Laser Therapy for Adhesive Capsulitis (Frozen Shoulder)
Frozen shoulder is a mysterious condition with a notoriously long healing process. Mysterious because the cause is most often not understood or identifiable, and a notoriously long healing process since the recovery process is slow and can often take anywhere from 18-24 months to regain range of motion and reduce pain. Extensive physiotherapy, anti-inflammatory drugs, and exercises/stretching are the current methods of treating frozen shoulder. With the addition of low level laser therapy (LLLT) into your treatment plan, recovery can achieved at a much faster rate.
The pathophysiology of frozen shoulder is generally poorly understood by western physicians and doctors. What is known is that capsular hyperplasia, or increased growth, occurs along with fibrosis, pathological thickening of connective tissue. This results in inflammation and thickening of the shoulder capsule reducing range of motion and causing pain.
Stage 1 (2-9 months) of frozen shoulder is marked by inflammation which causes mild to severe shoulder pain that is worse at night. Stage 2 (4-12 months), involves the formation of fibrotic scar tissue that accumulates within the glenohumeral joint space causing a decrease in range of motion and shoulder stiffness.
Laser therapy increases white blood cells and white blood cell activity which helps modulate the inflammatory process by increasing anti-inflammatory mediators and decreasing pro-inflammatory mediators. If you have read more about low level laser therapy, you know that the photobiomodulation process that occurs increases cell proliferation and differentiation, tissue regeneration, and collagen formation. It may seem contradictory to use a therapeutic system that increases these types of cells in an area with hyperplasia and fibrosis, however LLLT won’t increase the amount of cells and connective tissue in this case. In adhesive capsulitis, the type of collagen in the shoulder transforms from type 1 to type 3, changing the structure of the shoulder. Instead of increasing the amount of collagen, the laser facilitates the turnover of excessive type 3 collagen to healthier type 1 collagen.
In a trial that used low level laser therapy for frozen shoulder, it was concluded that LLLT plus exercise for eight weeks was more effective than exercise alone in terms of pain up to four weeks, and function for up to four months.
Another study published results that patients using low level laser therapy for frozen shoulder experienced a significant decrease in overall, night, and activity pain scores at the end of 4 wk and 8 wk of treatment, and at the end of 8 wk additional follow-up and a significant decrease in shoulder pain and disability index (SPADI) scores. They also achieved a significant decrease in shoulder pain and disability index (SPADI) scores after the course of treatment.
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