase.

What Treatments Are There for Frozen Shoulder?

There are various forms of treatments available to help stop frozen shoulder from progressing or relieve it more quickly. These treatments are in the form of oral medication, injections, home remedies and physiotherapy.

Doctors will typically prescribe anti-inflammatories, muscle relaxants, and pain killers in the form of tablets to be taken orally to help alleviate symptoms in an attempt to move through the freezing and frozen phases more quickly. 

Besides oral medication, one increasingly popular treatment is cortisone injections. Cortisone is an anti-inflammatory medication that reduces swelling and scarring. It has been found that this form of treatment is best administered during the early stages of the condition. 

Nerve Blocks are also another injection style treatment to relieve frozen shoulder. With these injections, a small injection of local anaesthetic above the spine of the scapula is made, and an infiltration of a long-acting local anaesthetic around the suprascapular nerve is given. 

The long-lasting anaesthetic is usually given in combination with cortisone to reduce the sensitivity of the nerve, thereby reducing pain. This is normally done only when other treatments have failed to provide relief. 

One home remedy that can help with the pain is applying an ice pack to the affected area for 10 -15 minutes several times a day. The cold from the ice pack slows the flow of blood, causing vasoconstriction, which relieves pain. 

The removal of the ice pack then causes vasodilation which is when the blood rushes back into the veins. The blood brings along essential chemicals to the injury site that help speed up the healing process.

Most athletes should be very familiar with physiotherapy as sports injuries are part and parcel of the job. Physiotherapy is almost always recommended together with any other treatments and ultimately will be what helps revitalise the joint capsule’s elasticity and regain the shoulder’s full range of motion. 

The journey to full recovery may be long and arduous, but it is the most effective form of treatment known for this ailment.  

What Happens if Frozen Shoulder Is Not Treated?

A frozen shoulder may go away on its own if left untreated, but it may also increase the risk of a permanent loss of a full range of motion after the thawing stage. It could also lead to other ailments developing, such as tendonitis and neck pain – which often may only be resolved with surgery. 

Capsular Release is a minimally invasive surgery whereby the tight capsular tissues surrounding the shoulder joint are cut and then cauterised. The surgery is performed under local or general anaesthetic. 

Recovery time varies, but one can expect to fully recover from 6 weeks to 3 months after the surgery. Doctors will generally recommend not exerting or using the shoulder to carry things or reach above the head for a minimum of 2 weeks.

What Movement or Activities Aggravate Frozen Shoulder?

Contrary to what most might think, keeping your shoulder immobile will worsen your condition. This will increase the number of adhesions that form and extend the period by which your shoulder will hurt and be stiff. 

This also does not mean that you should expose the shoulder to pulling, jerky or jarring movements, as these kinds of motions can put extra stress on your tendons and lead to the development of tendonitis. 

The secret here is to find a balance.

What Are Some Exercises for Frozen Shoulder?

There are several different types of arm and shoulder exercises that can help increase your mobility and heal your frozen shoulder more quickly. 

These exercises range from various kinds of stretching movements that make use of the arms, shoulders, and elbows. As mentioned, physiotherapy is the best-known form of treatment for getting your shoulder unfrozen and back into shape in the fastest time possible.