Relevium: A Specialized Physiotherapist & Chiropractor

Frozen Shoulder


Frozen Shoulder (Adhesive capsulitis)

Signs and symptoms of frozen shoulder - Relevium

Shoulder discomfort and reduced range of motion are classic symptoms of frozen shoulder. In most cases, frozen shoulder symptoms develop slowly, worsen over time, and eventually disappear on their own within a few years. As a result, it is sometimes referred to as a “self-limiting condition.”

An outer layer of connective tissue called the shoulder capsule surrounds the shoulder joint. This capsule is inflamed, thickens, and tightens in a frozen shoulder. This makes it difficult and unpleasant to move the shoulder.

Stages of frozen shoulder

Frozen shoulder develops in 3 stages-

  • Freezing, or painful stage: Pain steadily rises, making shoulder motion more difficult. Typically, pain is felt across the outside shoulder area and occasionally on the upper arm. The pain is typically worst at night.
  • Frozen: Progressive decrease of shoulder range of motion, despite the improvement of painful symptoms.
  • Thawing: The patient regains the majority or all of his or her shoulder movement, but the process takes months or years.

Risk factors for developing frozen shoulder

Age: Adults, most commonly between 40 and 60 years old.

Gender: More common in women than men.

Periods of inactivity. Long periods of inactivity—from an injury, surgery, stroke, or illness—can lead to a frozen shoulder.

Diabetes: People with diabetes are also more likely to develop this condition.

What is the procedure for diagnosing a frozen shoulder?

Our specialist physiotherapist will conduct the following tests to determine if you have a frozen shoulder:

  • Taking medical history and finding out clinical signs and symptom
  • Examination and palpation of arms and shoulder
  • Examining active range of motion and passive range of motion of shoulder joint.
  • Examination of capsular pattern- loss of external rotation followed by flexion/abduction and then internal rotation.

Common signs and symptoms for frozen shoulder

  • Intense pain in the shoulder joint. Occasionally, it may spread into the arm as well. It may be accompanied by upper back and neck ache.
  • Due to the limited range of motion of the shoulder joint, the patient has trouble doing ADLs such as combing hair, suiting up, and reaching behind the back.
  • Pain is often severe at night and frequently interferes with sleep.
  • Guarded shoulder movements. Rounded shoulders and stooped posture
  • Arm swing is reduced when walking
  • Individuals who are affected generally keep their arm close to their body.
  • Spasms of the muscles upper back muscles

Treatment for frozen shoulder

Typically, moist heat before joint movement, stretching, chosen range of motion exercises, low-level strengthening, and ice following activity or exercise is used to treat a frozen shoulder. It is critical for those who have a frozen shoulder to prevent reinjuring the shoulder tissues during their therapy. It is vital to avoid the following until fully recovered:

  • With the affected shoulder, make abrupt and jerking movements.
  • With the affected shoulder, perform strenuous lifting.
  • Extensive overhead activity
  • Inappropriate biomechanical manoeuvres


For the purposes of this guide, stretching will really equate to static stretching. This means taking the joint to a certain point in the range of motion and holding that position for a specified amount of time. It does not mean bouncing up and down, rocking back and forth, or holding the stretch for any less than 5-10 seconds.

Stretching exercises for frozen shoulder

Pendular stretch

  • Maintain a comfortable stance with your shoulders while performing the pendular stretch.
  • Lean forward and hang your arm toward the floor. Swing the upper body gently from side to side in a short circle.
  • Allow the affected arm to hang vertically and swing in a small circle around the torso, approximately 1 foot in circumference.
  • The arm moves in response to the swinging of the upper torso. If performed properly, the shoulder joint will feel a slight stress.
  • The exercise can be performed for 5 minutes at a time 2-5 times per day, or as directed by your physical therapist.
  • To advance the exercise and increase joint traction during shoulder pendulum exercises, the movement can be performed while clutching a tiny weight in the affected hand.

Towel stretch

  • Tie the towel’s two ends together behind your back.
  • Using the good arm, pull the towel and the affected arm up toward the shoulder.
  • Repeat it with another hand
  • Ten to twenty times per day, repeat this procedure.

