Will physical therapy help frozen shoulder?

Introduction:

What is frozen shoulder?

A condition that causes stiffness and pain in the shoulder joint, is often used injudiciously for any painful condition of the shoulder joint. However, there are two known entities which must me differentiated and a proper diagnosis should be arrived at, since the treatment of each is different. These condition are: 

(a)  Painful Shoulder 

(b) Adhesive Capsulitis 

So frozen shoulder physical therapy is an important part of treatment, so in this article you would come to know about the shoulder treatment as a whole.

(a) painful Shoulder: Any condition, around the shoulder that causes pain and limitation of movements of shoulder may be included in this group. Various conditions include tendinitis of the rotator cuff, bicipital tenosynovitis, sprain and tears of the rotator cuff and synovitis. The patient has limitation of movement which is more due to pain rather than due to intra-articular or capsular contractures. X-ray may show areas of calcification around the shoulder indicating a calcific tendinitis. 

(b) Adhesive Capsulitis: Capsular adhesions form as a result of inflammation in the capsule and synovium .The adhesion are more marked in the axillary fold, and the cause of capsular contracture is unknown. However, relative immobility of shoulder due to coronary artery disease, mastectomy, cervical spondylosis may lead to capsular contraction and thereby stiff shoulder. It affects mostly at the age of 40 to 60 years.

Clinical sign & symptoms of frozen shoulder:

Acute joint problems- Pain and muscle guarding limit motion, usually external rotation and abduction. Pain is frequently experienced radiating below the elbow and may disturb sleep.

Sub-acute joint problems- Capsular tightness begins to develop with limited motion is detected. Usually external rotation and abduction are most limited and internal rotation with flexion are least limited.

Chronic joint problems- Progressive restriction of the gleno-humeral joint capsule magnifies the signs of limited motion in a capsular pattern and decreased joint play. There is significant loss of function with an ability to reach overhead, outward, or behind the back. Aching is usually localised to the deltoid region muscle.

Clinically frozen shoulder is divided into three stages, they are as follows

1.Freezing Stage- It is characterized by intense pain even at rest and limitation of motion by 2 to 3 weeks after onset. These acute symptoms may last 10 to 36 weeks.

2. Frozen Stage- Characterized by pain only with movement, significant adhesions, and limited gleno humeral motions with substitute motions in the scapula. Atrophy in the deltoid, rotator cuff, biceps, triceps brachii muscle occurs. This stage lasts 4 to 12 months.

3. Thawing Stage- It is characterized by no pain and inflammation but significant capsular restriction from adhesions. This stage lasts 2 to 24 months or may be longer. Spontaneous recovery occurs on the average of 2 years from onset of frozen shoulder.

Diagnostic tests:

 Some test were performed by a licensed qualified Physical therapist for the confirmation of shoulder pain diagnosis, these test are 

1. Active test of range of motion(ROM) with slight overpressure at the terminal point of each movement.

2. Active resisted test of ROM, at the initial range usually there is no pain; however considerable resistance may be painful.

3. passive test of ROM-with the patient in supine position it is important to confirm the capsular pattern of restriction of the joint and the diagnosis of adhesive capsulitis.

4. Other test which are performed by patient includes

⬤ Hand on neck  

⬤ Hand on opposite shoulder 

⬤ Hand behind the back 

Physical Therapy of Frozen Shoulder

Physical therapy should be the first line of treatment for frozen shoulder before medications and surgery, the basic aim of physical therapy program is 

➤ To reduce pain 

➤ To increase extensibility of thickened and contracted capsule of shoulder at the anterior inferior border and at the attachment of capsule to anatomical neck of humerus.

➤ To improve strength of shoulder girdle muscles

➤ T improve mobility and function

Now comes the electrotherapy part of treatment followed by manual techniques performed by physical therapist, some machines were used for pain reduction and relaxation such as 

➤LASER machine

➤Ultrasound machine 

➤Hot & cold pack 

➤TENS machine 

After that some manual techniques are performed by physical therapist, so the patient is placed in supine position with the affected shoulder in maximum possible abduction and neutral rotation with elbow in 90* of flexion. The physical therapist grasping the arm ( as shown in the video) below the shoulder joint carries out relaxed passive gliding movements of the head of humerus on glenoid.

