Article Review: Are nerve cells involved in the pathogenesis of frozen shoulder? | Modern Manual Therapy Blog

Article Review: Are nerve cells involved in the pathogenesis of frozen shoulder?

Interesting research here. The control group actually had rotator cuff surgery, indicating there was either injury or dysfunction leading to tear and there were still significant differences. Of note is that there are capsular changes with increased cell density and fibroblastic proliferation with the frozen shoulder group. The review does not indicate the chronicity of either group.  It's a possibility since they were undergoing arthroscopy, that the R/C tears were at most subacute.

I've never believed what the research has shown in the past about frozen shoulder spontaneously thawing within 1-2 years of onset. It may "feel" better, but how could their function return without treatment? I haven't seen it clinically, but that could also be because they got better without treatment. I find successful outcome for return to function and restoration of pain free motion is highly dependent on the patient's

  • pain tolerance (not threshold) to appropriately aggressive STM and JM
  • compliance with their home program - much more so than the manual treatment
What has your experience with frozen shoulder been?


  1. I do not have the reference, but there was an RCT that compared early PT in the freezing stage to no treatment and advice to keep shoulder moving. The early PT group did the WORST. The theory being that we just made a painful problem worse in the "freezing stage." I go back and forth with this diagnosis, but it does not make any sense to me to torture someone with aggressive manual work if their primary complaint is pain. If there primary complaint is stiffness and aggressive manual techniques are tolerable to them AND they see the benefit AND they are making progress that is a different story.

  2. I remember that study. Using MDT as a reference for classification and progression, I treat patients and it's ok to have increased pain during the treatment, as long as it does not remain worse after the treatment. With each new technique or progression, I ask if it hurts, if it does, I stop the treatment, and if it doesn't remain worse, I'm not worsening the condition or causing new irritation. So I completely agree with your last point. I was mainly saying the pts who have the best outcomes have to be able to tolerate some discomfort as the manual technique plus the HEP are going to be uncomfortable. If they can't handle any traditional techniques, I normally start with some pain free ones like Mulligan MWM or counterstrain to get them moving.