frozen shoulder treatment

Frozen Shoulder: Understanding and Care

About Frozen ShoulderFrozen shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition that leads to pain and stiffness of the shoulder. Signs and symptoms begin gradually, worsen over time and then resolve, usually within one or two years. You will typically experience shoulder pain, followed by increasing stiffness. The stiffness may affect your ability to carry out everyday activities and, sometimes, you may not be able to move your shoulder at all.
1 Painful Stage
2 Frozen Stage
3 Thawing Stage

How does Frozen Shoulder progress?

Painful stage: During this stage, pain occurs with any movement of your shoulder, and your shoulder’s range of motion starts to become limited. This stage lasts for 3 to
9 months.
Frozen stage: Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and your range of motion decreases notably. This stages lasts from 4 to 12 months.
Thawing stage: During the thawing stage, the range of motion in your shoulder begins to improve with recovery. It may take anywhere from 12 to 42 months.

Frozen shoulder typically develops slowly, and in three stages. Each of these stages can last a number of months.

What are the Causes and Risk Factors?

Prolonged immobilization of the shoulder, such as after surgery (mastectomy) or an arm fracture. Usually affects woman above the age of 40 years. People who have certain medical problems appear to be predisposed to develop frozen shoulder.
Examples include:

  • Diabetes
  • Overactive thyroid (hyperthyroidism)
  • Underactive thyroid (hypothyroidism)
  • Cardiovascular disease
  • Tuberculosis
  • Parkinson’s disease

TIPS to Ease Your Symptoms

1. Use a hot pack on your shoulder for 10 to 15 minutes several times each day. Place a thin towel between your skin and the hot pack to prevent a burn.
2. Move your arm often, every hour if possible.
3. Use medication as prescribed by your doctor.
4. Sleeping Comfortably : If you sleep on your back, place a pillow under your involved arm and allow your hand to rest on your stomach. If you sleep on your side, sleep on the uninvolved side hugging a pillow across your chest.
5. Sitting Positions : Sit with good posture. Avoid slumping and slouching. Try to keep your shoulders back and down away from your ears.

Why is Physiotherapy Required?  Self diagnose frozen shoulder

This condition though self limiting, leads to decreased movement at the shoulder joint. Even though pain may reduce to negligible
after a particular time, stiffness and range will continue to remain affected. If you’ve had an injury that makes it difficult to move your
shoulder, talk to your doctor about it.

TIPS to Ease Your Symptoms

1. Use a hot pack on your shoulder for 10 to 15 minutes several times each day. Place a thin towel between your skin and the hot pack to prevent a burn.
2. Move your arm often, every hour if possible.
3. Use medication as prescribed by your doctor.
4. Sleeping Comfortably : If you sleep on your back, place a pillow under your involved arm and allow your hand to rest on your stomach. If you sleep on your side, sleep on the uninvolved side hugging a pillow across your chest.
5. Sitting Positions : Sit with good posture. Avoid slumping and slouching. Try to keep your shoulders back and down away from your ears.
A visit to your physical therapist may be beneficial to help you regain normal functional use of your arm. Your Physiotherapist can help you manage the pain and provide you with strategies to help you start using your arm normally again.

Do’s

  • Continue to move your shoulder else it will progress to the next stage of stiffness.
  • Use hot pack before exercise for improving movement, relaxation and reduction in pain.
  • Continue to use the shoulder for more functional activities like combing hair, reaching out for over head objects etc.
  • Keep your diabetes under control.
  • Take your pain medications on time.

Don’ts

  • Avoid vigorous shoulder movements.
  • Avoid wearing an arm sling to promote arm movement even if it keeps your arm in a pain-free zone,

This article is purely for general information. Please contact your healthcare expert for specialised medical care. Please go through our Disclaimer and Privacy policy.

cardiac physiotherapy

CardioVascular Diseases – Improving Heart Health via Cardiac Rehab Program

India is one of the most populous countries in the world. The present health scenario suggests that our country is undergoing an epidemiological transition. The epidemiological infectious diseases are getting superseded by the non-communicable diseases (NCD). Estimates indicate that NCDs account for 53% of total deaths in India & Cardiovascular diseases (CVD) mortality tops the list of NCD deaths with 45% of deaths accounted by CVD.#1

Increasingly even the government setups in India are also acknowledging and approving of Cardiac Rehab Programs as effective and needed to ensure SPEEDY Recovery and enhance surgical OUTCOME (cardiac surgery).

CARDIOVASCULAR DISEASES

Cardiovascular diseases (CVDs) are a class of diseases that involves heart or blood vessels.

Common CVDs include-

  • Ischaemic Heart Disease (IHD)
  • Hypertensive Heart Disease (HHD)
  • Rheumatic Heart Disease (RHD)
  • Cardiomyopathies
  • Congenital Heart Disease (CHD)
  • Peripheral Artery Disease (PAD)

The underlying mechanism varies for the above mentioned diseases; the most common cause being atherosclerosis.

RISK FACTORS FOR CVDs

  • Hypertension
  • Smoking
  • Excessive alcohol intake
  • Diabetes
  • Obesity
  • High blood cholesterol
  • Poor diet
  • LACK OF EXERCISE & SEDENTARY LIFE STYLE

However it is estimated that 90% of CVDs are preventable.

Also most of the CVD patients can help lower their risk of future heart problems if they make changes to improve their health.

CARDIAC REHABILITATION

What is Cardiac Rehabilitation?

Cardiac Rehabilitation (Cardiac Rehab) is a professionally supervised program to help people recover from heart attacks, heart surgeries, percutaneous coronary intervention procedures such as stenting & angioplasties.