Mobilization by passive accessory movements of acromioclvicular (AC), sternoclavicular (SC) and scapulothoracic joint articulations are extremely helpful.

After the whole Physical Therapy session some home exercises were also taught by therapist to the patient for maintaining the joint range of shoulder, all the home exercises are described in the below video.

                       

Important Note regarding Frozen Shoulder

Patient's with diabetes respond extremely slowly to the treatment and feel much more pain and discomfort as compared to non-diabetics.

Shoulder Physical Therapy Rehabilitation is also explained in the video below

Conclusion: 

Condition like frozen shoulder can be treated with physical therapy if you start the treatment as soon as possible without too much delay otherwise the recovery time may prolong and physical therapy has no side effect on your body.

So if you like this article about the knowledge regarding shoulder pain, you can give your valuable feedback in the comment section.

What does physical therapy do for the spine?

 

INTRODUCTION:

Spinal care is important because it is the back bone of our body and provides support to the muscles ,nerves, fascia and ligaments from cervical to tail bone region .The spine provides stability and mobility to our body to perform activities of daily living, so any injury or disease of spine pushes us backward and affects our performance.

According to a report by the Center for Advancing Health, in 2018, 75.8 million American adults aged 18 and older, which is 29.9% of the population, suffered from lower back pain. The report also states that 15% to 20% of adults have back pain during a single year. Additionally, 50% to 80% of adults will experience at least one episode of back pain during their lifetime.

It is worth noting that back pain is a leading cause of work limitations globally. In 2016, low back pain was the leading cause of years lived with disability (YLDs) among adults in the United States, accounting for about 3.07 million YLDs. Back pain statistics show that this condition is one of the most expensive conditions to treat in aggregate, accounting for over $100 billion in care each year 

Causes of spinal problem: 

 According to the latest research study of W.H.O  every 8th out of 10 individual faces a problem of spinal pain and discomfort in his lifespan, so we have to understand the importance spinal care in our life. Spinal problems such as slip disc, spondylosis, spinal disorders, postural imbalances, muscle spasticity, arthritis of spine, are some examples of spinal deformity.

Although trauma may be a cause of spine, most often there is no apparent reason for the onset of symptoms. Thus, it is thought that repetitive strain on the structures around the spine is the main cause of spinal deformity. To overcome all these deformity and problem you should go for physical therapy of spine to your nearest physical therapist.

Assessment of spine:

A physical therapist will manually examine your spine and tries to find out the exact cause of spinal pain or discomfort, assessment includes the following 

🔘 tenderness over the spine 

 

🔘 muscle tone around the spinal column

 

🔘  gait pattern while walking 

🔘  muscle strength of core, back and hips

🔘 body balance 

🔘 position changing from supine to siting 

🔘  posture

 Methods used by Physical Therapist

Physical therapists use various methods to test pain tolerance. One such method is dolorimetry. It uses an instrument called a dolorimeter to assess pain threshold and pain tolerance. Most dolorimeters apply heat, pressure, or electrical stimulation to parts of your body while you report your pain level.

Another method is pain pressure threshold (PPT). It is used to measure deep muscular tissue sensitivity. The test determines the amount of pressure over a given area in which a steadily increasing non painful pressure stimulus turns into a painful pressure sensation. A varying pressure is applied from 0.5 to 1 kg/sec in a perpendicular direction relative to the muscle.

It’s important to note that pain tolerance varies from person to person and is difficult to accurately measure. Factors such as genetics, age, sex, chronic illness, mental illness, stress, social isolation, past experience, and expectations can influence pain tolerance.

It’s also worth mentioning that pain tolerance can potentially be boosted by changing the way you perceive pain via therapies like yoga, mental imagery, and biofeedback. However, it’s important to consult a physical therapist before attempting any treatment.

