Physiotherapy for Shoulder Injuries: Rotator Cuff Tears and Frozen Shoulder

 

Physiotherapy for Shoulder Injuries: Rotator Cuff Tears and Frozen Shoulder

Introduction

Shoulder injuries are common in both athletes and the general population due to overuse, trauma, or age-related degeneration. Two of the most frequent shoulder problems are rotator cuff tears and frozen shoulder (adhesive capsulitis). These conditions can lead to pain, limited range of motion, weakness, and difficulty performing daily activities.

Physiotherapy is a cornerstone of shoulder rehabilitation, helping patients restore mobility, reduce pain, and regain strength without surgery in many cases. Even post-surgical patients benefit significantly from structured physiotherapy programs.

Understanding Shoulder Injuries

1. Rotator Cuff Tears

• Definition: Partial or complete tear of one or more of the four rotator cuff muscles: supraspinatus, infraspinatus, teres minor, subscapularis.
• Causes: Repetitive overhead activities, trauma, age-related degeneration.
• Symptoms: Shoulder pain, weakness, difficulty lifting the arm, clicking or popping sounds.

2. Frozen Shoulder (Adhesive Capsulitis)

• Definition: Stiffening of the shoulder joint capsule causing pain and restricted movement.
• Causes: Often idiopathic; may occur after injury, surgery, or prolonged immobilization.
• Symptoms: Painful restriction of both active and passive shoulder movements, especially abduction and rotation.

Goals of Physiotherapy in Shoulder Injuries

1. Reduce Pain and Inflammation: Alleviate discomfort and improve function.
2. Restore Range of Motion (ROM): Prevent stiffness and regain flexibility.
3. Strengthen Shoulder Muscles: Support injured or weakened muscles.
4. Improve Functionality: Enable safe performance of daily tasks and sports activities.
5. Prevent Re-Injury: Enhance joint stability and posture.

Physiotherapy Techniques for Rotator Cuff Injuries

1. Pain Management

• Ice or cold packs to reduce inflammation
• Heat therapy to relax tight muscles
• TENS (Transcutaneous Electrical Nerve Stimulation) for pain relief

2. Range of Motion Exercises

• Pendulum exercises: Gentle swinging of the arm to prevent stiffness
• Passive and active-assisted ROM: Therapist or patient moves the arm within pain-free range
• Wall climbs: Gradual upward movement along a wall to improve flexibility

3. Strengthening Exercises

• Resistance band exercises: External and internal rotation to target rotator cuff muscles
• Scapular stabilization: Shoulder blade exercises to improve support and alignment
• Light weights or dumbbells: Gradually increase strength without straining injured muscles

4. Functional Training

• Reaching and lifting tasks to simulate daily activities
• Sports-specific drills for athletes (throwing, overhead lifting)

5. Post-Surgical Rehabilitation

• Early passive movements to prevent stiffness
• Gradual strengthening once healing allows
• Focus on regaining full ROM and functional independence

Physiotherapy Techniques for Frozen Shoulder

1. Pain Relief

• Ice or heat therapy depending on patient comfort
• Gentle massage to relieve muscle tension

2. Range of Motion Exercises

• Pendulum exercises: Reduce stiffness in early stages
• Stretching: Gentle anterior, posterior, and lateral stretches
• Capsular mobilization: Therapist-assisted stretching to regain motion

3. Strengthening

• Gradual introduction of rotator cuff and scapular stabilizer exercises
• Focus on posture correction to prevent compensatory movements

4. Hydrotherapy (Optional)

• Warm water therapy helps relax muscles and allows gentle movements
• Reduces pain and encourages better joint mobility

Practical Tips for Patients

• Consistency: Daily exercises improve outcomes significantly.
• Avoid overexertion: Stop exercises if severe pain occurs.
• Maintain posture: Proper alignment reduces stress on the shoulder joint.
• Use supports when necessary: Slings may be advised in acute injury phases.
• Track progress: Note improvements in movement and strength to guide rehabilitation.

Case Example (Illustrative)

A 50-year-old female with a frozen shoulder experienced severe limitation in lifting her arm. Physiotherapy included:

• Daily pendulum and wall climb exercises
• Gentle stretching and scapular stabilization exercises
• Hydrotherapy sessions in warm water
  After 10 weeks, she regained almost full range of motion, reduced pain, and could perform daily activities independently.

Benefits of Physiotherapy for Shoulder Injuries

• Significant reduction in pain and discomfort
• Improved range of motion and flexibility
• Enhanced strength and joint stability
• Faster return to daily and sports activities
• Reduced risk of recurrent injury

Conclusion

Physiotherapy plays a critical role in managing shoulder injuries, including rotator cuff tears and frozen shoulder. Through a combination of pain management, stretching, strengthening, and functional exercises, patients can achieve full recovery, regain independence, and prevent future complications. Early intervention and consistent rehabilitation are key to restoring optimal shoulder function and quality of life.