Frozen shoulder (adhesive capsulitis)

Here’s what’s going on:

Frozen shoulder, also called adhesive capsulitis, is a condition where the shoulder joint becomes painful, stiff, and gradually loses its range of motion due to thickening and tightening of the joint capsule (the connective tissue surrounding the shoulder).

How it develops

The shoulder capsule becomes inflamed.
Over time, it thickens and tightens, forming adhesions (scar-like tissue).
This limits the movement of the ball-and-socket joint in the shoulder.

Typical Symptoms

Pain – Often a dull, aching pain deep in the shoulder (sometimes radiating into the upper arm).
Stiffness – Difficulty with everyday activities (reaching overhead, behind the back, or to the side).
Reduced motion – Both active (when you move it yourself) and passive (when someone else moves it) ranges are limited.

Phases

Freezing phase (Painful phase) – Pain worsens gradually, movement decreases (2–9 months).

Frozen phase (Stiff phase) – Pain may improve, but stiffness is significant (4–12 months).

Thawing phase (Recovery) – Movement gradually returns (6–24 months).

Causes & Risk Factors

Often no clear cause (idiopathic)

More common in:

People 40–60 years old
Women
People with diabetes, thyroid disorders, or after shoulder injury/surgery
Can occur after prolonged immobility (e.g., following a fracture or rotator cuff tear).

Muscle Geek Treatment

For Frozen Shoulder (adhesive capsulitis), muscle activation can be a game-changer—especially when combined with your Class IV Laser and Shockwave work—because it retrains the shoulder to move properly and reduces protective muscle guarding.

Why Muscle Activation Helps

Breaks the pain–inhibition cycle – Pain shuts down certain stabilizing muscles, leading to stiffness.
Rebalances muscle firing patterns – Restores coordinated motion between the rotator cuff, scapular stabilizers, and humeral movers.
Improves capsule mobility indirectly – Better muscle control means less joint compression and more fluid movement.

Key Muscle Groups to Activate

Rotator Cuff
- Supraspinatus – initiates abduction
- Infraspinatus & Teres Minor – external rotation control
- Subscapularis – internal rotation stability

Scapular Stabilizers
- Lower Trapezius – scapular depression and posterior tilt
- Middle Trapezius – retraction
- Serratus Anterior – protraction & upward rotation

Secondary Movers
- Deltoid – especially mid fibers for controlled elevation
- Rhomboids – mid-back support

Phase 1: Painful / Freezing

Gentle isometrics (5 sec hold × 5 reps):
- External rotation
- Internal rotation
- Scaption (mid-range)
Use Class IV Laser before activation to reduce pain/inflammation
Light pendulum swings to promote joint nutrition

Phase 2: Frozen

Assisted active range with activation:
- Wall slides with scapular retraction
- Side-lying external rotation with towel under arm
- Serratus punches (supine with light band)
Shockwave before activation to soften capsular restrictions
Laser after session for pain modulation if soreness present

Phase 3: Thawing

Resisted band work (theraband):
- ER, IR, rows, reverse fly, serratus wall slides
Closed-chain stability drills:
- Quadruped rocking
- Wall push-ups with plus
Functional patterns (lifting, reaching, rotation tasks)

Goals of Treatment

Phase 1 (Freezing) – Reduce pain and inflammation, maintain motion
Phase 2 (Frozen) – Break up adhesions, improve capsule elasticity
Phase 3 (Thawing) – Restore full range of motion and strength

Class IV Laser Therapy Protocol

Purpose: Reduce pain, stimulate circulation, decrease inflammation, and accelerate tissue repair in capsule and surrounding muscles.

Frequency:

Acute phase: 2–3x/week for 2–3 weeks
Subacute/chronic phase: 1–2x/week until ROM returns

Shockwave Therapy Protocol

Purpose: Stimulate cellular metabolism, increase blood flow, and help remodel thickened/fibrotic capsule tissue.