Treatment of Spinal condition:

 After the proper assessment and confirmation of the diagnosis there comes the treatment part of spinal problems so physical therapy should be the first line of treatment in spinal care. A qualified professional physical therapist will make a tailored physical therapy program for your type of condition. 

Physical therapy treatment is divided into two parts which includes electrotherapy part and exercise therapy part, so the electrotherapy part contains modalities such as

 

1. Laser machine 

 

2. Decompression traction machine

3. Ultrasound machine 

4. Tens machine 

5. Hot pack and cold pack machine

Exercise therapy part contains hands on manual technique such as 

1. Myofascial release 

2. Movement with mobilization technique 

3. Stretching

4.  Manipulation technique

5. Passive range of motion 

All this treatment is performed by qualified registered physical therapist, So according to the type of spinal problem a combination of both electrotherapy and exercise therapy is performed by physical therapist.

As to the road of recovery after 8 weeks of physical therapy session a home exercise program is also given to the patient to follow up and continue the exercises with the do's and don't as precaution care.

Physical therapy focuses on returning you to your normal activities and to achieve mobility goals with reduced pain and increased flexibility with strength.

  

Conclusion:                                     

                  Myself  Dr Shailendra Chourey ( Physical therapist) in Practice from year 2010 comes to a conclusion and sharing with you is prevent your back bone ( Spinal Column ) always to get a good posture and gain confidence with your physical appearance. Your body will thank you  for a healthy and strong spine.

My motto is to help people Feel better, Move better and Perform better. I want to help you learn to do the Same.

Share your feedback if you like the article 

What type of physical therapy is best for arthritis?

 Introduction:

Yes physical therapy will help arthritis in this article you would come to know, Arthritis is a degenerative disease mainly affecting the joints such as knees, hands, and hip joint, the sign and symptoms include crepitus and pain around the joint along with stiffness and oedema. According to a recent study in year 2023 it has affected more than 33 million adults and 3 lakh children in U.S, 

The character of arthritis disease is that it cannot be reversed but with the help of physical therapy the sign and symptoms can be minimized to a lower level so that an individual can perform his/her daily activities. Regular physical therapy for arthritis shows drastic changes in patient's recovery from pain reduction to range of movement and proper function of joints.

Types of Arthritis:

1.Osteoarthritis: The cartilage which covers the bone is damaged, it is the most common type of arthritis and mainly affecting weight bearing joint i.e., knee joint. over 12 million people above age 65 have symptomatic OA, researches show that physical therapy  is an effective treatment for OA knee rather then multiple steroid injections.

 A report also calculated that choosing physical therapy for OA knee over the steroid injections are found that doing so saves close to $14000 including all the hidden costs of your time, pain, missed life events and the money paid for services.

2. Rheumatoid Arthritis: This is a auto-immune disease which affects the synovial fluid of joints leading to stiffness, pain, swollen and warm around the joint.

3.  Gout: accumulation of higher level of uric acid in blood results in the form of inflammatory arthritis called gout.

4. Ankylosing spondylitis: arthritis of the spine ( mainly lumbosacral spine)

5. Reactive arthritis 

6. Psoriatic arthritis 

7. Juvenile arthritis 

8. Fibromyalgia

Risk Factors of Arthritis:

1. Obesity- excess body weight leads to have more pressure on weight bearing joints such as knee and hip.

2.  Gender- Arthritis are more common in women than in men.

3. Age- As age increase the type of arthritis increases as you get older.

4. Smoking- cigarette smoking increases a person's risk of developing RA(rheumatoid arthritis)

Diagnosis of Arthritis:

Diagnosis involves several methods:

1. Physical examination: Doctors check for swelling, redness, warmth, and joint movement.
2. Laboratory tests:
   • Erythrocyte sedimentation rate (ESR): A blood test to check inflammation.
   • C-reactive protein (CRP): Indicates acute inflammation.
   • Antinuclear antibody test (ANA): Measures antibodies attacking healthy proteins.
   • Anti-cyclic citrullinated protein test (Anti-CCP): Identifies the antibody causing rheumatoid arthritis.
3. Imaging tests:
   • X-rays: Visualize bone, cartilage loss, bone damage, and spurs.
   • MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues.
   • Ultrasound: Checks for fluid-containing structures in joints.