Finger walk

  • Place yourself in front of a wall, keeping an arm’s length gap between you and it.
  • Reach out with one arm and gently touch the wall with your fingertips, keeping your arm slightly bent at the waist.
  • Slowly walk your fingertips up the wall, reaching as far as your arm comfortably allows.
  • Retrace your steps down the wall to your starting positions.
  • Rep 10–20 times more. Rep 10–20 times with the other arm.

Crossbody reach

  • Take a seat or stand.
  • Lift your affected arm at the elbow and bring it up and across your body with your good arm, using slight pressure to stretch the shoulder.
  • Maintain the stretch for 15–20 seconds.
  • Repeat this procedure ten to twenty times per day.

Armpit stretch

  • Lift the injured arm onto a shelf about breast-high using your good arm.
  • Gently bend your knees, allowing your armpits to expand.
  • Slightly extend your knee bend, gently stretching your armpit, and then straighten.
  • Stretch slightly further with each knee bend, but do not strain it.
  • Repeat this procedure ten to twenty times per day.

Forward flexion in a supine position

  • Lie on your back, straightening your legs.
  • Lift your affected arm overhead with your unaffected arm until you feel a mild stretch.
  • Maintain for 15 seconds before lowering gradually to the beginning position.
  • Remain relaxed and repeat.

Range of motion

These exercises involve basically moving the shoulder through its available range of motion at a predetermined speed and repeating the action for a certain number of repetitions.

The most critical aspect of these exercises is to remain aware of the range of motion that is tolerable in light of the pain. In other words, you should avoid attempting to increase range of motion at the risk of dramatically increased shoulder pain.

However, in more advanced cases of frozen shoulder, stretching may need to be more vigorous due to the loss of motion. The range of motion should improve gradually over time as the discomfort and stiffness diminish concurrently.

If you are one of those who suffer from frozen shoulder, please get in touch with us so that we can provide you with a thorough remedy in the comfort of your own home. Our specialist physiotherapist will do a physical assessment to rule out any other potential reasons for your pain and then build a personalized treatment plan to help you find relief from your discomfort as quickly as possible.




The term “patellofemoral” arises from the two terms, “patella” (kneecap) and “femur” (thigh bone). The patellofemoral joint is where the back of the patella meets the femur at the front of the knee. As the name suggests, patellofemoral pain or patellofemoral pain syndrome (PFPS) is characterised by pain arising from the patellofemoral joint itself or the soft tissue surrounding it.

 Also known as the “runner’s knee”, the differential diagnosis includes chondromalacia patellae and patellar tendinopathy. Although the symptoms are similar, neither of these falls under the PFPS umbrella. Alternative treatments are available due to differences in pathophysiology.


More often than not, patellofemoral pain has multifactorial causes. However, one of the most prevalent causes is patellar orientation, or its alignment. A different orientation of the patella may cause it to glide more towards one side of the femur, resulting in overuse of that part of the femur and thus resulting in pain, discomfort, or irritation.

 The causes provoking PFPS may be intrinsic or extrinsic.

Intrinsic factors include:

  • Anatomical malalignment results in a deviation in the orientation of the patella.
  • A biomechanical abnormality results in the overuse of a particular bone in the patellofemoral joint.
  • Muscular imbalances: When the muscles around your hip and knee don’t keep your kneecap properly aligned.

Extrinsic factors include

  • Overuse of the joint and surrounding muscles due to athletic activity like running, jumping, etc.
  • Trauma to the kneecap results in damage to the cartilage under the kneecap.
  • Additional factors include hyperextension of the knee


 It is vital to keep in mind the major risk factors.

  • Age: Patellofemoral pain typically affects adolescents and young people.
  • Sex: Patellofemoral pain is twice as likely to affect women as men. This could be because a woman’s larger pelvis causes the bones in the knee joint to meet at a steeper angle.
  • Certain sports: Participation in running and jumping sports can put extra stress on the knees, especially when the training level is increased.
  • Surgery to repair the anterior cruciate ligament using your own patellar tendon as a graft increases the risk of patellofemoral pain.

Clinical Presentation

  • Anterior knee pain: Patients often complain of pain and discomfort in the anterior region of the knee.
  • Patellofemoral compressive forces: The pain is aggravated by activities that increase patellofemoral compressive forces, such as climbing stairs, sitting with knees bent, kneeling, and squatting.
  • Upon applying pressure, the area around the front of the knee feels tender.
  • Cracking/clicking sound with the knee movement.

