Frozen shoulder, medically known as adhesive capsulitis, is a painful condition that causes stiffness and gradually restricts shoulder movement. Everyday activities such as reaching overhead, dressing, combing your hair, or reaching behind your back can become surprisingly difficult.
Although frozen shoulder can affect anyone, people living
with diabetes have a significantly higher risk of developing it. A recent
systematic review and meta-analysis found that people with diabetes had
approximately 3.7 times higher odds of developing frozen shoulder than people
without diabetes.
So, why does diabetes make the shoulder more vulnerable—and
what role can physiotherapy play in preventing or managing the problem?
How Does Diabetes Increase the Risk of Frozen Shoulder?
The exact relationship between diabetes and frozen shoulder is complex, but several mechanisms may contribute.
1. High
blood sugar can affect connective tissue
Persistently elevated blood glucose can lead to chemical
changes in proteins within the body. Over time, these changes may make
connective tissues less flexible.
The shoulder joint is surrounded by a capsule made of connective tissue. When this capsule thickens and becomes less elastic, shoulder movement can gradually become restricted. This is one of the important processes involved in adhesive capsulitis.
2. Diabetes
may promote stiffness and inflammation
Diabetes can affect the body's normal healing and
inflammatory processes. Changes in tissue metabolism may contribute to thickening
and tightening around the shoulder joint.
As the shoulder becomes painful, a person may naturally start
moving it less. Unfortunately, prolonged lack of movement can contribute to
even greater stiffness, creating a cycle of pain → reduced movement → stiffness
→ more difficulty moving.
3. Duration
and control of diabetes may matter
The risk of musculoskeletal complications can be influenced
by several factors, including metabolic health and other conditions that
commonly occur alongside diabetes. Research has identified factors such as poor
glycemic control, obesity, high cholesterol, hypertension, and thyroid problems
among factors associated with frozen shoulder risk.
This does not mean that every person with diabetes will
develop frozen shoulder. However, diabetes should be considered an important
risk factor, particularly when shoulder pain or stiffness begins to appear.
Why Early
Physiotherapy Matters?
Physiotherapy can play an important role in maintaining
shoulder mobility, identifying early stiffness and managing symptoms.
One of the most useful advantages of physiotherapy is that
treatment can be individualized. A physiotherapist can assess shoulder
movement, strength, posture, pain levels and functional limitations before
developing an appropriate exercise programme.
1. Maintaining shoulder mobility
Regular, gentle movement can help prevent the shoulder from
becoming increasingly stiff. A physiotherapist may prescribe exercises designed
to maintain or gradually improve movements such as:
·
Raising the arm overhead
·
Rotating the shoulder outward and inward
·
Moving the arm across the body
·
Reaching behind the back
The exercises should be appropriate for the individual's
symptoms and stage of the condition. Stretching aggressively through severe
pain is generally not the goal.
2.
Strengthening the shoulder
Once movement is comfortable enough, strengthening exercises
can help maintain the function of the shoulder and surrounding muscles.
A physiotherapist may gradually introduce exercises for the
rotator cuff, shoulder blade muscles and upper-limb muscles. Maintaining
strength can help people continue performing everyday activities while
protecting overall shoulder function.
3. Reducing
the cycle of pain and inactivity
Shoulder pain often causes people to avoid using the affected
arm. While resting may provide temporary relief, prolonged inactivity can
contribute to stiffness.
Physiotherapy can help patients find safe ways to keep the
shoulder moving without unnecessarily aggravating symptoms. Depending on the
individual's condition, treatment may include therapeutic exercises, manual
therapy and education about activity modification.
Research specifically examining people with diabetes and
adhesive capsulitis has found that physiotherapeutic interventions—particularly
combinations involving joint mobilization and exercise—can improve range of
motion, function and pain, although researchers have noted limitations in the
quality of the available evidence.
What Can People With Diabetes Do to Protect Their Shoulders?
Prevention starts with awareness. People with diabetes should
not ignore persistent shoulder pain or gradually increasing stiffness.
A practical
approach includes:
Stay active: Regular physical activity and appropriate
shoulder movement can help maintain mobility.
Don't ignore early symptoms: Difficulty reaching overhead,
putting on clothes, or reaching behind the back may be early warning signs.
Follow your diabetes-management plan: Good overall metabolic
health is an important part of reducing diabetes-related complications.
Seek physiotherapy early: An assessment can identify
restrictions in movement and provide an individualized exercise programme.
Avoid pushing through severe pain: Shoulder exercises should
be appropriate for the individual's condition. A physiotherapist can guide the
intensity and progression.
People with diabetes are considerably more likely to develop
frozen shoulder than those without diabetes. Current evidence suggests that the
odds may be around 3.7 times higher, although the exact reasons for this
association are still being investigated.
The good news is that shoulder stiffness does not have to be
ignored. Early assessment, appropriate exercise, maintaining mobility, and
physiotherapy-guided rehabilitation can help manage symptoms and preserve
shoulder function.