Frozen shoulder, formally known as adhesive capsulitis, is a common condition causing significant pain and stiffness in the shoulder joint. This stiffness develops when the connective tissue capsule surrounding the joint thickens, tightens, and forms adhesions, restricting mobility. It typically progresses slowly through distinct phases—freezing, frozen, and thawing—making simple movements like reaching or dressing extremely difficult. Chiropractic care offers a non-invasive approach focused on managing this condition by targeting joint mechanics to restore movement and reduce discomfort.
Symptoms and Chiropractic Evaluation of Frozen Shoulder
The primary symptoms of adhesive capsulitis include a deep, dull ache, often worse at night, and a progressive loss of both active and passive shoulder movement. Active range of motion is the movement a person performs on their own, while passive range of motion is movement achieved with the help of a practitioner. This limitation in both active and passive movement helps distinguish frozen shoulder from other issues, such as a rotator cuff tear, where passive motion is typically preserved.
A chiropractor’s evaluation involves a detailed physical examination, including specific orthopedic tests designed to isolate the structures causing pain and stiffness. The practitioner measures the range of motion, noting that a loss of external rotation is a hallmark finding for frozen shoulder. This assessment helps the doctor of chiropractic (D.C.) confirm the diagnosis and determine the patient’s current stage: the painful “freezing,” the stiff “frozen,” or the improving “thawing” stage. This initial diagnostic role is central to a chiropractor’s practice. Imaging studies, such as X-rays or MRIs, may be requested to exclude other potential causes of pain and stiffness, like arthritis or severe rotator cuff pathology.
Manual Therapy Techniques Used by Chiropractors
Chiropractors employ a variety of hands-on techniques designed to progressively restore elasticity to the tightened joint capsule and surrounding soft tissues. Technique selection is tailored to the patient’s stage, focusing on pain management during the initial freezing stage and mobility restoration later. Joint mobilization is a primary technique, involving gentle, rhythmic, and controlled movements applied to the shoulder joint to encourage movement and reduce stiffness. These mobilizations are generally low-amplitude and low-velocity, especially in the painful freezing stage, to avoid aggravating inflamed tissues.
Soft tissue techniques address muscular tension that accumulates around the shoulder complex, including the rotator cuff and pectoral muscles. Methods like myofascial release or Active Release Technique (ART) involve applying specific pressure while the patient moves the limb, helping to break down fibrotic tissue and reduce muscle tightness. The aim of these treatments is to improve blood flow and reduce the secondary muscle guarding that contributes to the shoulder’s restricted state. Furthermore, the chiropractor may administer specific stretching protocols, such as Proprioceptive Neuromuscular Facilitation (PNF) stretching, to achieve a deeper stretch and improve flexibility in the clinic.
Recovery Expectations and Treatment Duration
Frozen shoulder is known for its protracted natural course, often taking one to three years to fully resolve, even without intervention. Chiropractic care aims to accelerate this process and manage symptoms throughout the stages, though setting realistic expectations is necessary. Treatment frequency is often higher during the painful freezing stage, sometimes requiring two to three sessions per week, focused on pain reduction and preventing further loss of motion. As the condition moves into the frozen and thawing stages, the frequency of visits is reduced as the focus shifts toward regaining range of motion.
Progress is tracked through consistent reassessment of pain intensity and objective measurements of active and passive range of motion. Early progress involves a reduction in pain during daily activities, followed by a slow but steady increase in shoulder flexibility. Recovery relies heavily on the patient’s dedication to the home exercises prescribed by the chiropractor. These exercises, which may include pendulum stretches or wall walks, reinforce the gains made during the in-office manual therapy sessions and are necessary for long-term improvement.
The Role of Co-Management and Referral
Chiropractic care for adhesive capsulitis is often most effective when integrated into a comprehensive, multi-disciplinary treatment plan. Chiropractors routinely work with other healthcare providers to ensure the patient receives appropriate care at every stage. A chiropractor may refer a patient to their primary care physician or an orthopedic specialist if the pain is severe and unresponsive to conservative care, or if the patient is a candidate for corticosteroid injections or hydrodilatation.
Referral is also warranted if imaging reveals a severe underlying pathology outside the scope of chiropractic practice, or if symptoms fail to improve after six to twelve weeks of consistent non-surgical treatment. Specific physical therapy exercises are a necessary adjunct to the joint mobilization and soft tissue work performed by the chiropractor. This combined approach ensures that both joint mechanics and muscular strength and endurance are fully addressed for a complete functional recovery.