Cardiac Rehab program usually provide education & counselling services to help heart patients increase physical fitness, reduce cardiac symptoms & improve health.

BENEFITS OF CARDIAC REHAB

  • Reduction in all cause mortality rate by 20-30% (as per AHA)
  • Reduced cardiac symptoms (angina, dyspnea, fatigue)
  • Improved adherence & preventive medication
  • Increased exercise performance
  • Improved quality of life.

Increasingly even the government setups in India are also acknowledging and approving of Cardiac Rehab Programmes as effective and needed to ensure SPEEDY Recovery and enhance surgical OUTCOME.

What kind of services does the Cardiac Rehab Program offer?

(Read more details at http://reliva.in/knowledge_center/cardiac-rehab–staying-heart-healthy )

  • Appropriate recommendations are made for medical examination, physical activity & exercises,  based on the risk stratification process as per the American College of Sports Medicine (ACSM) that assigns participants into 3 categories-
  • Low Risk
  • Moderate risk
  • High Risk
  • A comprehensive health fitness evaluation typically includes the following before the planning & prescription of the Cardiac Rehab program
  • Resting Heart rate, BP, Height, Weight, BMI, ECG
  • Cardiorespiratory Fitness (if required) – TMT
  • Muscular Strength – RM method
  • Flexibility
  • An exercising training program is best designed to meet the individual’s health & physical fitness goals.

COMPONENTS OF EXERCISE TRAINING

  • Cardiovascular (aerobic) fitness
  • Muscular strength & endurance
  • Flexibility

Exercises that improve neuromuscular fitness such as balance & agility are also recommended by ACSM particularly for older adults & highly deconditioned persons.

ACSM also recommends loading exercises (i.e. weight bearing & resistance exercises) to maintain bone health.

A single exercise session includes the following-

Cardiac Rehab in Progress at Reliva
Cardiac Rehab in Progress at Reliva
  • Warm –up – at least 5 to 10 minutes of low <40% to moderate intensity cardiovascular & muscular endurance activities.
  • Stretching – at least 10 minutes of stretching exercises performed after warm up or cool down phase
  • Conditioning – this phase includes aerobic/resistance &/or sports related exercises
  • Cool Down – at least 5-10 minutes of low (<40% to moderate 40% -<60%)intensity of cardiovascular & muscular endurance activities.

Cardiac rehabilitation takes place as

  • In-patient Rehabilitation Programs
  • Outpatient exercise Programs

Outpatient cardiac rehab programs should begin as soon as hospital dismissal.

Most patients are capable of beginning a supervised exercise program with 1-2 weeks of leaving the hospital.

SUMMARY OF THE ACTUAL CARDIAC REHAB PROGRAM

  • While actual training program for each patient would differ, an indicative plan would be as follows:
COMPONENTSACTIVITIESRECOMMENDED TIME
Warm upStretching/low level calisthenics10 minutes
Aerobic ConditioningTreadmill (Mod Bruce/Bruce protocols or other protocols as indicative), cycle ergometer, cross trainer, stair stepping20-30 minutes as tolerated
Muscular ConditioningWeight training15-30 minutes as tolerated
Cool DownSlow walking/ stretching5-10 minutes
  • An indicative exercise prescription would be as follows (FITT Priciple) :
Frequency3-5 days/week
IntensityRPE- 11-16/ 20-80% using Heart rate Reserve
TimeApprox 60 minutes
TypeTreadmill/elliptical/ Cycle ergometer/Cross trainer/stair climber
Resistance Training8-10 exercises (1 set per exercise of 8-12 reps) that conditions the major musle groups atleast 2 days per week
Initial level of FitnessHigh = higher work loadLow =  lower work load

 

Having the essence of the details about Cardiac rehabilitation, it is important to take up these best benefitting programs seriously by moving out of the cages of ignorance & myths about CVD’s.

The larger group of hospitals do provide the cardiac rehab services but they reach out to the very few.

Its time we start giving importance to clinic based Cardiac Rehab programs who plan for the Outpatient Exercise programs for cardiac patients.

ReLiva Physiotherapy & Rehab Clinic in Navi Mumbai has taken an initiative towards providing this utmost care to the cardiac patients by providing clinically monitored & supervised Cardiac Rehab Outpatient programs.

We believe in “Exercise is Medicine”. (Read what our Cardiac Rehab patients have to say about us by clicking here.)

Like all medicines, ‘Effective Dosage” of exercise is important for achieving the desired results. “More” is not better. For cardiac patients, more exercise could be as or more dangerous as consuming higher dosage of medication than prescribed.

“Less” would not deliver desired & long term outcomes. Patients’ cardiovascular capabilities may remain suboptimal; thus impacting the quality of life & overall health.

Monitoring while cardiac rehab
Monitoring while cardiac rehab

“ Effective dosage” changes as physical capacity & capabilities change. Hence regular monitoring is critical to evaluate & arrive at “effective Dosage” at different stages of Cardiac rehab.

Read about Contribution of progress in a patient due to Cardiac Rehab Program : Patient at ReLivaTM in the next post by clicking here.

With these advances in Cardiac rehab, this program can become recognized as a cornerstone in a comprehensive management of cardiac patients.

More awareness is the prime necessity to optimize the effectiveness of the cardiac rehab program.

With such initiatives together we can definitely contribute towards a better life for the Cardiac patients.

Contributed by Dr. Anuradha Purohit – Mandlekar (PT). She is BPT, MPT(Cardio-thoracic), MIAP, American Health Association (AHA) certified specialist at ReLiva Physiotherapy & Rehab and pioneers the Cardiac Rehab Program.

#1- (ref – 2013, Vol.2, No.2,ISSN 2319-4154,Health Sciences E-Journal)

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