Treatment of Arthritis:

Physical therapy should be the first line of treatment for any kind of arthritis followed by lifestyle changes and medication, arthritis pain and swelling is controlled by electrotherapy modalities while joint stiffness and tenderness is overcome by hands on manual technique by physical therapist. 

By doing physical therapy it has a direct effect on body part surrounding muscles and joint, the muscles around the joint will get stronger which in turn support the joint. Also reducing the stiffness results in increasing joint range of movement, joints will become supple and less likely to become stiff. 

Physical therapy exercises leads to release chemicals in the body called endorphins, these are natural painkillers which are produced by our body. Releasing them into blood through exercise can make us feel good, exercise improves our overall health and fitness and can help us to maintain healthy weight because as we know that obesity is a major reason of osteoarthritis. Also doing regular physical therapy exercise helps to get good sleep, which in turn help the body to repair itself naturally.

  Related article- can physical therapy help with chronic pain?

With physical therapy other treatment also aids to overcome arthritis, some of them are mentioned below:

• medication and supplements 

• fiber rich diet 

• lifestyle changes in which you have to avoid long sitting or standing

• occupational therapy 

• weight check regularly to prevent obesity

• daily routine exercises

Related article- best muscle rub to relieve pain

Physical therapy plays a crucial role in managing arthritis symptoms and improving overall function. Here are some ways physical therapy can benefit individuals with arthritis:

1. Joint Mobility and Flexibility: Physical therapists design personalized exercise plans to enhance joint mobility and flexibility. These exercises help maintain or restore the range of motion in affected joints.

2. Strength Training: Strengthening exercises are essential for supporting joints and preventing further damage. A physical therapist will guide you through exercises that target specific muscle groups, helping you build strength.

3. Pain Relief Techniques: Physical therapists teach techniques to alleviate pain. These may include proper posture, body mechanics during daily activities, and the use of assistive devices like walkers or canes.

4. Hot and Cold Therapy: Heat and cold treatments can ease joint pain and stiffness. Your therapist may recommend using heat packs or cold compresses as part of your self-care routine.

5. Environmental Modifications: If your environment affects your arthritis symptoms, a physical therapist can suggest modifications. For instance, ergonomic chairs or cushioned mats can reduce pain and improve function.

6. Individualized Plans: During physical therapy sessions, you’ll learn how to perform exercises and self-care techniques independently. The visits are typically short (about an hour) and focus on identifying functional problems and providing strategies for home care.

Remember, periodic visits every few months are usually sufficient to update your program if necessary. Whether your goal is pain-free movement, improved daily activities, or specific tasks, a physical therapist can tailor a plan to help you achieve it.

If you’re experiencing arthritis-related pain or stiffness, consider consulting a physical therapist to create a personalized treatment plan that suits your needs. 🌟

Conclusion: 

Arthritis is a degenerative joint disease which require special attention and care, also managed with lifestyle modification and exercises. Ergonomic changes at your home and work place controls arthritis up to a level and also try to be physically active as much as you can. Myself Dr. Shailendra Chourey in practice of physical therapy since 2010 comes to a conclusion that you should not ignore any type of arthritis pain and must visit a physical therapist for correct treatment. 

Was this article helpful to you please let me know in the comment section.

 

Diagnostics | Free Full-Text | Identifying Severity Grading of Knee Osteoarthritis from X-ray Images Using an Efficient Mixture of Deep Learning and Machine Learning Models

Bertolotti's syndrome

 Introduction: 

Bertolotti's syndrome is a type of lower back pain(waist line region) in which the transverse process of L5 vertebra fused with the sacrum or ilium causing discogenic disease and limited mobility around lumbo-sacral region. The pain caused by Bertolotti's syndrome is not uniform and originates from different pathology caused by the lumbosacral transitional vertebra(LSTV).It was first described in  1917 by Italian physician named Mario Bertolotti's.

