Conservative Treatments for Adhesive Capsulitis

This philosophy is used to decrease inflammation and relieve pain for adhesive capsulitis within the first 48 hours of a flare-up.

Ultrasound around your shoulder area for 5 - 10 minutes, 3 times per day. This is best accomplished with a personal, therapeutic ultrasound device.

Rest and limit your activity, if you have any inflammation. However, gentle massage and/or movement around the shoulder area are essential to ensure blood flow to the injured area, which will help to prevent scar tissue development, stiffness and loss of movement.

Ice your shoulder area 2-3 times/day for approximately 15 - 20 minutes at a time to help reduce blood flow and fluid build up. Gel packs are a better option than frozen peas if possible, as they mold to your body shape and are reusable (do not apply ice/gel packs directly on your skin, instead wrap cold compress in a wrap or cloth). Utilizing 2 gel packs with a wrap will allow you to cover your entire shoulder (front and back) area at one time.

Compress the area if possible by adding light pressure to minimize swelling (make sure the compress is snug, but not too tight as it could cause numbness, tingling or more pain). A neoprene brace or tensor bandage that wraps around your shoulder muscles is very useful.

Elevate your shoulder above chest level to relieve the pressure from swelling and allow fluid to drain from your injured area.

If you do not have access to ultrasound therapy or you have experienced an acute shoulder injury and/or have not been diagnosed, adhere to the RICE philosophy within the first 48 - 72 hours.

Ultrasound Therapy

Ultrasound is a great therapeutic option to decrease inflammation, pain and soft tissue (muscle, tendon, ligament, nerve and connective tissue) damage experienced with adhesive capsulitis, because it creates immediate blood flow to the injured area. This can be received using a portable, home ultrasound device (self-administered) or by seeing a physiotherapist. The treatment is easy, painless, safe, and generally requires between 5 - 10 minutes, 3 times a day. It is based on a form of deep tissue therapy, which is generated through high frequency sound waves (that we can not hear). These waves send vibrations deep into your body and raise the temperature of your soft tissue. The waves are delivered through a hand held transducer and medicinal conductive gel that are used together in a slow, circular motion on your skin over the injured area. You may experience a slight tingling or warm sensation during the process partly due to phonophoresis - a secondary enhancing, therapeutic effect of ultrasound.

Ultrasound therapy increases collagen and tissue elasticity, which in turn promotes blood flow (circulation) and brings oxygen and nutrients to your injured area. This cleans your tissue by getting rid of cell waste products and helps your injury to heal. If not treated properly injured tissue can heal with a weakened state, which can lead to scar tissue or calcification. If used on an ongoing basis, ultrasound will help to increase your range of motion by breaking down any scar tissue that may form in your upper thigh muscles and hip flexors. Ultrasound waves penetrate deep into your tissues, repair and relax your muscles and other tissues, decrease chronic inflammation and pain, and accelerate your recovery rate, so you can return to your daily activities as soon as possible.

Natural Supplements and Medications for adhesive capsulitis

Alternating Hot Therapy and Cold Therapy treatments can be used once your initial pain has decreased to provide relief and improve function. Heat Therapy involves using a hot compress and/or warm bath to help reduce your aches and pains, muscle spasms, joint and muscle stiffness that may accompany your adhesive capsulitis, and will help increase blood flow to your injury. Cold Therapy involves using a cold compress to help decrease any inflammation, swelling, muscle spasms, as well as tendon and ligament strains and sprains, by constricting blood flow and restricting fluid build up. Cold also has a numbing effect on your nerves to decrease feelings of pain.

The best way to get hot/cold therapy is by using a dual purpose Hot/Cold gel pack on the injured area. These are very effective, convenient, mess-free and long lasting. They are easy to use because they are portable, can be warmed up in the microwave or cooled in the freezer, and mold themselves to your knee shape. Once the treatment is over they can be washed and reused over and over again. You can also put the gel packs in a washable, polar fleece wrap to secure the packs to your body (very effective when the pain is in a hard to reach or multiple areas) and to create a barrier between your skin and the pack to prevent heat/ice burn.

Pain medications (analgesics) and non-steroidal anti-inflammatory drugs (NSAIDs) can be used if required to help manage your adhesive capsulitis. However, these medications will not cure your adhesive capsulitis; they will merely treat your symptoms.

These drugs aren't recommended for everyone or for long term use, as pain medications can cause liver damage, and NSAIDs can cause gastrointestinal difficulties (such as upset stomach, diarrhea, ulcers and intestinal bleeding). They can also trigger other serious side effects, and even inhibit the body's natural ability to heal itself. COX-2 Inhibitors (prescription NSAIDs like Celebrex, Bextra or Vioxx, block the COX-2 enzyme involved with prostaglandin production responsible for inflammation) have been linked with risks of heart attack, stroke and in some cases death. The US Food & Drug Administration (FDA) asked manufacturers to withdraw some COX-2 Inhibitors (Vioxx and Bextra) from the market as well as put a big black warning label on the packaging outlining the risks involved with use (Celebrex).

Cortisone/steroid and other injections or topical medications may initially help reduce inflammation and swelling of your adhesive capsulitis. However steroid injections are controversial, as there is the potential for a tendon rupture if the steroid is injected into a damaged tendon (this can be influenced by the type of injury and frequency of injections). Hydrodistension injections involve injecting a saline and steroid into the joint space to expand it, and nerve block injections block the nerves that send pain messages from the shoulder. Ask your doctor if any of these are a possible option for your adhesive capsulitis. Corticosteroids should be used with caution and never in conjunction with ultrasound therapy.

Some health professionals have also recommended natural supplements such as Glucosamine, MSM, Chondritin, Capsaicin, Devil's Claw, or Yucca Leaf to help relieve pain and/or strengthen your tissues. Hyaluronic Acid (Hyalgan) injections have also had some success.