Patellofemoral Pain Physiotherapy

  • Strengthening exercises: Greater improvements in pain relief and knee function are shown when both the knee and hip muscles are strengthened. Usually, the strengthening programme is applied to the hip abductor muscle and the quadriceps.
  • Manual therapy: This is a conservative treatment option for PFPS, consisting of techniques such as manipulation, joint mobilization, and soft tissue mobilization, thus achieving pain reduction, improved functionality, and mobility of the joint.
  • Taping involves holding the patella in place using a K-tape to make sure it moves in proper alignment. This may improve the ability to perform activities that would normally be painful.
  • Coordination training: The physical therapist may help retrain your hip and knee movement patterns to reduce knee pain. This is effective training for athletes.
  • Kinetic chain exercises:
    • Closed kinetic chain exercises (CKC): These are more functional than OKC because they cause less stress on the patellofemoral joint, especially at full extension (0° to max 40° of knee flexion).
    • Open kinetic chain exercises (OKC): These exercises might be a viable option in case the patient is unable to tolerate CKC exercises because the load that will be used can be better controlled than in CKC. When using OKC exercises, the patient should stay within a pain-free range of motion (ROM) of 40° to 90° of knee flexion.
  • Electrotherapy: Preference is given to electrotherapy in treating patients suffering from PFPS because of a neuromuscular disbalance.


 The following steps may help in preventing the pain:

  • Maintain strength: Strong quadriceps and hip abductor muscles assist in keeping the knee balanced, but it is advised to avoid deep squatting during weight training.
  • Alignment and techniques: Optimal techniques for jumping, running, and pivoting are crucial so that the patella tracks properly in its groove.
  • Lose excess pounds. Being overweight puts excessive stress on your knees.
  • Warm-up: Prior to engaging in intense physical activity, warm up with five minutes of light exercise.
  • Gently stretch: to increase flexibility and ease of movement.
  • Gradual increase in intensity: Avoid sudden changes in the intensity of your workouts.
  • Choice of footwear: Shoes used during exercise should fit well and provide good shock absorption. In the case of flat feet, shoe inserts might help.

At home, physiotheraphy exercises to relieve the pain.

Wall stretch for the hamstrings

  • Step 1: In a doorway, lie on your back. Keep one leg flat on the floor and extend it through the doorway.
  • Step 2: Slide the other leg up on the wall until you feel a gentle stretch and it is almost straight.
  • Step 3: Keep one heel in contact with the wall and one heel in contact with the floor. Don’t point your toes.
  • Step 4:Hold for at least one minute.

Front leg raises with straight legs

  • Step 1: Lie on your back with one leg straight on the floor and the other bent at the knee, with your foot flat on the floor.
  • Step 2:Raise the straight leg about a foot off the ground and simultaneously tighten the thigh muscles.
  • Step 3: After a few seconds, slowly lower your leg to the ground.
  • Step 4: Take a break of a few seconds between repetitions.
  • Step 5: Repeat with the other leg.

Try for 8–12 repetitions.

Hip Circles

  • Step 1: Lie down on your side with your legs slightly bent.
  • Step 2: Tighten your muscles and straighten your top leg.
  • Step 3: Make 20 small circles with the leg in a clockwise direction.
  • Step 4:Repeat in a counter clockwise direction.
  • Step 5: Change sides and repeat with the opposite leg.

The circles should be medium-sized. Do 3 sets of this exercise.

Step-Ups on the Sides

This exercise requires a platform. If you don’t have one, you can use a step.

  • Step 1: Stand beside the platform and place your adjacent foot on the platform.
  • Step 2: Step up on the platform so that the other foot comes off the ground, hanging loosely.
  • Step 3: Take a step back by lowering your hanging foot to the ground.
  • Step 4: Repeat 15 times on one side, then 15 times on the other.

Try for 3 sets of 15 step-ups.




Get physiotherapy at home

Sciatica is a term that refers to pain that travels down each leg along the course of the sciatic nerve from the lower back to the hips and buttocks. The condition usually only affects one side of the body.


Sciatica is a common symptom of a variety of medical disorders, but it is believed to be caused in 90% of instances by a herniated (slipped) disc.

