Freezing the Whole Body to Treat Frozen Shoulder

Research efforts are underway around the world to find effective ways to treat adhesive capsulitis (also known as “frozen shoulder”). Physical therapy is widely accepted as the most beneficial treatment for this problem. In this study from Korea, the use of whole body cryotherapy (WBC) for adhesive capsulitis is investigated.

Whole body cryotherapy refers to spending brief periods of time in a very cold walk-in chamber. The room is kept at -110 to -140 degrees Celsius (that’s -230 down to -284 degrees Fahrenheit). Patients who received the cryotherapy treatment were exposed to four-minutes of cold twice a day, three times a week for a month. There was an elaborate procedure to prevent frostbite, discomfort from the cold, and damage to the lungs from breathing cold air.

For example, a warmer (but still cold) prechamber was entered first for one-minute. Everyone wore a surgical mask and told to avoid holding their breath in order to protect the upper airways. Each person wore a protective hat, triple-layer gloves, dry socks, and shoes. Everyone was monitored by microphone and camera whenever they were in either of the chambers.

In this study, cryotherapy was not the only form of treatment. The patients were actually randomly placed in one of two groups. Everyone in both groups received physical therapy modalities (e.g., ultrasound, electrical stimulation) and manual therapy (joint mobilization) techniques used for adhesive capsulitis. One group also experienced the cryotherapy whereas the second group did not. There was not a control group (patients who did not receive any therapy) as this approach withholds any treatment and is not considered ethical.

Using pain, range-of-motion, and shoulder function as test measures, patients in both groups got better. But the cryotherapy group had more significant improvements in all areas compared to the group who did not receive the cold therapy.

The authors offer several suggestions why whole-body cryotherapy might aid patients with adhesive capsulitis more than just physical therapy modalities and joint mobilization. First, cold has a way of anesthetizing the area, which in turn, reduces pain. With less pain, patients are better able to move the arm and shoulder.

Second, joint mobilization has been shown to improve the flow of synovial fluid in the joint making it easier for the head of the humerus (upper arm bone) to slide and glide inside the shoulder socket.

Mobilization can also break up adhesions and scar tissue. This effect makes it possible for the collagen fibers that make up the joint capsule (soft tissue surrounding the head of the humerus) to line up better. The end result is improved gliding of the capsular fibers during movement. And joint mobilization seems to calm or quiet down cell receptors (called nociceptors) that set up a pain response in the first place.

It has been suggested that cold applied in this way to the whole body increases the release of chemicals in the body such as norepinephrine. Norepinephrine is known to decrease pain messages from the skin in the spinal cord and reduce (or stop) pain (or at least the perception of pain).

This may be the first study to compare physical therapy for adhesive capsulitis using standard mobilization techniques and modalities with whole-body cold (WBC) therapy. Although the results do show a significant improvement for patients who received WBC, there were some limitations to this study.

The authors point out that using a multimodal (many treatments) approach to the problem of adhesive capsulitis does not help sort out what each treatment component does. It is possible that just using one of these techniques would be enough to gain the same results.

The natural history of adhesive capsulitis (what normally happens with this
condition is a gradual improvement over a long period of time (12 to 42 months). Treatment may speed up improvements to less than one-month, which is why efforts are being made to find the best treatment or combinations of treatment approaches. As this study showed, adding whole-body cryotherapy to modalities and mobilization works better than modalities and mobilization alone.