Cause of Bertolotti's syndrome:

As the development of our body takes place, there is also spinal growth in which vertebrae located in the sacral region fuse together to form one bone called the sacrum of pelvis. similarly lumbar vertebra also grows with segments of transverse process and spinous process which provide movement at the lumbar region.

In some instances, during the developmental stage this transverse process typically enlarged and often looks like a fake joint which touches the pelvis. This fake joint between the enlarged transverse process and the sacrum, if inflamed causes back pain and looks similar to sacroiliitis, lumbar disc pain, and facet joint pain.

Bertolotti's syndrome

This is the X-ray of 67 year old women showing  Bertolotti's syndrome ( the red circle shows transverse mega -apophysis of L5 with pseudoaticulation with the sacral ala)

Classification of Bertolotti's syndrome:

On the basis of LSTV It is classified into four categories 

Type 1: At the lumbosacral junction a dysplastic transverse process shows a gap of less than 10mm,but greater than 2mm at lumbosacral junction.

Type 2: A gap less than 2mm at the pseudo articulation between adjacent transverse process.

Type 3: At the lumbosacral junction, complete fusion lateral to the facet at the ala, without spontaneous fusion of the disc of facet joints.

Type 4: Presence of unilaterally fused side with varying pseudo-articulation.

 
Diagnosis of Bertolotti's syndrome:

A physical therapist does the physical examination of patient including evaluation and assessment by checking the point of tenderness around the waist line, spine mobility, edema, and differentiate the other types of back pain with Bertolotti's syndrome. Lumbosacral spine radiographs helps in identification of the skeletal abnormality while MRI helps in confirmation.

Treatment of Bertolotti's syndrome:

Physical therapy should be first line of treatment as conservative and non-operative of this syndrome, other treatment include steroid injection, radiofrequency ablation and lastly surgical intervention. surgery carries higher risks and is reserved for patients failing previous lines of treatment.  

 Once the diagnosis is confirmed of Bertolotti's syndrome, therapist makes a treatment plan accordingly followed by a rehabilitation program. The overall physical therapy treatment includes:-

 1. Stretching exercises

2. Electrotherapy modalities

3. Manual techniques 

4. Strengthening exercises 

5. Range of motion exercises

6. Breathing exercises 

Stretching the back muscles is described in the video by professionally qualified Physical therapist Dr shailendra chourey

 

Benefits of Physical therapy

The benefits of physical therapy treatment is that it reduces the tightness of muscles around lumbosacral region by stretching the muscles such as lattisimus dorsi, gluteal muscles, erector spinae, thoracolumbar fascia, hamstring muscle, pyriformis and many more. 

Therapist also work on flexibility of LS spine to reduce the stiffness and increase range of motion. Muscle spasm and pain is reduced by electrotherapy modalities, and a good therapist will do the stretching of tight muscles and strengthening of weak muscles, thus physical therapy works overall on Bertolotti's syndrome treatment and management. 

What if untreated bertolotti syndrome ?

Most patient's can live their life without any discomfort or problem. Leaving symptomatic Bertolotti's syndrome untreated may cause worsening pain, affecting day to day activities, and premature degeneration of lumbar spine. Over a period of time, this may also lead to other problems in your spine such as spondylosis, disc herniation, chronic low back pain and radiculopathy. Talk to your physical therapist to see what you can do to overcome it and prevent it.

Related article- how do you know when you need physical therapy?

Conclusion:

 Being a physical therapist my aim is to treat patient according to the

 condition and educate him/her in a proper way so that  he/she

  should not be hesitated to deal with any kind of musculoskeletal

problem  in future. Myself  Dr Shailendra Chourey in practice of

 physical therapy since 2010 comes to a conclusion that you should

 not ignore any type of back pain whether it is acute or chronic and

 must visit a physical therapist for correct treatment.

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