Other causes of sciatica include:

  • Lumbar spinal stenosis is a constriction of the lower back’s spinal cord.
  • Spondylolisthesis occurs when a disc slips forward over the vertebra below it.
  • Tumours: The root of the sciatic nerve can be compressed by tumours in the spine.
  • Infection-affecting the spine in the end.
  • Cauda equina syndrome is a rare but serious condition that affects the nerves in the lower region of the spinal cord and requires immediate medical intervention.
  • Additional factors, such as injuries to the spine,


  • Age: Sciatica is most frequently caused by age-related changes in the spine, such as herniated discs and bone spurs.
  • Obesity: Excess body weight can add stress to the spine, resulting in spinal abnormalities that cause sciatica.
  • Occupation: If your employment demands you lift heavy objects, repeatedly twist or bend your back, or drive for extended periods of time, you may get sciatica.
  • Sedentary life style– Individuals who sit for long periods of time or live a sedentary lifestyle are more likely to develop sciatica than those who lead an active lifestyle.
  • Diabetes: This disorder, which impairs your body’s ability to use glucose, raises your risk of nerve injury.

Clinical Presentation

  • Shooting pain– Sciatica is distinguished by shooting pain that travels up the sciatic nerve root from the lower back to the buttocks and back of either leg.
  • Numbness in the back of the leg: Numbness in the back of the leg is sometimes associated with sciatica pain. At times, tingling or weakness in the feet or toes may occur. Prolonged sitting can increase the tingling sensation.
  • Posture-related symptoms: Sciatica symptoms may worsen while sitting, attempting to stand, bending the spine forward, twisting the spine, lying down, or coughing. Walking or applying a hot pack on the back or the pelvis can help alleviate discomfort.

Physiotherapy for Sciatica

Physical therapy and exercise are widely used as initial treatments for the relief, treatment, and prevention of sciatica symptoms.


  • It assists in relieving soreness.
  • Facilitate the healing of the underlying cause.
  • Attempt to avert flare-ups and recurrences.
  • Restores pain-free functional movement patterns.
  • Lower back, buttocks, thighs, and leg pain can be relieved.
  • Muscle spasms should be minimised.
  • Restore lumbar spine and sacroiliac joint function.
  • It also increases the mobility of the lower body.

Physiotherapy Management

  • Manual therapy procedures such as spinal manipulation, joint mobilisation, or soft tissue treatments such as myofascial release all contribute to pain relief by increasing spinal movement.
  • Neural mobilisation (nerve mobilisation) is a treatment that uses active or passive approaches to glide a symptomatic nerve into and out of tension in order to facilitate mobility and alleviate symptoms.
  • Exercises include core strengthening workouts, moderate lumbar spine and hamstring stretching, and frequent light exercise such as walking and back exercises.
  • The McKenzie Method is a technique that utilises a sequence of active directional motions to locate and treat a source of discomfort in the spine, muscles, or joints. Through exercise, the therapy focuses on bringing the radiating pain closer to the body’s centre. The concept behind this method is that centralising pain results in symptom relief. The objective is to alleviate radiating symptoms that originate in the spine.
  • Strengthening exercises include resistance exercises to strengthen the muscles of the abdomen, low back, hips, and legs.
    • Isometric exercises
    • Isotonic exercises
  • Reintroduction of functional motions such as lifting, carrying, and bending or squatting is part of functional retraining. To alleviate pain and prevent re-injury, good technique and healthy movement patterns are implemented.
  • The Muscle Energy Technique entails the patient contracting their muscles gently as the therapist moves the affected joints through a specific range of motion.
  • Gait training involves analysing one’s walking method and retraining one’s gait patterns to be more proper.

Preventing Sciatica

The following methods can assist individuals in avoiding sciatica or preventing it from recurring:

  • Exercise regularly. The most effective way to maintain a healthy back is to strengthen both your back muscles and your core muscles.
  • Maintain good posture and proper ergonomic care. Maintain an upright position. Ascertain that your work chair gives appropriate back support, sit with your feet on the floor, and use the armrest to relax your body frequently.
  • Patient education should include information about the low back’s nature, self-management measures, and encouragement to resume normal activities. 

Sciatica physiotherapy treatment at home

You or a loved one may benefit from at-home sciatica physiotherapy, which has helped many people heal from long-term discomfort. Complete physiotherapy treatment plans enable you to do the exercises in the privacy, safety, and comfort of your own home. Sciatica physiotherapy treatment at RELEVIUM is a common choice among people who desire to live their lives without pain. Please get in touch with us if you require experienced physiotherapy treatment at home.